Piedra Pedro A, Mansbach Jonathan M, Jewell Alan M, Thakar Sneha D, Grant Cameron C, Sullivan Ashley F, Espinola Janice A, Camargo Carlos A
From the Departments of *Molecular Virology and Microbiology and †Pediatrics, Baylor College of Medicine, Houston, TX; ‡Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; §Department of Paediatrics, University of Auckland, Auckland, New Zealand; and ¶Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Pediatr Infect Dis J. 2015 Jun;34(6):566-70. doi: 10.1097/INF.0000000000000596.
In the United States (U.S.), Bordetella pertussis incidence has increased. Cough and apnea are common findings in pertussis and also in bronchiolitis, the most common cause of hospitalization in U.S. infants. The objective was to determine the prevalence of B. pertussis infection in children hospitalized with bronchiolitis and to describe its clinical course.
Children hospitalized with bronchiolitis and age <2 years were eligible for a prospective, multicenter cohort study during 3 consecutive winter seasons (November-March) from 2007 to 2010. Sixteen sites in 12 states participated using a standardized enrollment protocol. Families were asked the 2010 Centers for Disease Control and Prevention pertussis classification questions. Nasopharyngeal aspirates were obtained and tested by real-time polymerase chain reaction for 16 viruses, Mycoplasma pneumoniae and B. pertussis.
Two thousand sixty-eight (94%) of 2207 children had 1 or more respiratory pathogens. B. pertussis was identified in 4 children [0.2%; 95% confidence interval (CI): 0.1-0.5%] with 3 having a viral co-infection. All 4 were younger than 4 months; 2 met the Centers for Disease Control and Prevention definition of probable pertussis; and 3 had received at least 1 dose of an acellular pertussis vaccine. During the hospitalization, 2 had paroxysmal cough, 1 required intensive care unit care and the median length of stay was 13 days.
Our data support that B. pertussis is an uncommon pathogen in U.S. children hospitalized with bronchiolitis in the winter. Making a diagnosis of pertussis can be challenging because the disease can be atypical and may not meet the Centers for Disease Control and Prevention definition of probable infection.
在美国，百日咳博德特氏菌的发病率有所上升。咳嗽和呼吸暂停在百日咳中很常见，在细支气管炎中也很常见，细支气管炎是美国婴儿住院的最常见原因。目的是确定因细支气管炎住院的儿童中百日咳博德特氏菌感染的患病率，并描述其临床病程。
2007年至2010年连续3个冬季（11月至3月），年龄小于2岁且因细支气管炎住院的儿童符合一项前瞻性、多中心队列研究的条件。12个州的16个地点采用标准化入组方案参与研究。向家庭询问了2010年疾病控制与预防中心的百日咳分类问题。采集鼻咽抽吸物，通过实时聚合酶链反应检测16种病毒、肺炎支原体和百日咳博德特氏菌。
2207名儿童中有2068名（94%）感染了1种或更多种呼吸道病原体。4名儿童（0.2%；95%置信区间：0.1 - 0.5%）检测出百日咳博德特氏菌，其中3名同时感染了病毒。所有4名儿童均小于4个月；2名符合疾病控制与预防中心可能百日咳的定义；3名至少接种过1剂无细胞百日咳疫苗。住院期间，2名儿童出现阵发性咳嗽，1名需要重症监护病房护理，中位住院时间为13天。
我们的数据支持百日咳博德特氏菌在冬季因细支气管炎住院的美国儿童中是一种不常见的病原体。诊断百日咳可能具有挑战性，因为该疾病可能不典型，可能不符合疾病控制与预防中心可能感染的定义。
