Critical Pertussis Illness in Children
- 1 May 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pediatric Critical Care Medicine
- Vol. 14 (4), 356-365
- https://doi.org/10.1097/pcc.0b013e31828a70fe
Abstract
Objective: Pertussis persists in the United States despite high immunization rates. This report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies among children requiring admission to the PICU. Design: Prospective cohort study. Setting: Eight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States. Patients: Eligible patients had laboratory confirmation of pertussis infection, were younger than 18 years old, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011. Interventions: None. Measurements and Main Results: A total of 127 patients were identified. Median age was 49 days, and 105 (83%) patients were less than 3 months old. Fifty-five (43%) patients required mechanical ventilation and 12 patients (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%) and was present in 75% of patients who died, compared with 6% of survivors (p < 0.001). Median WBC was significantly higher in those requiring mechanical ventilation (p < 0.001), those with pulmonary hypertension (p < 0.001), and nonsurvivors (p < 0.001). Age, sex, and immunization status did not differ between survivors and nonsurvivors. Fourteen patients received leukoreduction therapy (exchange transfusion [12], leukopheresis [1], or both [1]). Survival benefit was not apparent. Conclusions: Pulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality and whether leukoreduction might be efficacious.Keywords
This publication has 40 references indexed in Scilit:
- Testing the hypothesis that diphtheria–tetanus–pertussis vaccine has negative non-specific and sex-differential effects on child survival in high-mortality countriesBMJ Open, 2012
- The decline and resurgence of pertussis in the USEpidemics, 2011
- The Collaborative Pediatric Critical Care Research Network Critical Pertussis Study: Collaborative research in pediatric critical care medicine*Pediatric Critical Care Medicine, 2011
- Mechanisms and Regulation of the Gene-Expression Response to SepsisPEDIATRICS, 2010
- Pertussis Toxin Stimulates IL-17 Production in Response to Bordetella pertussis Infection in MicePLOS ONE, 2009
- Pathology and Pathogenesis of FatalBordetella pertussisInfection in InfantsClinical Infectious Diseases, 2008
- Adenylate cycalse toxin ofBordetella pertussisinhibits TLR-induced IRF-1 and IRF-8 activation and IL-12 production and enhances IL-10 through MAPK activation in dendritic cellsJournal of Leukocyte Biology, 2008
- Pertussis requiring intensive careArchives of Disease in Childhood, 2007
- Molecular Pathogenesis, Epidemiology, and Clinical Manifestations of Respiratory Infections Due toBordetella pertussisand OtherBordetellaSubspeciesClinical Microbiology Reviews, 2005
- Predictors of death in infants hospitalized with pertussis: a case-control study of 16 pertussis deaths in CanadaThe Journal of Pediatrics, 2003