Related Experiment Videos
Diagnostic value of clinical and bacteriological findings in pertussis
G Granström1, B Wretlind, M Granström
1Department of Infectious Diseases, Danderyd Hospital, Sweden.
Abstract:
Clinical and bacteriological findings in the diagnosis of pertussis were evaluated in 300 consecutive patients with parental or the patient's own suspicion of the disease. Serology was used as a reference method. Of the 285 (95%) patients fully sampled, 163 (57%) were diagnosed as having pertussis while the remaining 122 patients constituted the non-pertussis control group. The clinical and epidemiological data were collected at the first visit made on median day seven of illness. In this population of mainly unimmunised children, the highest predictive values were obtained for the physician's diagnosis of pertussis (100%) and for the physician's diagnosis of some other illness (93%). The only clinical symptom with a high predictive value for pertussis was the report of whoops (92%). Among epidemiological data the highest predictive value (90%) was obtained for reported household exposure in unimmunised children more than 1 year of age. Culture of Bordetella pertussis was found to have an overall 50% sensitivity. Isolation of other bacteria had no predictive value in the differential diagnosis of pertussis.
Insights
Physician diagnosis and whooping cough symptoms are highly accurate for diagnosing pertussis in unvaccinated children. Household exposure also strongly predicts pertussis in this group.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Pertussis, a highly contagious respiratory infection, poses a significant threat, particularly to unvaccinated children.
- Accurate and timely diagnosis of pertussis is crucial for effective treatment and public health control measures.
- Clinical and bacteriological findings are key components in diagnosing pertussis, but their diagnostic values vary.
Purpose of the Study:
- To evaluate the diagnostic accuracy of clinical and bacteriological findings for pertussis.
- To determine the predictive values of specific symptoms and epidemiological data in diagnosing pertussis.
- To assess the utility of Bordetella pertussis culture in the differential diagnosis of suspected cases.
Main Methods:
- A study of 300 patients with suspected pertussis, using serology as the reference standard.
- Collection of clinical and epidemiological data at the first patient visit (median day 7 of illness).
- Evaluation of Bordetella pertussis culture sensitivity and the predictive value of symptoms and exposure history.
Main Results:
- Physician's diagnosis showed high predictive values (100% for pertussis, 93% for other illnesses).
- The symptom 'whoops' had a high predictive value (92%) for pertussis.
- Reported household exposure in unvaccinated children over 1 year old had a high predictive value (90%); Bordetella pertussis culture sensitivity was 50%.
Conclusions:
- Physician's clinical judgment and the presence of 'whoops' are highly valuable in diagnosing pertussis, especially in unvaccinated children.
- Household exposure is a significant epidemiological indicator for pertussis in unvaccinated children.
- Bordetella pertussis culture has moderate sensitivity, and other bacterial isolations are not useful for differential diagnosis.