Heininger U, Klich K, Stehr K, Cherry J D
Universitatsklinik mit Poliklinik fur Kinder und Jugendliche, Erlangen, Germany.
Pediatrics. 1997 Dec;100(6):E10. doi: 10.1542/peds.100.6.e10.
To study the clinical presentation of culture-confirmed pertussis in children and their contacts with cough illnesses in an outpatient setting.
In conjunction with a large pertussis vaccine efficacy trial in Germany, a central laboratory to isolate Bordetella species from nasopharyngeal specimens was established in Erlangen in October 1990. Pediatricians in private practices in southern Germany, the Saar region, and Berlin were encouraged to obtain nasopharyngeal specimens and clinical characteristics from patients with cough illnesses >/=7 days' duration. Bordetella species were isolated by use of calcium alginate swabs, Regan-Lowe agar, and modified Stainer-Scholte broth. Clinical characteristics were determined by initial and follow-up questionnaires.
From October 1990 to September 1996, 20 972 specimens were submitted, and B pertussis was isolated in 2592 instances (12.4%). Of the culture-proven cases, 50.7% were female, and the age range was 6 days to 41 years, with a mean and median of 4.3 years and 4.1 years, respectively. The following characteristics were noted. Only 4% of the patients had received pertussis vaccine. Of unvaccinated patients, 90.2% had paroxysmal cough, 78.9% demonstrated whooping, and 53.3% presented with posttussive vomiting; 5.7% had fever >/=38 degrees C. The duration of cough was </=4 weeks in 37.9% and </=3 weeks in 17.4%. Leukocytosis and lymphocytosis (values above the age-specific mean) were observed in 71.9% and 75.9% of unvaccinated patients, respectively. The overall complication rate was 5.8%, and pneumonia (29%) was the most frequent complication. In infants <6 months of age, the rate of complications was 23.8%. One death in a 7-month-old infant occurred.
Typical symptoms of pertussis were observed in the great majority of patients regardless of age group. However, the duration of cough was surprisingly short in one sixth of the patients. These short illness cases would not be classified as pertussis according to the World Health Organization clinical case definition, which requires >/=21 days of spasmodic cough.
研究门诊环境中确诊为百日咳的儿童及其咳嗽相关接触者的临床表现。
1990年10月，在德国埃尔朗根建立了一个中央实验室，与德国一项大型百日咳疫苗效力试验合作，从鼻咽标本中分离博德特氏菌属。鼓励德国南部、萨尔地区和柏林的私人诊所的儿科医生从咳嗽持续时间≥7天的患者中获取鼻咽标本和临床特征。使用藻酸钙拭子、Regan-Lowe琼脂和改良的Stainer-Scholte肉汤分离博德特氏菌属。通过初始问卷和随访问卷确定临床特征。
1990年10月至1996年9月，共提交了20972份标本，其中2592份（12.4%）分离出百日咳博德特氏菌。在培养确诊的病例中，50.7%为女性，年龄范围为6天至41岁，平均年龄和中位数分别为4.3岁和4.1岁。观察到以下特征。只有4%的患者接种过百日咳疫苗。在未接种疫苗的患者中，90.2%有阵发性咳嗽，78.9%有哮吼，53.3%有咳嗽后呕吐；5.7%的患者体温≥38℃。37.9%的患者咳嗽持续时间≤4周，17.4%的患者咳嗽持续时间≤3周。未接种疫苗的患者中，分别有71.9%和75.9%观察到白细胞增多和淋巴细胞增多（值高于特定年龄平均值）。总体并发症发生率为5.8%，肺炎（29%）是最常见的并发症。在6个月以下的婴儿中，并发症发生率为23.8%。一名7个月大的婴儿死亡。
无论年龄组如何，绝大多数患者都观察到百日咳的典型症状。然而，六分之一的患者咳嗽持续时间出奇地短。根据世界卫生组织的临床病例定义，这些病程短的病例不会被归类为百日咳，该定义要求痉挛性咳嗽持续时间≥21天。
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