Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is generally presumed that children who have had reactions to diphtheria-tetanus-pertussis (DTP) immunization will be more likely to have similar reactions or more severe reactions upon subsequent immunization. To evaluate this contention, we studied the rates of selected reactions occurring within 48 hours of primary DTP immunization in 1,241 infants less than one year of age. Both local and systemic reactions were significantly more frequent following subsequent DTP immunization if present following a prior immunization. The rates of local reactions following subsequent DTP immunization as a function of previous reactions were as follows (no prior reactions/prior reaction): local redness greater than or equal to 2.5 cm, 12.5%/25.5% (p less than 0.0001); local swelling greater than or equal to 2.5 cm, 16.8%/29.0% (p less than 0.0001); local pain, 37.4%/56.4%; (p less than 0.0001). The rates of systemic reactions as a function of previous reactions were as follows (no prior reactions/prior reaction): drowsiness, 24.9%/42.8% (p less than 0.0001); fretfulness, 47.5%/64.7% (p less than 0.0001); vomiting, 4.8%/11.2% (p = 0.0084); anorexia 16.0%/26.3% (p = 0.0001); fever greater than or equal to 38 degrees C, 37.6%/58.5% (p less than) 0.0001); persistent crying, 2.6%/4.5% (p = 0.3557). In addition, infants who experienced a fever greater than or equal to 38 degrees C on the first of two immunizations were more likely to have a temperature greater than or equal to 39 degrees C following the second immunization, 4.2% vs. 12.4% (p = 0.0017). These data strongly support the presumption that children who have had previous reactions following DTP immunization are more likely to have similar reactions upon subsequent immunization.
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PMID:DTP vaccine reactions: effect of prior reactions on rate of subsequent reactions. 387 87

A review was conducted of all patients seen at Upstate Medical Center, Syracuse, NY, from June 1975, to June 1983, whose nasopharyngeal specimens were positive by specific Bordetella pertussis-fluorescent antibody stain. Sixty-one patients were identified; 46 were hospitalized and 15 were outpatients. The age and immunization status of the two groups were compared. Admission diagnosis, indices of illness severity, and clinical course were assessed for the hospitalized patients. Review of the house officers' initial differential diagnoses disclosed that pertussis was considered in the diagnosis in only 45% of the cases. Bronchiolitis was the next most commonly listed diagnosis. Frequent vomiting and severe coughing were the most helpful clinical findings leading to an accurate diagnosis. Abnormal chest roentgenograms and elevated white blood cell counts were present in a minority of our patients, whether the initial diagnosis was correct or not. Younger and less-immunized patients had more severe and prolonged clinical courses. This study demonstrates that the diagnosis of pertussis is often missed or delayed because clinical findings are similar to those of other respiratory infections in infancy. Suspicion of the diagnosis in children with nonspecific respiratory illness is required for early diagnosis, treatment, and prevention of spread to susceptible individuals.
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PMID:Inaccurate diagnosis in infants with pertussis. An eight-year experience. 401 97

ALTHOUGH WE HAVE FAILED TO PRODUCE EITHER PAROXYSMAL COUGH OR VOMITING IN RHESUS MONKEYS, CYNOMOLGUS MONKEYS AND MARMOSETS, WE HAVE FOUND IN MARMOSETS SEVERAL FEATURES OF PERTUSSIS INFECTION SIMILAR TO THOSE SEEN IN CHILDREN WITH WHOOPING COUGH: catarrh, persistence of colonization of the naso-pharynx with Bordetella pertussis for 4-11 weeks, change of serotype during colonization and inability of type 1 organisms to establish themselves as the predominant serotype.As in children, we have found that intramuscular vaccine of type 1,2,3 was more effective than type 1,2 in preventing persistent infection with the currently prevalent serotypes 1,2,3 and 1,3. A mixed vaccine (1,2,3 and 1,3) seemed to produce agglutinin 3 in the serum more consistently than a pure type 1,2,3 vaccine. The duration of colonization, after naso-pharyngeal challenge, was greatly reduced in animals with agglutinin 3.Local immunity, resulting from previous infection, was even more effective than a good vaccine in preventing subsequent persistent colonization. Marmosets may be useful in studying the possible development of aerosol pertussis vaccine for human use.
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PMID:Experimental pertussis infection in the marmoset: type specificity of active immunity. 436 10

There is increasing evidence that pertussis occurs frequently in adults, but there is limited information on the clinical course of this disease beyond childhood. A household contact study on the efficacy of an acellular pertussis vaccine was used to study the symptoms of pertussis in adults. Among 257 patients with pertussis identified in 121 families during a two-year period in one study center with a low whole-cell pertussis-vaccine uptake, 79 (30.7%) were adults, aged 19-83 years (mean age: 36 years) with a 1:1.8 male to female ratio. Ninety-one percent of the adults suffered from coughing (mean duration: 54 days), and in 80% this cough lasted > or = 21 days. Whoops were rare (8%), whereas cough followed by vomiting and/or choking (53%) and cough disturbing sleep (52%) were common. This is the first report to describe sweating attacks as symptom of pertussis (14%). Pharyngeal symptoms (37%), influenza-like symptoms (30%), sneezing attacks (22%), hoarseness (18%), sinus pain (16%) and headaches (14%) were also observed. Various complications were seen in 23% of the patients. In order to minimize the spread of the organism, microbiological diagnostics should be vigorously applied to all symptomatic contacts of a patient with pertussis but also to all patients with long lasting cough-irrespective of age.
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PMID:Symptoms and complications of pertussis in adults. 749 1

Concurrent outbreaks of illnesses that were manifested by cough and that were suspected to be due to Bordetella pertussis and Mycoplasma pneumoniae infection were investigated in a midwestern town in Illinois. Three studies were conducted: questionnaires on the clinical and epidemiological characteristics of illness were administered to patients; serological tests were performed to confirm the presence of each pathogen and to develop case definitions for each illness; and case definitions were applied to responses to a mail-in questionnaire for estimating the magnitude of both outbreaks. In 135 cases of suspected pertussis and 42 cases of suspected mycoplasmal infection, subjects had a cough for > or = 14 days (the pertussis outbreak case definition). Among 20 laboratory-confirmed cases, a cough for > or = 14 days had a specificity of 20% for pertussis, and a cough for > or = 28 days plus whoop and/or vomiting had a specificity of 90% for pertussis. Six hundred-seventeen pertussis cases per 100,000 population and 1,179 cases of M. pneumoniae infection per 100,000 population occurred. In this setting, the standard outbreak case definition for pertussis lacked adequate specificity to distinguish pertussis from mycoplasmal infection. The magnitude of each outbreak was greater than the number of reported cases suggested.
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PMID:Concurrent outbreaks of pertussis and Mycoplasma pneumoniae infection: clinical and epidemiological characteristics of illnesses manifested by cough. 775 86

The polymerase chain reaction (PCR) was recently added to conventional culture and serology for the diagnoses of Bordetella pertussis infection in a large vaccine efficacy trial in Germany. In vaccinees or family members who had illnesses with cough, two nasopharyngeal swabs (calcium alginate for culture and Dacron for PCR) were taken and initial and follow-up clinical data were obtained. PCR was done using oligonucleotide primers PTp1 and PTp2 which amplify a 191-base pair DNA fragment of pertussis toxin operon. From December, 1993, to May, 1994, 555 pairs of swabs were processed; 28 grew B. pertussis and 9 grew B. parapertussis. Twenty-six of the 28 subjects with B. pertussis-positive cultures also had positive PCR results as did one of the 9 B. parapertussis cases and 82 additional samples were positive by PCR. PCR increased the identification of subjects with B. pertussis infections by almost 4-fold. Clinical characteristics were analyzed by laboratory category (Group 1, 28 culture-positive; Group 2, 82 culture-negative, PCR-positive; and Group 3, 436 culture- and PCR-negative). Group 1 subjects were more likely to have a diagnosis of definite or probable pertussis and to have paroxysmal cough, posttussive vomiting, whooping and a cough duration of > or = 4 weeks than Group 2 or 3 subjects. In contrast Group 2 subjects were more likely than Group 1 subjects to have had previous pertussis immunization or prior antibiotics. PCR identified many mild illnesses caused by B. pertussis that were not identified by culture.
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PMID:Polymerase chain reaction identification of Bordetella pertussis infections in vaccinees and family members in a pertussis vaccine efficacy trial in Germany. 776 Nov 86

Whooping cough can be caused by either Bordetella pertussis or Bordetella parapertussis. Although the two species share an almost complete DNA identity, Bordetella parapertussis does not produce pertussis toxin, which is thought to be the main virulence factor of Bordetella pertussis. In order to elucidate the role of pertussis toxin in causing the typical symptoms of whooping cough, clinical information from 33 patients with culture-positive Bordetella parapertussis infection was collected and compared to that from 331 patients with infection caused by Bordetella pertussis. Isolated strains of Bordetella parapertussis lacked pertussis toxin expression, as was demonstrated by negative tests for histamine sensitization. This was further substantiated in vivo by a significantly lower leukocyte count in the parapertussis group as compared to the pertussis group. Frequencies of typical symptoms of whooping cough, such as paroxysmal coughing, whooping and vomiting, were almost identical in the two groups. Nocturnal coughing and contact anamnesis were noted more often in the Bordetella pertussis group. Children in the parapertussis group were significantly more often vaccinated with whole-cell pertussis vaccine than children infected with Bordetella pertussis. The results indicate that pertussis toxin may not play a decisive role in causing the typical symptoms of whooping cough, such as paroxysmal coughing, whooping and vomiting.
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PMID:Role of pertussis toxin in causing symptoms of Bordetella parapertussis infection. 795 64

In conjunction with a pertussis vaccine efficacy trial in Germany, nasopharyngeal specimens were collected from May, 1992, to March, 1993, from patients with cough illnesses. Clinical data were obtained by initial and follow-up questionnaires. Bordetella parapertussis was isolated from 38 patients (mean age, 3.5 years; 68% girls). Clinical characteristics in these cases were compared with those of 76 patients (matched by age and sex) with illness caused by Bordetella pertussis during the same period. Findings were: (B. pertussis/B. parapertussis): cough > 4 weeks 57%/37% (P = 0.06); whoop 80%/59% (P = 0.07); whoop > 2 weeks 26%/18% (P = 0.05); paroxysms 90%/83% (P = 0.5); body temperature > or = 38 degrees C 9%/0% (P = 0.17); vomiting 47%/42% (P = 0.69); and mean leukocyte and lymphocyte counts 12,500/mm3 and 7600/mm3 (P < 0.0001) and 7800/mm3 and 3500/mm3 (P < 0.0001), respectively. Illness caused by B. parapertussis was typical of pertussis but less severe than that caused by B. pertussis. In contrast with B. pertussis infection, lymphocytosis is not a characteristic of B. parapertussis infection. This is most likely a result of the lack of production of lymphocytosis-promoting factor toxin by B. parapertussis.
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PMID:Clinical characteristics of illness caused by Bordetella parapertussis compared with illness caused by Bordetella pertussis. 803 48

One hundred forty-five infants were vaccinated with 25 micrograms of pertussis toxoid (NICHD-Ptxd) at 3, 5 and 7 or at 3, 5 and 12 months of age. One month after the third vaccination all had high serum IgG and neutralizing antibodies (antitoxin) against pertussis toxin. Vaccination at 3, 5 and 12 months resulted in higher antibody titers than vaccination at 3, 5 and 7 months. Sera obtained from 109 children at 3 years of age showed a decline of antibodies, but all had detectable antibodies. Adverse reactions were confined to local redness and swelling, which exceeded 2 cm after 17% of all injections. When the children were 3 years old, a comparison was made of the incidence of clinical pertussis in 142 of the 145 vaccinated children and in 284 age-matched controls living in the same areas. Information on symptoms of pertussis was obtained from the parents during telephone interviews. None of the vaccinated children had clinical pertussis, defined as a 6-week course of paroxysmal cough with whooping attacks or vomiting, whereas 57 controls (20%) had experienced these symptoms. Sixteen vaccinated children were exposed to pertussis in the household. Two of them had laboratory-verified Bordetella pertussis infections with cough of 2 and 4 weeks, respectively, without whooping attacks or vomiting, whereas 14 did not develop a cough. The study shows that NICHD-Ptxd is immunogenic in infants and that it most likely confers a high degree of protection against pertussis.
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PMID:Safety, immunogenicity and an open, retrospective study of efficacy of a monocomponent pertussis toxoid vaccine in infants. 817 Jul 28

Since June 1991 pertussis cases have been reported in the Swiss Sentinel Network (Sentinella). A total of 150-200 general practitioners, physicians specialized in internal medicine, and pediatricians participate in this system on a voluntary basis. Of the three specialties involved, this non-randomized sample represents 3.0%-3.5% of all physicians registered in Switzerland. The objective of this surveillance system is to monitor clinical pertussis over time. The case definition included all patients with a cough illness lasting at least 14 days with one of the following: paroxysms of cough, inspiratory "whoop", post-tussive vomiting (sporadic cases), or an epidemiological link to a pertussis case (epidemic cases). A laboratory diagnosis based on the polymerase chain reaction technique (PCR) was available for 82.7% of cases reported in 1994 and 1995. Of these, 27.7% had a positive PCR result. Reports of epidemic pertussis tested for Bordetella pertussis by PCR were confirmed by the laboratory in 46.5% of cases. The laboratory confirmation rate was more than twice as high among epidemic cases than among sporadic cases (20.7%). The crude incidence rate of whooping cough was 70 cases per 100,000 population per year in 1992 and 1993. Compared to previous years, pertussis incidence was significantly higher in 1994 and 1995 (370 cases per 100,000 population and 280 cases per 100,000 population respectively). The increase in reports was especially marked between July and October 1994 and whooping cough became epidemic in the third trimester of 1994 and at the beginning of 1995. In these 2 years, Switzerland experienced an estimated 40,000 clinical pertussis cases. Based on the proportion of PCR-positive pertussis cases in the sentinel sample, 12,500 of these would have been laboratory-confirmed. Most cases were observed in infants and in children up to 6 years of age. Assuming a vaccination coverage of 90%, the global efficacy of vaccination (3 or more doses versus less than 3) for 1994 and 1995 among children aged 12 to 47 months and not born before 1991 was 0.74 (0.59 and 0.88 for a vaccination coverage of 85% and 95% respectively). Vaccine efficacy was higher in PCR-positive cases (0.87; 0.79; 0.94) than in PCR-negative cases (0.54; 0.27; 0.78). Vaccination efficacy estimates on the basis of surveillance data are certainly less precise than those inferred from clinical trials. However, our results indicate that the efficacy of vaccination in children significantly declined with increasing age. Whooping cough still has the potential to cause epidemics in Switzerland in spite of a high vaccination coverage. With the introduction of acellular pertussis vaccines and new vaccination schemes in Switzerland, the Swiss Sentinel Network fulfills an important task as a monitoring system and contributes to the evaluation of new vaccination strategies.
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PMID:[Monitoring of a whooping cough epidemic 1994/95 in Switzerland using the sentinel notification system. Sentinella Registry]. 884 4


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