| Objective:To study the clinical characteristic of pertussis in children and risk factors for severe pertussis. To provide the clinical experiences for early diagnosis and treatment.Methods:247 confirmed cases of pertussis in Children’s Hospital of Chongqing Medical University between Jan 2013 and Dec 2014 to review the prevalence, clinical feature, complication, laboratory examinations, treatments and prognosis.Results1. The disease occurred sporadically every year from 2013 to 2014. The age of onset ranged from 23 days to 4 years old, and 120/247 (48.6%) of them were under 6 months,120/247 (48.6%) of them were under 3 months. The disease could occurred all around the year, but 182/247 (73.7%) of the sick were in hospital in summer and autumn.2. The children unvaccinated DTP was about 188/247 (76.1%), 120/247 (48.6%) of the patients acquired pertussis before the vaccination age,54/247(21.9%) of them contacted with cough patient.13/13 (100%) cases in severe group unvaccinated DTP that was obviously less than the result in ordinary group 175/234 (71.7%) (P<0.05).8/13 (61.5%) cases in severe group and 47/234 (20.1%) cases in ordinary group had contacted with cough patient, it was significant difference (P<0.05).3. The hospitalization time varied from 2 days to 40 days, the medium length of stay was 10.32 days. It was obviously shorter in group under 3 months than that was in group order 3 months (P<0.05). And it was significantly difference between group unvaccinated DTP and group vaccinated DTP on their average hospitalization time (P<0.05).4. The main clinical features were paroxysmal cough(238/247,96.4%), few accompanied by emesis (52/247,21.1%) and 21.1% cases with fever. 92.5% cases presented paroxysmal cough in group under 3 months, it was rare in group order than 3 months. Infants under 3 months were often with episodes of cyanosis, apnea and suffocation.It was significant difference (P <0.05).5. Complications were found in 224/247 (90.7%) cases. Including pneumonia, sever pneumonia, respiratory failure, pulmonary consolidation and/or atelectasiss, encephalopathy. Such as severe pneumonia, pulmonary consolidation, respiratory failure and encephalopathy were more common in group under 3 months than in group older than 3 months (P<0.05).6.224/247 (90.7%) cases leukocytosis,182/247 (73.7%) of them with predominant lymphocytosis. WBC in group under 3 months, group unvaccinated DTP and sever group were higher than the corresponding group (P<0.05). Chest imaging manifestations were diversify:pneumonia (40.7%), Interstitial lesion (8.6%), pulmonary consolidation, atelectasis (8.7%), peumonic pleural involvement (0.8%).7. The medial course of treatment with Macrolide antibiotic was 2.46. 13 cases (100%) sever pertussis entered NICU with respiratory therapy. 244/247 cases (98.8%) heal,3/247 (1.2%) were death. All cases of death were under 3 months and unvaccinated DTP.8. Contact history in sever group and ordinary group was 20.1% (47/234) and 61.5%(8/13) respectively, unvaccinated DTP was 100% (13/13) and 71.7%(175/234), it was more than in ordinary group(P<0.05). Patients with fever, lung positive sings and positive sputum culture in sever group were more than in the ordinary group(P<0.05).11/234(5%) cases chest imaging appeared pulmonary consolidation, it was more common in sever group(8/13,61.5%), and WBC count was higher than onset of ordinary Group, it was significant difference (P<0.05).Conclusion1. The incidence of pertussis in Chongqing is increasing. It happened more among the children under 6 months without DTP vaccination. It was more common in urban areas than in the rural city. It can happen all the year, mostly in summer and fall.2. Infants unvaccinated DTP, have a cough patient contact are more likely to be infected with pertussis. It was high incidence under the vaccinate age children.3. Clinical features were obviously different in different ages. Infants under 3 months were often with episodes of cyanosis, apnea and suffocation. In older children, sometimes persistent cough was sole symptom.4. Infants who under 3 months and not vaccinated DTP with high susceptibility for pertussis, often had a heavy clinical presentation, and serious complications. The hospitalization time and course of treatments with Macrolide antibiotic was longer, and with a higher mortality.5. Most of cases peripheral WBC increased, and with predominant lymphocytosis. Infants under 3 months, unvaccinated and sever group of WBC increased obviously.6. The chest imaging of pertussis appearances were mostly slight, such as pneumonia, interstitial inflammation change, few indicate show appearance of pulmonary consolidation, Invasion of pleura and pulmonary hilarity, mediastinal lymph nodes, often need to distinguish with other diseases.7. The one who at a lower age, positive contact history, unvaccinated DTP, complicated with bacterial infection has a high risk of severe pertussis. The sever pertussis children was mostly due to higher WBC and chest imaging appeared pulmonary consolidation. |
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