Wright S W, Edwards K M, Decker M D, Zeldin M H
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-4700, USA.
JAMA. 1995 Apr 5;273(13):1044-6.
To determine the prevalence of Bordetella pertussis infection in adult patients with persistent cough.
Prospective case series.
Urban university hospital emergency department.
Convenience sample of 75 patients aged 18 years or older with a cough lasting 2 weeks or longer. Serum specimens from 67 patients without respiratory complaints were used to develop reference values.
In patients with cough, nasopharyngeal culture and direct fluorescent antibody testing for B pertussis were performed and serum samples were obtained at the first visit and 1 month later. Serum specimens were assayed for antibody to pertussis toxin (PT) and filamentous hemagglutinin (FHA).
A subject with one or more of the following was defined as having a pertussis infection: a positive B pertussis culture result, a four-fold change in PT or FHA titer, and/or a single PT or FHA titer at least 2 SDs greater than the geometric mean of the control group.
No subject tested culture positive for B pertussis. Sixteen (21%) (95% confidence interval [CI], 13% to 32%) of 75 subjects met the serologic criteria for pertussis infection; for 13 (81%; 95% CI, 54% to 96%) of the 16, the criteria were met by the initial serum specimen. In contrast, the geometric mean levels of antibody to PT and FHA for the remaining 59 subjects with cough did not differ from those of the control group. Clinical symptoms and the lymphocyte count did not differentiate patients with pertussis from those without the disease.
Pertussis is a common cause of persistent cough in adults and should be considered in the differential diagnosis. Clinical symptoms, pertussis culture, direct fluorescent antibody testing, and lymphocytosis are of limited value in making the diagnosis.
确定持续性咳嗽成年患者中百日咳博德特氏菌感染的患病率。
前瞻性病例系列研究。
城市大学医院急诊科。
选取75名年龄在18岁及以上、咳嗽持续2周或更长时间的患者作为便利样本。67名无呼吸道症状患者的血清标本用于确定参考值。
对咳嗽患者进行鼻咽培养和百日咳博德特氏菌直接荧光抗体检测，并在首次就诊时和1个月后采集血清样本。检测血清标本中百日咳毒素（PT）和丝状血凝素（FHA）抗体。
符合以下一项或多项标准的受试者被定义为百日咳感染：百日咳博德特氏菌培养结果阳性、PT或FHA滴度有四倍变化，和/或单个PT或FHA滴度至少比对照组几何平均值高2个标准差。
无受试者百日咳博德特氏菌培养呈阳性。75名受试者中有16名（21%）（95%置信区间[CI]，13%至32%）符合百日咳感染的血清学标准；16名中的13名（81%；95%CI，54%至96%）在初次血清标本时即符合标准。相比之下，其余59名咳嗽患者的PT和FHA抗体几何平均水平与对照组无差异。临床症状和淋巴细胞计数无法区分百日咳患者和非百日咳患者。
百日咳是成人持续性咳嗽的常见原因，在鉴别诊断中应予以考虑。临床症状、百日咳培养、直接荧光抗体检测和淋巴细胞增多在诊断中的价值有限。
