Shojaei J, Saffar Mj, Hashemi A, Ghorbani Gr, Rezai Ms, Shahmohammadi S
Department of Health, Provincial Center for Diseases Control and Prevention, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Pediatric Infectious Diseases and Antimicrobial Resistant Nosocomial Infections Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Ann Med Health Sci Res. 2014 Nov;4(6):910-4. doi: 10.4103/2141-9248.144911.
The clinical presentations of pertussis infection have considerable variation. Many infections and illnesses can cause prolonged repetitive paroxysmal cough that could be confused with Bordetella pertussis infection.
This retrospective study was designed to compare the clinico-laboratory findings between two groups of hospitalized infants with confirmed, and those who have clinical pertussis disease; to identify the possible additional diagnostic clues "for the diagnosis of confirmed pertussis disease".
The study population consisted of infants ≤12 months of age with clinical diagnosis of pertussis that fulfilled the World Health Organization definition for pertussis or those diagnosed by physicians. Clinico-laboratory findings were compared between two groups of patients (confirmed vs. clinical cases).
From a total of 118 infants admitted with a clinical diagnosis of pertussis, 16% (19/118) were confirmed by laboratory to have confirmed pertussis. Twelve of 19 (63%) and 71.99% of confirmed and clinical cases were younger than 6 months of age, respectively. For most patients, the duration of symptoms before hospitalization was <14 days. There were no significant differences between two groups of patients for paroxysmal cough and facial discoloration. However, whoop and apnea were more common among confirmed pertussis cases: P = 0.01, and P = 0.02, respectively. Leukocytosis (≥16,000/ml) (P = 0.01) and lymphocytosis (≥11,000) (P = 0.02) were reported significantly more frequently in confirmed pertussis cases.
Given the unavailability of a highly sensitive diagnostic test, in every afebrile patient with paroxysmal cough lasting for ≥7 days associated with whoop and/or apnea, particularly if accompanied by leukocytosis/lymphocytosis, pertussis disease should be considered. In this situation, prompt administration of empiric treatment for cases, and providing control measures to prevent infection transmission to contacts are recommended.
百日咳感染的临床表现有很大差异。许多感染和疾病可导致长时间反复阵发性咳嗽，可能与百日咳博德特氏菌感染相混淆。
本回顾性研究旨在比较两组住院婴儿的临床实验室检查结果，一组为确诊百日咳的婴儿，另一组为临床诊断百日咳的婴儿；以确定“确诊百日咳疾病诊断”可能的额外诊断线索。
研究人群包括年龄≤12个月、临床诊断为百日咳且符合世界卫生组织百日咳定义的婴儿，或经医生诊断的婴儿。比较两组患者（确诊组与临床诊断组）的临床实验室检查结果。
在总共118例临床诊断为百日咳的住院婴儿中，16%（19/118）经实验室确诊为百日咳。19例确诊病例中有12例（63%），临床诊断病例中有71.99%年龄小于6个月。对于大多数患者，住院前症状持续时间<14天。两组患者在阵发性咳嗽和面色改变方面无显著差异。然而，鸡鸣样吸气吼声和呼吸暂停在确诊百日咳病例中更常见：P值分别为0.01和0.02。确诊百日咳病例中白细胞增多（≥16,000/ml）（P = 0.01）和淋巴细胞增多（≥11,000）（P = 0.02）的报告频率明显更高。
鉴于缺乏高度敏感的诊断检测方法，对于每一位无发热、阵发性咳嗽持续≥7天且伴有鸡鸣样吸气吼声和/或呼吸暂停的患者，尤其是伴有白细胞增多/淋巴细胞增多时，应考虑百日咳疾病。在这种情况下，建议对病例迅速给予经验性治疗，并采取控制措施以防止感染传播给接触者。
