Finger H, Wirsing von König C H, Tacken A, Wassilak S G
Institute for Hygiene and Laboratory Medicine, Municipal Hospital, Krefeld, Germany.
Dev Biol Stand. 1991;73:343-55.
Whooping cough continues to be a major childhood disease in parts of West Germany. At age six, more than one third of the children in our area have had pertussis according to parental information, whereas only 12% received a specific vaccination. During a four-year period from 1984 to 1987, a total of 2,881 clinically diagnosed cases of whooping cough were investigated. The children had a mean age of 4.1 years, 11% of all patients were younger than one year and 6% of the patients were adults with a mean age of 35.8 years. No sex difference was observed in children (less than 20 years) with clinically overt whooping cough. The seasonal distribution showed that whooping cough was present throughout the year, peaking in early winter. In relation to clinical symptoms, the isolation rate of Bordetella pertussis or Bordetella parapertussis from nasopharyngeal swabs continuously decreased with the duration of paroxysms, starting with 56% positive swabs on day 1. Titers (greater than or equal to 1:100) of IgA-antibodies to B. pertussis antigens increased with the duration of paroxysmal coughing. B. pertussis, however, was also isolated from 152 of 964 patients without the clinical signs of whooping cough. IgA-antibodies were also found in 522 patients with non-typical respiratory symptoms, but not in healthy blood donors. Children with clinically diagnosed whooping cough were compared to a group of children showing the symptoms but without any clinical or laboratory signs of whooping cough. We can assume from our data that the incidence and duration of non-paroxysmal coughing, the nocturnal increase in coughing, fever, auscultatory findings and a contact anamnesis occurred with a similar frequency in the whooping cough group and the control group. Apart from the typical paroxysmal fits, whooping and vomiting were found significantly more often in the pertussis group. At least 19% of patients with a recent infection with B. pertussis, however, were not diagnosed by clinical symptoms. The leukocyte count differed only marginally between the three groups and was of no great diagnostic value. A relative lymphocytosis, however, was found significantly more often in whooping cough patients and in patients with laboratory-diagnosed infection with B. pertussis. Our study indicates that part of the symptomatology and some laboratory findings in whooping cough patients in endemic areas of West Germany may differ from the classical form of the disease. Furthermore, our data stress the importance of an accurate procedure in diagnosing B. pertussis infection, and this can be facilitated by a combination of bacteriological and serological tests.
百日咳在西德部分地区仍然是一种主要的儿童疾病。据家长提供的信息，在我们地区，六岁的儿童中有超过三分之一患过百日咳，而只有12%的儿童接受过特异性疫苗接种。在1984年至1987年的四年期间，共调查了2881例临床诊断为百日咳的病例。这些儿童的平均年龄为4.1岁，所有患者中有11%小于一岁，6%的患者为成年人，平均年龄为35.8岁。临床明显患百日咳的儿童（小于20岁）未观察到性别差异。季节分布显示，百日咳全年都有，在初冬达到高峰。就临床症状而言，从鼻咽拭子中分离百日咳博德特氏菌或副百日咳博德特氏菌的比率随着阵咳持续时间的延长而持续下降，第1天鼻咽拭子阳性率为56%。针对百日咳博德特氏菌抗原的IgA抗体滴度（大于或等于1:100）随着阵咳持续时间的延长而升高。然而，在964例无百日咳临床症状的患者中，也有152例分离出百日咳博德特氏菌。在522例有非典型呼吸道症状的患者中也发现了IgA抗体，但在健康献血者中未发现。将临床诊断为百日咳的儿童与一组有症状但无百日咳任何临床或实验室体征的儿童进行比较。从我们的数据可以推断，非阵发性咳嗽的发生率和持续时间、咳嗽的夜间加重、发热、听诊结果以及接触史在百日咳组和对照组中出现的频率相似。除典型的阵咳外，百日咳组中发现哮吼和呕吐的频率明显更高。然而，至少19%近期感染百日咳博德特氏菌的患者未通过临床症状诊断出来。三组之间白细胞计数仅略有差异，并无可靠的诊断价值。然而，百日咳患者和实验室诊断为百日咳博德特氏菌感染的患者中相对淋巴细胞增多的情况明显更常见。我们的研究表明，西德流行地区百日咳患者的部分症状和一些实验室检查结果可能与该疾病的经典形式有所不同。此外，我们的数据强调了准确诊断百日咳博德特氏菌感染的重要性，而细菌学和血清学检测相结合有助于实现这一点。
