Walsh Paul F, Kimmel Lauren, Feola Melanie, Tran Ty, Lim Christina, De Salvia Lisa, Pusavat James, Michaelson Scott, Nguyen Tuan Anh, Emery Kirt, Mordechai Eli, Adelson Martin E
Department of Emergency Medicine, Kern Medical Center, Bakersfield, California 93305, USA.
J Emerg Med. 2011 Mar;40(3):256-61. doi: 10.1016/j.jemermed.2008.04.048. Epub 2008 Dec 4.
The clinical presentation of Bordetella pertussis can overlap with that of respiratory syncytial virus (RSV), and coinfection does occur, but management differs.
The prevalence of B. pertussis is < 2% among Emergency Department (ED) patients with bronchiolitis. Our secondary hypothesis was that the prevalence of Bordetella parapertussis is also < 2% among these patients.
Nasal washings were obtained from children up to 18 months of age (inclusive) who presented to a county hospital ED with a clinical diagnosis of bronchiolitis. These washings were frozen to -70°C before testing for B. pertussis and B. parapertussis using species-specific real-time polymerase chain reaction (PCR) assays. The assays were optimized to target conserved regions within a complement gene and the CarB gene, respectively. A Bordetella spp. genus-specific real-time PCR assay was designed to detect the Bhur gene of B. pertussis, B. parapertussis, and B. bronchiseptica. RSV antigen detection was also performed.
There were 227 patients enrolled. After exclusions, 204 remained in the analysis. RSV antigen testing was positive in 109/186 (59%) of the patients in whom it was performed. All samples were tested for B. pertussis. B. parapertussis testing could not be completed on 23 samples. No cases (0/204; 95% confidence interval [CI] 0-1.8%) tested positive for B. pertussis or B. parapertussis (0/181; 95% CI 0-2%).
The prevalence of B. pertussis in children presenting to the ED with bronchiolitis was < 2%.
百日咳博德特氏菌的临床表现可能与呼吸道合胞病毒（RSV）的临床表现重叠，且确实会发生合并感染，但治疗方法有所不同。
在急诊科（ED）诊断为细支气管炎的患者中，百日咳博德特氏菌的患病率<2%。我们的次要假设是，在这些患者中，副百日咳博德特氏菌的患病率也<2%。
从一家县医院急诊科临床诊断为细支气管炎的18个月及以下（含18个月）儿童中获取鼻洗液。在使用种特异性实时聚合酶链反应（PCR）检测百日咳博德特氏菌和副百日咳博德特氏菌之前，将这些洗液冷冻至-70°C。这些检测方法分别针对补体基因和CarB基因内的保守区域进行了优化。设计了一种博德特氏菌属特异性实时PCR检测方法，用于检测百日咳博德特氏菌、副百日咳博德特氏菌和支气管败血博德特氏菌的Bhur基因。还进行了RSV抗原检测。
共纳入227例患者。排除后，204例纳入分析。在进行RSV抗原检测的186例患者中，109例（59%）检测结果为阳性。所有样本均检测百日咳博德特氏菌。23个样本无法完成副百日咳博德特氏菌检测。没有病例（0/204；95%置信区间[CI]0-1.8%）百日咳博德特氏菌或副百日咳博德特氏菌检测呈阳性（0/181；95%CI0-2%）。
在急诊科诊断为细支气管炎的儿童中，百日咳博德特氏菌的患病率<2%。
