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

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

A neonate presenting to the emergency department can present a challenge to even the most experienced clinician. This article has focused on four deceiving and potentially devastating neonatal diseases. 1. Neonatal herpes is a potentially devastating illness without pathognomonic signs or symptoms. Early recognition and therapy can reduce mortality markedly. Although no specific sign or symptom is diagnostic,the diagnosis should be strongly considered in the presence of HSV risk factors, atypical sepsis, unexplained acute hepatitis, or focal seizure activity. Acyclovir therapy should be initiated before viral dissemination or significant CNS replication occurs. 2. Pertussis is a disease in which infants are at greatest risk of death or severe complication. Neonatal pertussis often presents in an atypical manner, lacking the classic signs and symptoms such as the "whoop."More common signs and symptoms include cough, feeding difficulty,low-grade fever, emesis, increasing respiratory distress, apnea, cyanosis,and seizures. Management should include hospitalization, supportive care, and antibiotics. 3. Congenital heart defects, particularly ductal-dependent lesions, may have an initial asymptomatic period that culminates in a rapidly progressive and fatal course. A neonate with CHD presents with shock refractory to volume resuscitation or pressor support. Resuscitative efforts are ineffective unless PGE, is administered. 4. Inborn errors of metabolism often are unsuspected because of their protean and heterogeneous nature. Signs and symptoms are subtle,are nonspecific, and often mimic other, more common diseases.An elevated index of suspicion, along with application and correct interpretation of a select few laboratory tests, is the key to making a diagnosis. Therapy is relatively straightforward and focused on resuscitation followed by prevention of catabolism and correction of specifically identified abnormalities. Although these disorders are relatively uncommon, prompt diagnosis and therapy can lead to a decrease in morbidity and mortality. The key is to maintain a high index of suspicion.
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PMID:Unsuspected neonatal killers in emergency medicine. 1547 77

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

Pertussis is a highly contagious, vaccine-preventable bacterial illness characterized by paroxysmal cough, posttussive vomiting, and inspiratory whoop. Pertussis also can occur as a mild or moderate cough illness in persons who are partially immune. In the United States, most hospitalizations and nearly all deaths from pertussis are reported in infants aged <6 months, but substantial morbidity does occur in other age groups. Infant/childhood vaccination has contributed to a reduction of more than 90% in pertussis-related morbidity and mortality since the early 1940s in the United States. Estimates of childhood vaccination coverage with > or =3 doses of pertussis-containing vaccine have exceeded 90% since 1994; however, reported pertussis cases increased from a historic low of 1,010 in 1976 to 11,647 cases in 2003. A substantial increase in reported cases has occurred among adolescents, who become susceptible to pertussis approximately 6-10 years after childhood vaccination. Recently, booster vaccines for adolescents and adults combining pertussis antigens with tetanus and diphtheria toxoids (Tdap) were approved by the Food and Drug Administration (FDA). On June 30, 2005, the Advisory Committee on Immunization Practices (ACIP) recommended Tdap for all persons aged 11-18 years. This report summarizes national surveillance data on pertussis reported to CDC during 2001-2003 and focuses on pertussis reported among persons aged 10-19 years before implementation of national recommendations for adolescent pertussis vaccination.
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PMID:Pertussis--United States, 2001-2003. 1637 44

Unexplained subdural and retinal haemorrhages in an infant are commonly attributed to 'shaking', the mechanism of which is believed to be traumatic venous rupture. However, the haemorrhagic retinopathy reported as a result of Valsalva manoeuvres and the subdural bleeding that is a rare complication of pertussis together demonstrate that if a sustained rise in intrathoracic pressure is transmitted to cerebral and retinal vessels, it may result in bleeding, similar to that reported in inflicted injury. Such haemorrhages would be expected to occur whenever severe paroxysmal coughing were induced, whatever the cause. This study used a computer modelling approach to investigate feeding accidents as the trigger for bleeding. A dynamic circulatory model of a 3-month-old infant was induced to 'cough', and the response to changes in physiological variables monitored. It showed that coughing causes intracranial pressures to build up exponentially to approach a maximum, proportional to the amount of pressure the musculature of the thorax can produce, as venous return is impeded. They do not have time to become dangerous during individual coughs, as blood quickly returns after the cough is over, reestablishing normal pressures. Paroxysmal coughing, however, does not allow blood to return between coughs, with the result that very high luminal pressures may be generated, sufficient to damage veins. A history of coughing, vomiting or choking is not uncommon in otherwise normal infants with retinal and subdural bleeding. Our findings suggest that paroxysmal coughing could account for such bleeding in some cases.
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PMID:Paroxysmal coughing, subdural and retinal bleeding: a computer modelling approach. 1708 77

The accurate and timely diagnosis of pertussis continues to be challenging. The widespread use of pertussis vaccines has dramatically altered the epidemiology and clinical presentation of pertussis disease, such that many cases do not present with the hallmark symptoms, such as inspiratory whoop, post-tussive vomiting and paroxysmal cough. A variety of laboratory tools are available to aid in the diagnosis of pertussis, including culture, direct fluorescent antibody testing, PCR, and paired and single serology techniques. This article reviews the strengths and limitations, including the sensitivity and specificity, of each of these diagnostic tools.
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PMID:Diagnosis of pertussis: a historical review and recent developments. 1714 Mar 72

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

Since 2004, more than 25,000 cases of pertussis have been reported in the United States each year. Symptoms in adults range from mild cough to severe persistent cough with posttussive emesis. The characteristic paroxysmal cough (whoop) may be absent, and the diagnosis is often missed, especially when the cough is mild. The most useful diagnostic test to confirm pertussis is a polymerase chain reaction assay of a nasopharyngeal swab sample. Patients are infectious for three weeks from the cough onset. Antibiotic treatment, preferably with macrolide antibiotics, is indicated during this time for pertussis treatment and prophylaxis. In 2005, two new acellular pertussis vaccines were licensed: one (Boostrix) for patients aged 10 to 18 years and another (Adacel) for patients aged 11 to 64 years.
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PMID:The prevention and treatment of pertussis. 1740 82

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


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