Chantreuil J, Fakhri N, Labarthe F, Saliba E, Favrais G
Réanimation pédiatrique et néonatologie, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France.
Réanimation pédiatrique et néonatologie, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 37000 Tours, France.
Arch Pediatr. 2015 Jan;22(1):84-7. doi: 10.1016/j.arcped.2014.10.010. Epub 2014 Nov 4.
Malignant pertussis is a critical clinical state associated with fatal outcome in 70% of cases. The severity criteria are a lung infection with pulmonary hypertension and hyperleukocytosis usually above 50 G/L. We report the case of a 2.5-month-old girl hospitalized with critical pertussis in a pediatric intensive care unit. She had acute respiratory distress syndrome with pulmonary hypertension complicated by a bacterial secondary infection with Enterobacter cloacae managed by high-frequency oscillatory ventilation associated with pulmonary vasodilatation therapy. In the absence of clinical improvement and before considering extracorporeal life support, exchange transfusion was performed at day 9 to reduce hyperleukocytosis at 70 G/L. Exchange transfusion was successfully performed with a reduction of leukocytes to under 40 G/L followed by steady improvement of pulmonary function. Weaning from mechanical ventilation and discharge took place at day 23 and 38, respectively.
Exchange transfusion should be considered in infants suffering from malignant pertussis with extreme leukocytosis before hemodynamic failure to improve the survival prognosis.
恶性百日咳是一种危急的临床状态，70%的病例会导致致命后果。严重程度标准为肺部感染伴肺动脉高压和白细胞增多症，白细胞计数通常高于50 G/L。我们报告一例2.5个月大的女童，因重症百日咳入住儿科重症监护病房。她患有急性呼吸窘迫综合征伴肺动脉高压，并伴有阴沟肠杆菌继发细菌感染，采用高频振荡通气联合肺血管扩张治疗。在临床无改善且未考虑体外生命支持之前，于第9天进行了换血治疗，以降低白细胞计数至70 G/L。换血治疗成功进行，白细胞计数降至40 G/L以下，随后肺功能稳步改善。分别于第23天和第38天撤机和出院。
对于患有恶性百日咳且白细胞极度增多的婴儿，在血流动力学衰竭之前应考虑进行换血治疗，以改善生存预后。
