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Pertussis (i.e., whooping cough) is a prolonged cough illness caused by the bacteria Bordetella pertussis and associated typically with an inspiratory "whoop," paroxysmal cough, and posttussive vomiting. B. pertussis can cause severe illness or death, especially in infants who have not completed their pertussis vaccination series. Adolescents (i.e., persons aged 13-17 years), adults, and recently vaccinated persons often report atypical symptoms, resulting in delay of recognition and creation of infectious reservoirs for further transmission. In 2003, the Minnesota Department of Health (MDH) investigated a fatal case of unsuspected B. pertussis infection in an elderly adult. This report summarizes the case investigation, which documents the rare isolation of B. pertussis from blood and underscores the need for clinicians to consider pertussis infection in adolescents and adults who have a prolonged cough illness.
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PMID:Fatal case of unsuspected pertussis diagnosed from a blood culture--Minnesota, 2003. 1498 63

The clinical presentations of laboratory-confirmed Bordetella pertussis infection in Chang Gung Children's Hospital during 1997 and 2001 were analyzed. Of the 46 cases, 25 (54.3%) were male. The patients ages ranged from 24 days to 37 years, with a mean and median of 4.3 years and 10.5 years, respectively. Forty four patients had vaccination records, among them 23 patients (52.2%) had received > or = 3 doses of pertussis vaccine. Of the patients who were partially vaccinated (received 1 or 2 doses vaccine) or unvaccinated, 16 (69.6%) presented with whooping cough, 5 (22.2%) with post-tussive vomiting, and 13 (59.1%) with cyanosis. Leukocytosis (white blood cells > or = 15,000 cells/microL) and lymphocytosis (lymphocytes > or = 10,000 cells/microL) were observed in 17 (47.2%) and 16 (44.4%) of the patients, respectively. Fourteen patients (30.4%) developed complications, among which pneumonia was the most common (92.3%). Among infants < or = 1 year of age, 95.2% were partially vaccinated (20/21), compared with 5% (1/20) of the patients > 1 year of age (p<0.05). The overall complication rate was 37.5%, compared with 18.2% for patients > 1 year of age (p<0.05). One 2-month-old patient required ventilatory support after the development of cardiopulmonary failure. There was no mortality in this study. In summary, pertussis most commonly occurred in infants who were unvaccinated or partially vaccinated. These patients usually presented with atypical symptoms such as cyanosis or apnea. The importance of vaccination still cannot be overemphasized because immunized patients usually present with milder disease than those who are not immunized.
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PMID:Bordetella pertussis infection in northern Taiwan, 1997-2001. 1549 10

In December 2004, an infant aged 29 days in West Virginia died from pertussis after exposure to adult family members with probable undiagnosed pertussis. Pertussis (i.e., whooping cough) is a prolonged respiratory illness caused by the bacterium Bordetella pertussis and characterized by a violent cough, inspiratory whoop, and posttussive vomiting. The cough often lasts from several weeks to up to 3 months. However, adolescents and adults, even those previously vaccinated as children, often have disease not recognized as pertussis, leading to intrafamilial and nosocomial transmission. In the United States, children aged <6 months are at the highest risk for severe illness or death from pertussis because most infants do not complete their primary vaccination series until age 6 months. This report summarizes results of the West Virginia Department of Health and Human Resources (WVDHHR) case investigation, which underscore the critical need to prevent pertussis transmission to infants from adolescents and adults with undiagnosed disease.
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PMID:Fatal case of pertussis in an infant--West Virginia, 2004. 1567 86

Seven-week-old 32-week premature triplets were hospitalized because of rhinorrhea, cough with color change and posttussive emesis. One infant had a positive direct fluorescent antibody test for Bordetella pertussis, so all were treated with 5 days of azithromycin. Two of the infants were subsequently diagnosed with hypertrophic pyloric stenosis and underwent surgical pyloromyotomies 6 and 7 weeks, respectively, after the initial admission.
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PMID:Infantile hypertrophic pyloric stenosis in infants treated with azithromycin. 1725 89

This study compared the influence of age and immunization status on symptoms in pediatric patients with pertussis. The files of 60 children, aged 7 to 18 years and 20 infants aged up to 6 months, admitted to our pediatric hospital with a diagnosis of pertussis were reviewed. There were no between-group differences in day and night cough or vomiting. The older group had a longer mean interval to diagnosis than the infants, and the infant group had more symptoms of whooping cough, facial redness during cough, cyanosis, a higher white blood count, a higher percentage of lymphocytes, and more abnormal chest X-rays. Statistically significant differences were found between vaccinated and unvaccinated older children for whooping cough and white blood cell count. Daytime and nighttime coughs are common symptoms of pertussis in all pediatric age groups, regardless of vaccination status. High white blood count is related to immunization status, and percentage of lymphocytes is related to age. In infants, symptoms are more grave but are typical, leading to early diagnosis.
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PMID:Pertussis symptoms in adolescents and children versus infants: the influence of vaccination and age. 1752 92

The aim of this study was to evaluate the existence and the rate of pertussis infection in December 2002 among the symptomatic contacts in Konurhaciobasi village of Kirikkale province (placed in middle Anatolia, Turkey, with a population of 500 people), where a laboratory-confirmed pertussis case was defined by culture positivity. Sixty contacts with cough history of more than two weeks have been interviewed and their nasopharyngeal swabs have been collected together with the serum samples from 47 of them. "Probable case" definition included cough lasting longer than two weeks together with at least one of the following symptoms: paroxysms of cough, inspiratory "whooping" and post-tussive vomiting without other apparent cause. The samples were inoculated onto cephalexin Bordet-Gengou agar (C-BGA), and following the growth of suspected colonies identification tests including slide agglutination by using Bordetella pertussis phase 1 and B.parapertussis specific antisera, were performed. IgG antibodies against B.pertussis were searched with an in-house ELISA method by using purified pertussis toxin, and titers of > or = 100 ELISA units (EU)/ml were considered as acute/recent infection. Among the subjects 80% were children and 75% were female. Thirty-six subjects (76.6%) had a history of immunization with 3-4 doses of diphtheria-pertussis-tetanus (DPT) vaccine. According to questionnaires the mean household number was calculated as 5.0 +/- 0.26. Fifteen contacts (age range: 4-12 years, 11 were female) were defined as "probable cases", however all of them were found to be culture negative. All these cases had been vaccinated with DPT vaccine. Among the probable cases 12 serum samples were available, and six of them were evaluated as acute/recent pertussis infection, since their antibody titers were found as > or = 100 EU/ml. In addition, the evaluation of ELISA results of 47 individuals indicated that 27 of them had antibody titers of > or = 100 EU/ml, who could be considered as acute or recent pertussis infection. The data of this field survey indicated a possible pertussis outbreak in this village.
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PMID:[A field survey carried out on the confirmation of a pertussis case in a village of Kirikkale Province, Turkey]. 1768 3

Pertussis, or whooping cough, is a highly infectious, nationally notifiable respiratory disease associated with prolonged cough illness and paroxysms of coughing, inspiratory "whoop," or posttussive vomiting. Reported pertussis cases have tripled in the United States since 2001, with 25,616 probable or confirmed cases reported in 2005. This increase has been attributed to increased circulation of Bordetella pertussis, waning vaccine-induced immunity among adults and adolescents, heightened awareness of pertussis among health-care providers, increased public health reporting, and increased use of polymerase chain reaction (PCR) testing for diagnosis. To minimize the spread of pertussis, control measures must be implemented early in the course of illness when the risk for transmission is highest. However, diagnosis of pertussis is complicated by nonspecific signs and symptoms, particularly in the early catarrhal stage of disease. In addition, the lack of rapid, sensitive, and specific laboratory tests makes early and accurate identification of pertussis challenging. This report describes two hospital outbreaks and one community outbreak of respiratory illness during 2004-2006 in New Hampshire, Massachusetts, and Tennessee that were attributed initially to pertussis. However, subsequent investigations revealed negative or equivocal laboratory results and epidemiologic and clinical features atypical of pertussis, suggesting that pertussis was not the cause of these outbreaks. The findings in this report underscore the need for thorough epidemiologic and laboratory investigation of suspected pertussis outbreaks when considering extensive control measures.
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PMID:Outbreaks of respiratory illness mistakenly attributed to pertussis--New Hampshire, Massachusetts, and Tennessee, 2004-2006. 1771 12

We report co-infection with two phenotypically and genotypically distinct strains of Bordetella pertussis in an infant male hospitalized with a 2-week history of cough, paroxysms and vomiting. Colonies from the two B. pertussis phenotypes were isolated and evaluated by PFGE profile analysis, gene sequence typing and PCR-RFLP of a portion of the 23S rRNA gene. These results demonstrated simultaneous infection with two different strains of B. pertussis.
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PMID:Co-infection with two different strains of Bordetella pertussis in an infant. 1828 6

We studied 45 cases of adult and adolescent pertussis. The diagnosis of pertussis was made by two criteria. 1) 4-fold increase in antibody against B. pertussis with paired sera (A group: 15 cases). 2) Titer of anti PT antibody above 100 EU/ml (B group: 30 cases). Paroxysmal cough was 100% in A and B group, whooping cough was present 93% in A group, 92% in B group, posttussive vomiting was 78% in A group, 67% in B group. Familial infection was 18 cases of 15 families (33%). Marked lymphocytosis was not detected in any stage of pertussis. When initial examination was made 3-4 weeks after cough onset, the proof of 4-fold increase in antibody against B. pertussis with paired sera was low. Nine cases (20%) of 45 adult and adolescent pertussis cases had bronchial asthma, but bronchial asthma did not prolong the duration of cough. As proof of 4-fold increase in antibody against B. pertussis with paired sera in adult and adolescent pertussis is difficult, it is expected that the cut-off point of antibody titer against B. pertussis in single sera is determinated rapidly.
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PMID:[Clinical study on 45 cases of adult and adolescent pertussis]. 1878 28

Bordetella holmesii is a rare cause of bacteremia. It occurs mainly in hyposplenic patients, such as those affected by sickle cell anemia. The most frequent clinical signs are not very specific: fever, cephalalgia, cough, dyspnea, vomiting, etc. B. holmesii is frequently isolated from blood cultures. We describe the case of a 26-year-old sickle cell patient, presenting with dry cough and fever caused by a B. holmesii blood stream infection, identified by 16S rRNA gene sequencing. The outcome was favorable with amoxicillin. It is useful to know about B. holmesii, especially for physicians managing sickle cell or hyposplenic patients, because of its variable susceptibility to beta-lactams.
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PMID:[Bordetella holmesii bacteremia in a 26-year-old patient with sickle cell disease]. 1958 32


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