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

Whooping cough continues to be a major childhood disease in parts of West Germany. At age six, more than one third of the children in our area have had pertussis according to parental information, whereas only 12% received a specific vaccination. During a four-year period from 1984 to 1987, a total of 2,881 clinically diagnosed cases of whooping cough were investigated. The children had a mean age of 4.1 years, 11% of all patients were younger than one year and 6% of the patients were adults with a mean age of 35.8 years. No sex difference was observed in children (less than 20 years) with clinically overt whooping cough. The seasonal distribution showed that whooping cough was present throughout the year, peaking in early winter. In relation to clinical symptoms, the isolation rate of Bordetella pertussis or Bordetella parapertussis from nasopharyngeal swabs continuously decreased with the duration of paroxysms, starting with 56% positive swabs on day 1. Titers (greater than or equal to 1:100) of IgA-antibodies to B. pertussis antigens increased with the duration of paroxysmal coughing. B. pertussis, however, was also isolated from 152 of 964 patients without the clinical signs of whooping cough. IgA-antibodies were also found in 522 patients with non-typical respiratory symptoms, but not in healthy blood donors. Children with clinically diagnosed whooping cough were compared to a group of children showing the symptoms but without any clinical or laboratory signs of whooping cough. We can assume from our data that the incidence and duration of non-paroxysmal coughing, the nocturnal increase in coughing, fever, auscultatory findings and a contact anamnesis occurred with a similar frequency in the whooping cough group and the control group. Apart from the typical paroxysmal fits, whooping and vomiting were found significantly more often in the pertussis group. At least 19% of patients with a recent infection with B. pertussis, however, were not diagnosed by clinical symptoms. The leukocyte count differed only marginally between the three groups and was of no great diagnostic value. A relative lymphocytosis, however, was found significantly more often in whooping cough patients and in patients with laboratory-diagnosed infection with B. pertussis. Our study indicates that part of the symptomatology and some laboratory findings in whooping cough patients in endemic areas of West Germany may differ from the classical form of the disease. Furthermore, our data stress the importance of an accurate procedure in diagnosing B. pertussis infection, and this can be facilitated by a combination of bacteriological and serological tests.
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PMID:The epidemiological situation of pertussis in the Federal Republic of Germany. 177 29

An outbreak of pertussis in primary school-children in the St David's area of Pembrokeshire provided the opportunity to estimate pertussis vaccine efficacy. The estimate of efficacy was 88% when notified cases were used, but this fell to 68% when all children with bouts of coughing for two or more weeks were included. Notified cases were significantly less likely to have been vaccinated than other cases with similar symptoms. Therefore vaccine efficacy estimates based upon notified cases are likely to be biased. However, even the lower estimates suggest that pertussis immunisation is highly desirable and efforts to improve coverage should be increased.
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PMID:Vaccine efficacy and control measures in pertussis. 186 99

Although there is increased awareness among physicians regarding their role in protecting adults against vaccine-preventable diseases, many physicians are unaware that adults develop pertussis. Studies of adults with prolonged cough have found that 20% to 25% have serologic evidence of recent pertussis infection. Investigations of outbreaks have documented that adults develop infection with Bordetella pertussis and transmit the organism to susceptible children. Adults are the major reservoir of infection for children who may develop severe illness. Pediatric health care workers and patients infected with the human immunodeficiency virus might be at higher risk than the general population. Because most adults are susceptible to pertussis, physicians must consider pertussis in the differential diagnosis of patients with prolonged cough. Physicians who care for adults should be active in the diagnosis and treatment of pertussis, supportive of studies of the epidemiology of pertussis in adults, and interested in the development and testing of new diagnostic and preventive measures.
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PMID:Pertussis in adults. What physicians need to know. 187 55

The epidemiologic features and clinical spectrum of pertussis in the elderly are poorly understood. In October 1985, the Wisconsin Division of Health investigated an outbreak of pertussis in residents of a nursing home in rural Wisconsin. Clinical information and nasopharyngeal swab and acute- and convalescent-phase serum specimens were obtained from all consenting residents and employees. Of 105 residents, 38 (36.2%) were seropositive, including four who were culture-positive for Bordetella pertussis. Culture-positive residents (age range, 52-81 years) had cough lasting 43-54 days. Three of these residents had paroxysmal cough, and all four had cough that interrupted sleep; none of the residents had cough with apnea or vomiting, and all recovered without sequelae. Of six seropositive residents with clinical pertussis, five lived on the south wing of the facility. Of 104 employees, 8 (7.7%) were seropositive, but none were culture-positive for B. pertussis. The higher attack rate for residents and the clustering of clinical cases were consistent with ongoing transmission within the nursing home.
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PMID:A pertussis outbreak in a Wisconsin nursing home. 189 32

The efficacy of two acellular pertussis vaccines was estimated for various clinical case definitions, with and without the requirement of culture confirmation, from a randomized trial in Sweden. Efficacy increased with duration of coughing spasms and when the case definition included whoops or whoops plus at least nine coughing spasms a day. After deletion of clinical cases not believed to be caused by pertussis, efficacies were closer to the higher values for culture-confirmed disease. Nonspecificity of the clinical criterion "21 days of coughing spasms with whoops" resulted in estimates of predictive value for pertussis of 85% for placebo recipients and 56% for vaccinees. We conclude that laboratory confirmation of suspected cases is needed in pertussis vaccine trials. A suggested case definition is 21 days or more of coughing spasms with confirmation by culture, serologic study, or household exposure to culture-confirmed pertussis.
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PMID:Acellular pertussis vaccines. Efficacy and evaluation of clinical case definitions. 195 Dec 22

Within a period of four years the diagnosis of pertussis was made in 169 adults (105 women, 64 men; mean age 35.8 [18-79] years). based on symptoms, specific antibodies and bacteriological examination of nasopharyngeal swabs (in 53). The findings were compared with those obtained in a control group of 2,771 children (1,381 females, 1,390 males; mean age 4.3 years). In the adult the dominant symptom was persisting cough, at times convulsive, while the other symptoms, characteristic in children, of rib retraction and vomiting were significantly less common in adults (retraction: 3% vs 40%; vomiting 12% vs 59%). A history of contact was elicited in only 17% of adults (38% in children). Confirmation of the diagnosis was obtained by growing Bordetella pertussis from a nasopharyngeal swab (6 of 53 patients [11%]; in children 45%), or finding significantly elevated antibody concentration or titre rise of specific antibodies against B. pertussis (IgG: 81% vs 68%; IgA: 91% vs 73%; IgM: 44% vs 72%). Half the adult patients were aged between 20 and 35 years. Contrary to the sex distribution of pertussis in children, significantly more women than men contracted the infection (P less than 0.01). It is concluded that even in adults pertussis should be considered in the differential diagnosis of persisting cough.
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PMID:[Whooping cough in adults]. 201 39

The cumulative incidence of pertussis at six years of age in the first unvaccinated cohort after cessation of immunisation in Sweden was investigated by serological methods and by a validation of the national epidemiological surveillance system by reports from the Child Health Centres (CHCs). In 312/385 (81%) eligible children, both an interview with the parents and a blood sample from the child could be obtained. The CHC reports yielded a cumulative incidence of 31%, whereas the serological assays found 54%. Of the cases reported by the parents to the CHCs, 89% were seropositives. In the additional cases of pertussis reported at the study interview, only 61% could be confirmed (p less than 0.001). Among children with reported severe cough not suspected to be pertussis, 46% were seropositive, distributed as 33% seropositives in cases with cough duration of less than 4 weeks and 69% for longer coughs (p less than 0.01). In the CHC reports, the parental diagnosis was found to have been confirmed in three-quarters of cases by medical personnel. The CHC reporting system was thus found to be reliable with an observed specificity of 93%, but sensitivity of only 52%. Thus, even this surveillance system, which yields the highest incidence rates, underestimates the incidence of the disease.
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PMID:Cumulative incidence of pertussis in an unvaccinated preschool cohort based on notifications, interview and serology. 204 7

Maternal antibody to an outer membrane 68-kilodalton (kDa) protein of Bordetella bronchiseptica was shown to be protective in experiments on specific-pathogen-free piglets. After challenge with B. bronchiseptica, 100% (n = 19) control piglets from nonimmunized sows developed pneumonia, coughing, and sneezing, and 74% of the animals developed severe atrophic rhinitis. In 12 piglets from a sow immunized with 68-kDa protein, pneumonia occurred only in 34% of offspring, coughing was reduced, the duration of coughing bouts was shortened, and severe atrophic rhinitis occurred in one animal only (8%). The difference in the occurrence of atrophic rhinitis and of pneumonia in immunized and nonimmunized offspring was statistically significant (P less than 0.05). Sera of protected piglets had high titers (enzyme-linked immunosorbent assay) of antibodies that showed a high specificity for the 68-kDa protein isolated from B. bronchiseptica, whereas their reactivity with an analogous 69-kDa protein isolated from Bordetella pertussis was low or absent. The 68-kDa protein of B. bronchiseptica appeared to be the major protective antigen in B. bronchiseptica infection; however, isolated protein alone did not induce such a solid protection, as observed in a previous study after the application of an effective whole cell vaccine.
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PMID:Identification of a 68-kilodalton outer membrane protein as the major protective antigen of Bordetella bronchiseptica by using specific-pathogen-free piglets. 213 11

A 25-year-old man infected with the human immunodeficiency virus (HIV) presented with paroxysmal cough and dyspnea of 4-months duration. An extensive evaluation including bronchoscopy was negative. A nasopharyngeal swab was positive by direct fluorescent antigen detection and culture for Bordetella pertussis. Respiratory isolation, treatment with erythromycin, and prophylaxis of household contacts was used to eradicate the organism and prevent transmission. Pertussis should be considered as a cause of prolonged cough and dyspnea in patients with HIV infection. The course of this patient was consistent with the concept that cell-mediated immunity is necessary for elimination of B. pertussis.
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PMID:Pertussis in an adult man infected with the human immunodeficiency virus. 218 11

Isolation of the causative agent remains the "gold standard" for the early diagnosis of pertussis. For this purpose, the nasopharynx is swabbed with a calcium alginate swab. Cephalexin-containing charcoal horse blood medium is used for the transport of the swabs to the bacteriology laboratory. As an alternative, the isolation of bordetellae can be performed at the paediatrician's office by direct inoculation of charcoal horse blood agar plates. Long-lasting cough of unknown aetiology is the main field for pertussis serology (ELISA). Even today, severe courses of whooping cough requiring hospitalization are not rare, especially in infants. Erythromycin (given in high doses for 14 days) is the antibiotic of choice for pertussis. As an alternative to the macrolides, cotrimoxazole may be administered or amoxycillin. Salbutamol and the corticosteroids have been shown to be useful for the symptomatic treatment of severe pertussis in infants.
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PMID:[Pertussis: diagnosis, clinical aspects and therapy]. 219 59


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