Bouziri A, Hamdi A, Khaldi A, Smaoui H, Kechrid A, Menif K, Ben Jaballah N
Service de réanimation pédiatrique, Hôpital d'enfants, Tunis, Tunisie.
Med Trop (Mars). 2010 Jun;70(3):245-8.
Malignant pertussis is a rare life-threatening illness characterized by severe respiratory failure, severe leukocytosis, and pulmonary hypertension. The purpose of this study was to determine the prevalence of malignant pertussis in infants admitted to a pediatric intensive care unit (PICU) for severe acute respiratory failure associated with severe leukocytosis.
This retrospective study was based on review of the medical charts of infants aged less than 3 months admitted to the PICU between 2006 and 2008 for severe acute respiratory failure requiring mechanical ventilation with leukocytosis greater than 50,000/mm3. Clinical and laboratory data were collected. Polymerase chain reaction (PCR) for detection of Bordetella pertussis was performed on nasopharyngeal washes (NPW) stored at -70 degrees C.
Ten patients meeting inclusion criteria were identified. Median age was 2.1 months (range, 0.6 - 3). None of the infants had been vaccinated against pertussis. Although PCR for pertussis was positive in all ten cases, presumptive diagnosis was made in only 3 patients during hospitalization. Nine patients died within a mean of 4.7 +/- 3.3 days after admission. The cause of death was refractory shock and hypoxemia in all cases. Only one patient survived.
Malignant pertussis is a severe disease that is almost always fatal. It was underdiagnosed in our PICU. Use of PCR for detection of B. pertussis, i.e., the reference method, should be promoted in developing countries.
恶性百日咳是一种罕见的危及生命的疾病，其特征为严重呼吸衰竭、严重白细胞增多和肺动脉高压。本研究的目的是确定因严重急性呼吸衰竭合并严重白细胞增多而入住儿科重症监护病房（PICU）的婴儿中恶性百日咳的患病率。
这项回顾性研究基于对2006年至2008年间因严重急性呼吸衰竭需要机械通气且白细胞增多超过50,000/mm³而入住PICU的3个月以下婴儿的病历进行回顾。收集临床和实验室数据。对保存在-70℃的鼻咽冲洗液（NPW）进行聚合酶链反应（PCR）检测百日咳博德特氏菌。
确定了10名符合纳入标准的患者。中位年龄为2.1个月（范围0.6 - 3个月）。所有婴儿均未接种过百日咳疫苗。尽管所有10例患者的百日咳PCR检测均为阳性，但住院期间仅3例患者得到初步诊断。9例患者在入院后平均4.7±3.3天内死亡。所有病例的死亡原因均为难治性休克和低氧血症。仅1例患者存活。
恶性百日咳是一种严重疾病，几乎总是致命的。在我们的PICU中其诊断不足。在发展中国家应推广使用PCR检测百日咳博德特氏菌这一参考方法。
