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[Malignant pertussis: an underdiagnosed illness]

A Bouziri1, A Hamdi, A Khaldi

  • 1Service de réanimation pédiatrique, Hôpital d'enfants, Tunis, Tunisie. asma.bouziri@yahoo.fr

Medecine Tropicale : Revue Du Corps De Sante Colonial
|August 26, 2010
PubMed

Insights

Malignant pertussis is a severe, often fatal illness in infants, characterized by respiratory failure and high white blood cell counts. Early diagnosis using PCR for Bordetella pertussis is crucial, especially in developing countries.

Area of Science:

  • Pediatric Intensive Care
  • Infectious Diseases
  • Neonatology

Background:

  • Malignant pertussis is a rare but life-threatening condition in infants.
  • It presents with severe respiratory failure, extreme leukocytosis, and pulmonary hypertension.
  • Underdiagnosis is a significant challenge in pediatric intensive care units (PICUs).

Purpose of the Study:

  • To determine the prevalence of malignant pertussis in infants admitted to the PICU.
  • To identify infants with severe acute respiratory failure and severe leukocytosis.
  • To assess the diagnostic accuracy of clinical suspicion versus laboratory confirmation.

Main Methods:

  • Retrospective review of medical charts for infants under 3 months old admitted to the PICU (2006-2008).
  • Inclusion criteria: severe acute respiratory failure requiring mechanical ventilation and leukocytosis >50,000/mm3.
  • Polymerase chain reaction (PCR) testing for Bordetella pertussis on stored nasopharyngeal washes (NPW).

Main Results:

  • Ten infants met the criteria; median age was 2.1 months.
  • None of the infants had received pertussis vaccination.
  • PCR confirmed Bordetella pertussis in all ten cases, but only 3 were presumptively diagnosed.
  • Nine out of ten infants died within days of admission due to refractory shock and hypoxemia.

Conclusions:

  • Malignant pertussis is a highly fatal disease with a high mortality rate.
  • The condition was significantly underdiagnosed in the studied PICU.
  • Promoting PCR for Bordetella pertussis detection is recommended, particularly in resource-limited settings.
Abstract

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