Borgi Aida, Menif Khaled, Belhadj Sarra, Ghali Narjess, Salmen Loukil, Hamdi Asma, Khaldi Ammar, Bouaffsoun Aida, Kechaou Sonia, Kechrid Amel, Bouziri Asma, Benjaballah Nejla
Pediatric intensive care unit, children's hospital Bechir Hamza of Tunis.
Microbiology laboratory, children's hospital Bechir Hamza of Tunis.
Mediterr J Hematol Infect Dis. 2014 Sep 1;6(1):e2014059. doi: 10.4084/MJHID.2014.059. eCollection 2014.
Critical pertussis is characterized by severe respiratory failure, important leukocytosis, pulmonary hypertension, septic shock and encephalopathy.
To describe the clinical course of critical pertussis, and identify predictors of death at the time of presentation for medical care.
Retrospective study conducted in children's hospital Tunisian PICU between 01 January and 31 October 2013. Patients with critical pertussis confirmed by RT-PCR and requiring mechanical ventilation were included. Predictors of death were studied.
A total of 17 patients was studied. Median age was 50 days. Mortality was 23%. Predictors risk of mortality were : high PRISM score (Pediatric Risk of Mortality Score) (p=0,007), shock (p=0,002), tachycardia (p=0,005), seizures (p=0,006), altered mental status (p=0,006), elevated WBC count (p=0,003) and hemodynamic support (p=0022). However, the difference did not reach statistical significance in comorbidity, pneumoniae, high pulmonary hypertension or exchange transfusion. Concomitant viral or bacterial co-infection was not related to poor outcome.
Young infants are at high risk to have critical pertussis. Despite advances in life support and the treatment of organ failure in childhood critical illness, critical pertussis remains difficult to treat.
重症百日咳的特征为严重呼吸衰竭、显著白细胞增多、肺动脉高压、感染性休克和脑病。
描述重症百日咳的临床病程，并确定就医时的死亡预测因素。
2013年1月1日至10月31日在突尼斯儿童医院儿科重症监护病房进行的回顾性研究。纳入经逆转录聚合酶链反应（RT-PCR）确诊且需要机械通气的重症百日咳患者。研究死亡预测因素。
共研究了17例患者。中位年龄为50天。死亡率为23%。死亡风险预测因素为：高PRISM评分（儿科死亡风险评分）（p = 0.007）、休克（p = 0.002）、心动过速（p = 0.005）、惊厥（p = 0.006）、精神状态改变（p = 0.006）、白细胞计数升高（p = 0.003）和血流动力学支持（p = 0.022）。然而，在合并症、肺炎、高肺动脉高压或换血方面，差异未达到统计学意义。同时发生的病毒或细菌合并感染与不良预后无关。
小婴儿患重症百日咳的风险很高。尽管儿童危重病的生命支持和器官衰竭治疗取得了进展，但重症百日咳仍然难以治疗。
