Clinical Research In Complications Of Pertussis In Children

Objective:To investigate the clinical characteristics of complications of pertussis in children.Methods:Clinical data was taken from children,hospitalized by Bordetella pertussis infection,confirmed by culture or real-time polymerase chain reaction(PCR)of nasopharyngeal secretion between October 2013 and December 2015.The clinical data were analyzed retrospectively according to the different types of pertussis complications.Results:(1)Between October 2013 and December 2015,501 children were hospitalized at Shenzhen Children's hospital with Bordetella pertussis infection.352 were infants less than 3 months of age.(2)309 patients(62.05%)were diagnosed with pneumonia,confirmed by chest X-ray or chest CT,Patient's median age was 3 months.252 cases(81.55%)had a paroxysmal cough.97 cases(31.39%)had wheezing.69 cases(22.33%)had tachypnea.105 cases(33.98%)displayed cyanosis.The time between onset of cough and radiologically confirmed pneumonia was between 1 and 66 days.The most common pathogen of coinfection was Respiratory Syncytial Virus(RSV).306 cases were treated with macrolides for a mean of(8.21±3.58)days.All cases showed significant improvement.There were more male children,and more instances of comorbidity in the group diagnosed with pneumonia.The pneumonia group was younger.All differed significantly(P<0.05).Sex(male),age,and underlying disease are independent risk factors for pertussis-associated pneumonia.(3)8 cases of Pertussis encephalopathy were involved in the study,the mean age was(45.50±23.23)days.Pertussis encephalopathy occurred in 0.92%of all pertussis cases,occurring in 2.27%of those the same age.8 cases had paroxysmal cough;7 cases displayed cyanosis;2 cases showed frequent apnea.Encephalopathy occurred at 6~29 days from the onset of the cough.All cases presented with seizures.Encephalopathy was associated with fever in 5 cases,the highest temperature was 38.9?.Lumbar puncture was performed in 6 cases.Cerebrospinal fluid(CSF)showed elevated pressure in 3 cases with mildly elevated protein in 4 cases.Brain CT examination was performed in 6cases,cerebral edema was seen in 2 cases.Brain magnetic resonance imaging(MRI)was normal in 3 cases.8 cases were treated with erythromycin or azithromycin,mean(9.88±2.70)days.All cases showed significant improvement.(4)2 cases of pulmonary hypertension were all with congenital heart disease,and the highest value of pulmonary arterial pressure was 72mmHg and 67mmHg respectively.The maximum leucocyte count was 23.79×10~9/L and 18.12×10~9/L respectively.Both of them were treated with erythromycin for 7 days.All of them were cured and discharged from hospital.(5)The white blood cell count over 20×10~9/L in 195 cases(38.92%).All treated with macrolide,without the use of exchange transfusion treatment,were cured and discharged.Conclusion:Complications of pertussis,such as pneumonia,hyperleukemia,are common in hospitalized pertussis children.Encephalopathy and pulmonary hypertension are rare,but these diseases are easy to progress.Pneumonia is more likely to be male,young,have underlying diseases,especially the course of 2 weeks.Pertussis encephalopathy should be considered in patients not vaccinated with DTP,especially the course of 2~4 weeks.Timely identification of pertussis complications and timely treatment can help to reduce the incidence of poor prognosis.