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Is leukocytosis a predictor of mortality in severe pertussis infection?
1Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Severe infant respiratory failure from Bordetella pertussis can lead to pulmonary hypertension. Extreme leukocytosis (high white blood cell count) in infants was a significant predictor of death, potentially due to vascular obstruction.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Hematology
Background:
- Bordetella pertussis infection can cause severe respiratory failure in infants.
- Pulmonary hypertension is a common complication in infants with severe pertussis.
- Treatment-resistant cases highlight the need to understand disease severity factors.
Purpose of the Study:
- To investigate predictors of mortality in critically ill infants with Bordetella pertussis.
- To explore the role of hyperleukocytosis in severe pertussis cases.
- To understand the potential mechanisms linking leukocytosis to poor outcomes.
Main Methods:
- Retrospective case series analysis of 13 critically ill infants diagnosed with Bordetella pertussis.
- Clinical data review, focusing on white blood cell counts and outcomes.
- Statistical analysis to identify independent predictors of death.
Main Results:
- Hyperleukocytosis, defined as a white blood cell count greater than 100 x 10(9)/l, was observed in critically ill infants.
- Hyperleukocytosis was identified as an independent predictor of mortality in this cohort.
- The study suggests extreme leukocytosis may contribute to disease severity.
Conclusions:
- Extreme leukocytosis is a significant risk factor for death in infants with severe Bordetella pertussis.
- The formation of leukocytic aggregates in pulmonary vasculature is a proposed mechanism for increased disease severity.
- Early identification of hyperleukocytosis may aid in risk stratification for severe pertussis in infants.
Abstract:
Bordetella pertussis causing severe respiratory failure in infants that is unresponsive to treatment is well described. Pulmonary hypertension is a prominent feature of such cases. In this series of 13 critically ill infants with B. pertussis, hyperleukocytosis ( > 100 x 10(9)/l) was an independent predictor of death. We suggest that such extreme leukocytosis may contribute to disease severity via the formation of aggregates in the pulmonary vasculature.