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Query: UMLS:C0043167 (pertussis)
 19,595 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There has been a noticeable increase in the incidence of pertussis in West Germany over the last decade. Since the availability of adequate bacteriological diagnosis a much broader clinical spectrum can be attributed to infections with B. pertussis. Three patients with an unusual clinical presentation of pertussis are presented. A three month old infant presented with severe apneic spells without cough as the sole clinical symptoms of the infection. B. pertussis was isolated in the nasopharyngeal swab. A nine month old premature infant with bronchopulmonary dysplasia after long time intubation and artificial ventilation presented with apneic spells, pulmonary and cardiac decompensation and required ventilatory support. The diagnosis was suggested by a massive leucocytosis with lymphocytosis. The diagnosis on the patient was established by serologic methods. Adult contacts of this patient developed longstanding cough and clinical signs of pertussis. The diagnosis of pertussis in these persons was established by nasopharyngeal culture. The third patient with trisomy 21 and a corrected AV canal suffered from nonspecific cough and gradually developed signs of congestive heart failure with pneumonia. B. pertussis was isolated from the nasopharynx. This patient showed neither the typical paroxysmal coughing spells nor disclosed the typical lymphocytosis in his white blood count. Microbiological investigations of patients with symptoms of respiratory tract infections should include the isolation of B. pertussis. Thus, additional cases of pertussis not suspected on the basis of their initial clinical presentation will be detected.
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PMID:[Pertussis--an illness with typical clinical symptoms?]. 143 95

Due to a low acceptance of active immunisation against Bordetella pertussis, whooping cough continues to be a frequent childhood disease in parts of Germany. The age distribution in the lower Rhine area showed a peak incidence at 4.3 years of age, whereas 11% of all cases were observed in infants, and 6% were observed in adults. A significant sex difference was not found in children suffering from pertussis; in adult patients, however, women were more often affected. Whooping cough occurred during the whole year, its peak incidence was found during early winter. In children, paroxysmal coughing fits, vomiting and whooping were the primary symptoms of disease; adults and infants, however, developed these symptoms only in reduced frequency. About 25% of all cases showed an atypical course, and could only be diagnosed by laboratory tests. While leukocyte count and ESR did not have diagnostic significance, a combination of microbiological and serological tests showed a high diagnostic sensitivity and specificity. In contrast to the former GDR and to most European neighbours, the former Federal Republic overrated the side effects of active vaccination as compared to the various risks of natural infection. This resulted in a decline of vaccine acceptance to less than 10% in several areas of the former FRG. It is anticipated that the altered recommendation in favour of vaccination, and especially the future application of acellular vaccines with less side effects, will result in the elimination of whooping cough in all areas of Germany.
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PMID:[The epidemiology of whooping cough]. 145 May 37

In an open randomized multicenter study 190 culture-positive pediatric ambulatory pertussis patients were treated for 14 days with either erythromycin estolate (EST) (n = 93; 40 mg/kg/day divided in 2 doses) or erythromycin ethylsuccinate (ETH) (n = 97; 60 mg/kg/day divided in 3 doses). On day 14 Bordetella pertussis was recovered from cultures of 2 patients (2.2%) treated with EST and 1 patient (1.0%) treated with ETH. Despite the fact that 151 patients (79.4%) had reached the early paroxysmal stage at initiation of antimicrobial therapy, clinical improvement was seen in the majority (reduced frequency and severity of coughing: EST, 77.4 and 67.7%; ETH, 74.2 and 63.9%, respectively). Drug-related side effects were noted in 11 patients (11.8%) treated with EST and 16 patients (16.5%) treated with ETH (P greater than 0.05) and consisted mainly of minor gastrointestinal complaints. Erythromycin estolate in a lower dose administered only twice a day was equivalent to erythromycin ethylsuccinate in all aspects and proved to be adequate antimicrobial treatment for pertussis patients.
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PMID:Comparison of erythromycin estolate and erythromycin ethylsuccinate for treatment of pertussis. The Erythromycin Study Group. 156 32

We present 19 cases of pertussis in infants under 4 months of age. In all cases, Bordetella pertussis was isolated from nasopharyngeal swabs. A whooping cough, cyanotic episodes and eating disturbances were the most characteristic clinical findings. Treatment included: supportive care, salbutamol, beclomethasone, and josamycin. Lymphocyte counts higher than 40,000/mm2 were associated with a greater severity of illness. The most frequent complications were: recurrent cough and pneumonia. None of the patients died.
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PMID:[Evolution and treatment of 19 cases of pertussis in infants under 4 months of age]. 160 13

Bordetella pertussis produces a protein virulence factor termed pertussis toxin. Many candidate pertussis vaccines are based on the rationale that an immune response that neutralizes the virulence activities of this toxin, which are thought to arise from its catalytic ADP-ribosyltransferase activity, would be beneficial. The report describes two methods that quantify the inhibition of this activity by human serum. One, termed a direct assay, involves an initial incubation of toxin with serum, a second incubation that activates the toxin, and a third incubation that measures the ADP-ribosyltransferase activity of the mixture. The other assay, termed a plate assay, involves immobilization of the toxin, exposure of the immobilized toxin to serum and washing of the plate, and then activation and assay of the toxin's ADP-ribosyltransferase activity. The plate assay may be more selective than the direct assay in terms of identifying antibodies that neutralize the toxin in vivo. Sera from controls, selected patients presenting with cough, and vaccinated infants were first analyzed by the direct assay. In contrast to sera from controls, sera from several of the patients and vaccinated infants strongly inhibited activity. Dose-response curves of inhibition were determined for samples from three vaccinated infants by both the direct and plate assays. One of the samples had a dose-response curve of a different shape and thus differed not only in titer but also in functional characteristics. A comparison of inhibition of ADP-ribosyltransferase activity and neutralization in a CHO cell assay indicated that there was incomplete agreement between the two assays. Taken together, these results indicate that measurement of inhibition of ADP-ribosyltransferase activity by human serum is practical and may be useful in the evaluation of responses to pertussis vaccines.
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PMID:Detection of antibodies inhibiting the ADP-ribosyltransferase activity of pertussis toxin in human serum. 162 52

Clinical and chest radiographic findings were recorded prospectively in 185 children with cough who attended an outpatient clinic in Papua New Guinea. Children were studied if they were between 8 weeks and 6 years of age; patients with wheeze, stridor, measles, or pertussis were excluded. 56 children (30%) had radiological evidence of pneumonia. The presence of either a respiratory rate greater than or equal to 50/min or chest indrawing, or of both signs, was a good indication of pneumonia, with a predictive power of 46% for a positive test and 83% for a negative test. A more complex definition of tachypnoea, as a respiratory rate greater than or equal to 40/min in children over 12 months old and greater than or equal to 50/min in infants, showed little additional diagnostic benefit.
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PMID:Clinical signs of pneumonia in children. 168 34

During a randomized trial of a cellular pertussis vaccines, significantly fewer recipients of a two-component vaccine (Japanese National Institute of Health [JNIH]-6) were diagnosed as primary or coprimary cases in households than either placebo recipients or those who received a monocomponent pertussis toxoid vaccine (JNIH-7). After household exposure to a culture-confirmed primary case, efficacy for JNIH-6 was estimated to be 35% (95% confidence interval, -14% to 57%) against any culture-confirmed disease and 58% (95% confidence interval, -6% to 84%) against clinical disease with 21 days or more of coughing spasms. The corresponding efficacy estimates for JNIH-7 were 67% (95% confidence interval, 32% to 80%) and 82% (95% confidence interval, 41% to 96%). Differences between the JNIH-6 and JNIH-7 vaccines in efficacy after household exposure were not statistically significant. No association could be established between protection against pertussis after household exposure and serum levels of IgG antibody to pertussis toxin or filamentous hemagglutinin in vaccinated individuals, in either study children or other household members.
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PMID:Pertussis antibodies, protection, and vaccine efficacy after household exposure. 173 45

A 39-year-old man developed paroxysmal cough, occasional vomiting after cough, and subconjunctival hemorrhage. His illness was complicated by episodes of seizure, with clonic movements of the arms and legs, brief loss of consciousness, and confusion. The episodes were triggered by mild, unremarkable coughing paroxysms. A diagnosis of pertussis was confirmed serologically by measurement of IgG, IgA, and IgM antibodies to pertussis toxin and filamentous hemagglutinin. Serologic studies confirmed the presence of Bordetella pertussis infection in the patient's 10-year-old daughter and suggested that his wife was infected as well. This case report illustrates the occurrence of typical pertussis with serious complications in an adult. Further research is required to determine the scope of this problem and the need for a program of adult immunization against pertussis.
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PMID:Pertussis encephalopathy in an adult: case report and review. 177 35

Development of antibody titres in non-vaccinated children with whooping cough of different duration (all confirmed by positive culture) were investigated by ELISA using lymphocytosis promoting factor (LPF, pertussis toxin), filamentous haemagglutinin (FHA), 69 kDa protein and lipopolysaccharide (LPS) as antigens. The antibody responses occur in three different patterns: Firstly, the LPF antibody response develops very quickly starting with the first day of clinical cough with all three classes, IgG, IgM and IgA appearing simultaneously; LPF antibody appears to be a dominant feature. Secondly, FHA and 69 kDa antibodies appear, starting as IgM with the shift to IgG and IgA later. The third pattern is represented by LPS antibody, the IgA appearing early, but with IgM predominant. Higher titres of IgG reacting with LPS were observed in vaccinated children. Transplacental transfer of antibody was also studied. All antibody titres determined in maternal blood and cord blood were proportional except for anti-LPS antibody which was retarded. Most IgG antibody was IgG1 subclass; surprisingly the 69 kDa antibody consisted of a mixture of approx. 90% IgG1 and 10% IgG4.
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PMID:Analysis of antibody profiles in children with whooping cough. 177 18

The trial cohort from the Swedish efficacy trial conducted during 1986-1987 is still under non-blinded surveillance. During post-trial follow-up until March 11, 1990, efficacy of the mono-component vaccine, JNIH-7, was estimated to be 65% (95% confidence interval, CI, 49-76%) and the efficacy of the two-component vaccine, JNIH-6, to 77% (95% CI 64-85%). For culture-confirmed cases with more than 30 days of cough efficacy for JNIH-7, was 79% (95% CI 66-87%) and for JNIH-6, 92% (95% CI 83-96%). The data indicate that two doses of acellular pertussis vaccine provide protection for 3 1/2 years or more. Continued analysis of data from the trial suggests that acellular pertussis vaccines protect against typical illness to the same extent as whole cell vaccines and that protection against infection may be augmented by adding one or more components to a pertussis toxoid-based vaccine. In spite of promising efficacy data, acellular pertussis vaccines are still not licensed outside Japan. The need for direct comparisons with efficacy and safety of whole cell vaccines will be discussed and salient problems of case definitions and case ascertainment in clinical trials will be emphasised.
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PMID:The Swedish efficacy trial of acellular pertussis vaccines--update and time for reflection. 177 27


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