Long Stephen, Lowe Robert B
Internal Medicine & Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, USA.
Hospital Medicine, Geisinger Health System, Danville, USA.
Cureus. 2022 Jul 15;14(7):e26885. doi: 10.7759/cureus.26885. eCollection 2022 Jul.
commonly infects individuals of all ages. However, pertussis, the disease caused by infection, is most severe in young infants. Severe pertussis, defined by the presence of refractory hypoxemia, pneumonia, cardiogenic shock, and hyperleukocytosis, is associated with significant morbidity and mortality. Both hyperleukocytosis and pulmonary hypertension have been found to be predictive of mortality in young infants. Leukoreductive strategies such as leukapheresis and exchange transfusion have been employed to treat these complications. Pulmonary hypertension is thought to be a result of aggregation of white blood cells in pulmonary vasculature; however, studies have suggested that the mechanism of pulmonary hypertension is multifactorial. We report a case of a 10-month-old unvaccinated Amish female with pertussis complicated by an initial hyperleukocytosis of 204,900 10/uL successfully treated with leukapheresis in our pediatric intensive care unit. This infant never showed signs of pulmonary hypertension, which is often associated with hyperleukocytosis in severe or fatal cases of pertussis in infants and neonates. To our knowledge, this is the most significant degree of hyperleukocytosis reported in pertussis. The findings in this case support the clinical utility of leukoreductive therapy in severe pertussis and provide some evidence that the mechanism of pulmonary hypertension in these patients is multifactorial.
通常感染所有年龄段的人。然而，由感染引起的疾病百日咳在幼儿中最为严重。严重百日咳定义为存在难治性低氧血症、肺炎、心源性休克和白细胞增多症，与显著的发病率和死亡率相关。白细胞增多症和肺动脉高压均已被发现可预测幼儿的死亡率。诸如白细胞去除术和换血疗法等白细胞减少策略已被用于治疗这些并发症。肺动脉高压被认为是肺血管中白细胞聚集的结果；然而，研究表明肺动脉高压的机制是多因素的。我们报告了一例10个月大未接种疫苗的阿米什族女性患百日咳，并发初始白细胞增多症，白细胞计数达204,900/μL，在我们的儿科重症监护病房通过白细胞去除术成功治疗。该婴儿从未出现肺动脉高压的迹象，而在婴儿和新生儿百日咳的严重或致命病例中，肺动脉高压常与白细胞增多症相关。据我们所知，这是百日咳中报告的最严重程度的白细胞增多症。该病例的发现支持了白细胞减少疗法在严重百日咳中的临床实用性，并提供了一些证据表明这些患者肺动脉高压的机制是多因素的。
