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

A five week old male infant is treated under suspicion of whooping cough because of pertussis like cough, cyanosis, and attacks of reflex apnea. These attacks are seen up to 40 times per day. After exclusion of a cerebral genesis there was found a ventral indentation of the trachea. It was also seen by tracheoscopy, but this part of the trachea was not pulsating. In the angiography the compriming structure was identified as the innominate artery. The genesis of this anatomic variant, the often threatening symptoms in this case without inspiratoric stridor, and the diagnostic and therapeutic steps are discussed.
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PMID:[Tracheal compression by the innominate artery (author's transl)]. 39 7

During an outbreak of pertussis in the Cardiff area in 1974, 229 children with the disease were studied to assess the effect of immunisation upon its natural history and severity. The typical clinical features of pertussis, such as paroxysmal cough, whooping, vomiting, cyanosis, and irregular breathing, were less prevalent in both the immunised and the older children. Immunisation is the main factor in protecting against complications such as fits; and, together with older age, it protects against hospitalisation. Nevertheless, pertussis today can be just as severe as it was 40 years ago, and the vaccine remains the major factor ameliorating its natural history. The immunisation programme needs more active support by all child health workers.
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PMID:The effects of immunisation upon the natural history of pertussis. A family study in the Cardiff area. 71 79

To test the hypothesis that the development of airway hyperresponsiveness (AHR) lasting greater than or equal to 3 days after the last antigenic exposure required repeated mediator release, we compared dose-response changes in lung resistance (RL) to acetylcholine (ACh) in animals sensitized with 1% ovalbumin (OA), 4% Bordatella pertussis aerosol and subsequently challenged with 0.5% OA aerosol twice weekly for 4-6 wk vs. animals receiving saline aerosol instead of OA. Despite antihistamine pretreatment, each OA challenge produced cyanosis and inspiratory indrawing. Blood gas analysis in six guinea pigs revealed an immediate fall in arterial PO2 (PaO2) from 104.3 +/- 4.9 to 35.4 +/- 2.2 Torr after a 1-min exposure to aerosolized OA. ACh dose-response measurements of RL 3 days after the last OA challenge demonstrated a leftward shift and an increased magnitude of response. These differences were less marked at 7 days, and by 14 days after the last OA challenge, ACh dose-response curves were not different from those of control guinea pigs. Sensitization without repeated antigen challenge did not cause hyperresponsiveness. Morphometric analysis showed significantly increased numbers of eosinophils in the epithelium of airways in hyperresponsive guinea pigs, without neutrophil infiltration or alterations in epithelium and airway wall areas. We conclude that repeated antigenic challenge, but not sensitization alone, causes prolonged AHR in guinea pigs, which is associated with tissue eosinophilia.
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PMID:Repeated antigen challenge induces airway hyperresponsiveness with tissue eosinophilia in guinea pigs. 255 77

This paper reports a one-month-old female with a one-week history of low grade fever and rhinorrhea, and one day of intermittent cough and cyanosis. The signs and symptoms are typical for pertussis in an infant less than six months old. The incidence of pertussis in the neonate and infant appears to be increasing. The disease still carries significant morbidity and mortality, especially in this age group. Pertussis should be included in the differential diagnosis of protracted cough with cyanosis or vomiting, persistent rhinorrhea, and marked lymphocytosis in children under six months of age.
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PMID:Pertussis in an infant. 268 10

Despite the increasing prevalence of pertussis in young adults and infants, reports of maternal-neonatal pertussis are rare. Our study involves three neonates who apparently acquired pertussis from their adolescent mothers. The diagnosis of pertussis was initially missed in all of the patients. The mothers had mild respiratory disease. All three newborns presented with life-threatening coughing and choking spells without a characteristic inspiratory whoop. Two neonates had apnea, bradycardia, cyanosis, and unresponsiveness, but were without the initial lymphocytosis that is distinctive of pertussis. These two neonates had a clinical course that was consistent with the historic "100-day-cough." They required prolonged ventilatory support and hospitalization at a high cost. The other neonate had a terminal pulmonary hemorrhage. Strategies for the early diagnosis, treatment, and prevention of this potentially lethal disease in neonates are discussed.
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PMID:Pertussis in neonates. 280 62

Overnight tape recordings of breathing movements, airflow, and arterial oxygen saturation from six infants aged 3 weeks to 7 months, who had cyanotic episodes associated with pertussis, were compared with recordings from 12 age matched healthy controls. In all patients clinically apparent apnoeic episodes were associated with the rapid onset and progression of central cyanosis. When overnight recordings were compared, patients with pertussis had a greater frequency of apnoeic pauses (particularly those greater than or equal to 12.0 seconds duration) and a greater frequency of episodes of hypoxaemia (oxygen saturation less than or equal to 80% for greater than or equal to 0.5 seconds) associated with apnoeic pauses. In addition to episodes of hypoxaemia associated with a prolonged absence of breathing movements, patients with pertussis had frequent dips in oxygen saturation in association with continued breathing movements with and without continued inspiratory airflow. These episodes of hypoxaemia during continued breathing movements were more common in patients with pertussis. These findings suggest that episodes of abnormal apnoea accompanied by evidence of a mismatch between ventilation and perfusion of the lungs may produce the rapid onset of severe hypoxaemia in infants with pertussis.
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PMID:Severe hypoxaemia in pertussis. 338 89

Symptoms after routine primary immunisation of 6004 infants with diphtheria/tetanus/pertussis (DTP) vaccine and 4024 infants with diphtheria/tetanus (DT) vaccine have been compared. After each dose, crying, screaming, and feverishness were more frequent with adsorbed DTP than adsorbed DT, but the difference was small. Attacks of high-pitched screaming, episodes of pallor or cyanosis with limpness, convulsions, and local reactions occurred with similar frequency after both vaccines. There was a considerable increase in local reactions after the 3rd dose with both vaccines. Over 1000 doses of plain DTP (with no aluminium hydroxide adjuvant) were given during the study. Post-vaccination symptoms were more common after the plain than after the 2 adsorbed preparations.
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PMID:Symptoms after primary immunisation with DTP and with DT vaccine. 614 44

Pertussis, one of the most communicable respiratory diseases, has a wide spectrum of severity, which generally decreases with age. Adults with waning immunity, who have subclinical pertussis, frequently infect nonimmunized or underimmunized children within the same household. High levels of pertussis activity persist, even in highly immunized populations. Infants less than 2 months of age have the highest attack rate and greatest morbidity and mortality. Serious complications include apnea, pneumonia, encephalopathy, and recurrence of coughing spasms with cyanosis. These complications further contribute to a protracted disease course in young infants. Although a decrease in the incidence of pertussis has occurred since the advent of active immunization in the United States, recent data show a striking resurgence in cases. Widespread transmission of disease, even in immunized individuals, and subclinical adult infection, which serves as a reservoir for disease in young infants, underscore the need for a more effective vaccine immunization strategy.
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PMID:Pertussis in the young infant. 776 15

Systemic anaphylaxis in the rat has major manifestations in the small intestine. In August rats, but not in other strains, intestinal anaphylaxis was accompanied by petechial hemorrhages in Peyer's patches. The occurrence of petechiae was not proportional to the intensity of prostration, cyanosis or gut congestion. No hemorrhages were found in other organs. The petechiae occurred in August rats of either sex after sensitization and challenge with any of several antigens and adjuvants and after passive sensitization with antiserum. The number of Peyer's patches with hemorrhage varied from one to all 20 in individual rats. The occurrence of petechiae was not influenced significantly by the route of sensitization or challenge, by the presence or absence of pinworms in the cecum, or by ancillary treatment at time of challenge with normal serum, normal blood, heparin, pertussis vaccine or lipopolysaccharide. The intestinal mast cells of the susceptible August rats were not different from the mast cells of the resistant strains. Furthermore, mast cells did not reside in the lymphoid follicles of Peyer's patches which was the site of the petechial hemorrhages in anaphylactic August rats. Nor did injections of histamine, serotonin or both cause hemorrhages in Peyer's patches.
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PMID:Petechial hemorrhages in the small intestinal Peyer's patches: a new manifestation of systemic anaphylaxis. 965 62

Hypotonic-hyporesponsive episode (HHE) is a term used to describe a somewhat heterogenous group of clinical disorders that have been reported primarily in association with whole-cell pertussis vaccination. A 1991 review by the Institute of Medicine determined that the evidence available was indeed consistent with a causal relation between whole-cell pertussis-diphtheria-tetanus immunization and HHE, but that the evidence was insufficient to indicate a causal relationship between HHE and the subsequent development of permanent neurologic damage. More recent data from clinical trials conducted in Europe suggest that HHE also occurs after vaccination with acellular pertussis vaccines. The US Food and Drug Administration, in collaboration with the US Public Health Service, sponsored a workshop on HHE in Rockville, Maryland, on June 19, 1997. The primary goals of the workshop were to develop a case definition of HHE and to evaluate the general design and feasibility of possible studies of HHE using the federal Vaccine Adverse Event Reporting System (VAERS), a national passive surveillance system. The goals of such studies would be to understand better the acute HHE event and to evaluate the possibility of long-term sequelae. Case Definition. There has been no generally accepted definition of HHE, and a standard definition would be useful for vaccine safety work and would potentially facilitate interstudy comparisons of the growing number of licensed vaccines containing acellular pertussis components. The workshop defined HHE as an event of sudden onset occurring within 48 hours of immunization, with duration of the episode ranging from 1 minute to 48 hours, in children younger than 10 years of age. All of the following must be present: 1) limpness or hypotonia, 2) reduced responsiveness or hyporesponsiveness, and 3) pallor or cyanosis or failure to observe or to recall skin coloration. HHE is not considered to have occurred if there is a known cause for these signs (eg, postictal), if urticaria is present during the event, if normal skin coloration is observed throughout the episode, or if the child is simply sleeping. This inclusive (sensitive) case definition will allow investigators, through the technique of stratification according to certain characteristics (eg, time from vaccination to onset of HHE), to attempt to hone the definition and make it more specific. Refinement of the definition of HHE has been hindered by the lack of information on its pathophysiology and by the lack of pathognomonic signs, symptoms, and diagnostic tests. Another hindrance is that by the time the child presents for medical evaluation, the signs of HHE often have normalized. Moreover, different mechanisms may be involved in different individuals whose events meet this workshop's HHE definition. Further Study of HHE. Probably the most important question about HHE is whether it has any permanent sequelae. The workshop assessed the possible contribution VAERS-based studies could make to answering this question and found substantial methodologic problems; however, ongoing studies in Sweden and The Netherlands have the potential to provide useful information on this question. The most useful contribution of VAERS data would be in a descriptive study of HHE, with a possible case-control study of factors that may affect the risk of HHE after vaccination, rather than a study of possible permanent sequelae. The workshop participants felt that a detailed descriptive study of approximately 100 HHE events reported during a 1- to 2-year period could provide a more in-depth description of HHE cases in greater numbers than has been published previously, but the study would not address the issue of long-term sequelae of HHE. Better descriptive data may lead to new hypotheses concerning risk factors, etiology, and pathophysiology of HHE that might be evaluated further by studying subsequent cases and controls from VAERS or from other sources, depending on the hypoth
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PMID:Report of a US public health service workshop on hypotonic-hyporesponsive episode (HHE) after pertussis immunization. 979 82


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