Clinical Analysis Of Severe Pertussis In 135 Infants And Children

Objective:To investigate the clinical characteristics of severe pertussis in infants and children,analyze the risk factors for death of severe pertussis,and improve the understanding of severe pertussis in infants and children.Methods:Retrospective analysis was used to review the clinical data of 135 infants and children who were diagnosed with severe pertussis and were admitted to the Children's Hospital of Chongqing Medical University from January 2015 to December 2019.Symptoms,auxiliary examinations,treatment,complications and prognosis were analyzed.All data were processed using SPSS 26.0 and EXCEL software.Results:1.There were 135 infants and children were diagnosed with severe pertussis in this study.Among them,108(80.0%)persons were less than 6months old.The ratio of male to female is 1.05:1.69(51.1%)patients had a history of exposure to cough patients.111(82.2%)children did not accept vaccination of DTaP.2.Clinical manifestations:97(71.9%)cases had paroxysmal coughing,24(37.8%)cases presented post-tussive vomiting,recurrent apnea was seen in 27(20.0%)cases,39(24.4%)cases of them were with inspiratory whoop,54(40.0%)cases had fever.There were 19(14.1%)cases of convulsions.Paroxysmal coughing,post-tussive vomiting,and fever were more common in the group of>3 months.Dyspnea,episodic bruising,spitting and choking milk,cardiac and respiratory arrest were more common in the group of?3 months.The difference between the two groups was statistically significant(P<0.05).3.Of the 135 children,40 had underlying disease,accounting for29.6%.Common complications included 115 cases(85.2%)of severe pneumonia,12 cases(8.9%)of ARDS,17 patients(12.6%)with pulmonary hypertension,15 patients(11.1%)with circulatory failure,27 patients(20.0%)with pertussis encephalopathy,8 patients(5.9%)with hypoglycemia,4 cases(3.0%)of multiple organ failure.Circulatory failure,hypoglycemia,pulmonary hemorrhage,ARDS,and pulmonary hypertension were more common in the death group,and the differences are statistically significant(P<0.05).4.The median WBC count of 135 children was 33.66×10~9/L.with45.2%of them have the L?0.6.The WBC count was higher in the group of children who were more than 3 months old,and there are statistically significant differences(P<0.05).The etiology of sputum showed that 43cases(31.9%)were only infected with Bordetella pertussis,69 cases(51.1%)with bacterial infections,5 cases(3.0%)infected with Mycoplasma or Chlamydia,and 46 cases(34.1%)with viral infections.Chest imaging test indicated that 61 cases(45.2%)had lung consolidation,17 cases(12.6%)had atelectasis.5.All patients used azithromycin.74 people used invasive ventilation,39 people used non-invasive ventilation.16 people performed ET.2children used ECMO.110 patients(81.5%)had clinical signs that improved significantly and were discharged from the hospital;25 patients died,and the mortality rate was 18.5%.6.Setting P<0.1,the univariate analysis showed statistically significant differences between the survival group and the death group for circulatory failure,PH caused by pertussis,PH caused by congenital heart diseases,hypoglycemia,pulmonary hemorrhage,ARDS,pulmonary hypertension,WBC count,heart rate at admission,corticoid use,HFOV treatment.ECMO treatment,they were further included in the stepwise multivariate regression model.Finally,we obtained pulmonary hypertension,circulatory failure,WBC count were statistically different(P<0.05).Conclusion:1.The incidence of severe pertussis is gradually decreasing with age.Babies less than 6 months old are easily affected.There are many children did not conduct the DTaP vaccination procedures.2.Typical symptoms of pertussis such as spastic cough with post-tussive vomiting are more common in children with age of over 3months old.On the contrary,the atypical symptoms such as apnea,paroxysmal cyanosis are more common seen in children under 3 months old.Children over 3 months of age and those who are in the death group had higher peak WBC count.3.Children with severe pertussis could have bacterial,viral or other pathogenic co-infections.The death group may have serious complications,such as hyperleukocytosis,pulmonary hypertension,circulatory failure,pulmonary hemorrhage,ARDS,etc.4.High WBC count,complicated with pulmonary hypertension,circulatory failure,are independent risk factors for death in children and infants with severe pertussis.