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Molecular detection and quantification of pertussis and correlation with clinical outcomes in children
J P DeVincenzo1, Cliff Guyton, Harrison Rea
1Memphis University School, Memphis, TN 38119, USA.
Abstract:
Pertussis is an under-recognized serious infection. Conventional cultures are insensitive and of limited utility after antibiotic exposure. We corroborated the utility of real-time polymerase chain reaction (PCR) as a diagnostic tool in pertussis and investigated its role as a prognostic tool by evaluating its benefit in the quantification of pertussis bacterial load. All pertussis-positive PCR tests (n = 104) submitted over 5 years were collected for retrospective study. PCR cycle threshold was compared to quantitative culture in 43. Compared to PCR, the sensitivity of culture was 41%. Our PCR assay reliably quantified bacterial load and was quantitatively reproducible. Higher bacterial load correlated with longer duration of hospitalization (P = 0.0003), and multivariate logistic regression models demonstrated this association to be independent. The study confirmed PCR as a superior diagnostic tool in pertussis. PCR quantification of bacterial load at initial diagnosis predicts later clinical disease severity, suggesting a potential benefit of PCR as a prognostic tool in pertussis.
Insights
Real-time polymerase chain reaction (PCR) is a superior diagnostic tool for pertussis, outperforming traditional cultures. PCR also quantifies bacterial load, predicting disease severity and hospitalization duration.
Area of Science:
- Microbiology
- Infectious Diseases
- Molecular Diagnostics
Background:
- Pertussis (whooping cough) is a serious, often under-recognized respiratory infection.
- Conventional culture methods for diagnosing pertussis have low sensitivity, especially after antibiotic treatment.
- There is a need for more sensitive and reliable diagnostic and prognostic tools for pertussis.
Purpose of the Study:
- To confirm the utility of real-time polymerase chain reaction (PCR) as a diagnostic tool for pertussis.
- To investigate the potential of PCR in quantifying pertussis bacterial load as a prognostic indicator.
- To evaluate the correlation between bacterial load and clinical disease severity.
Main Methods:
- Retrospective analysis of 104 pertussis-positive real-time PCR tests over 5 years.
- Comparison of PCR cycle threshold values with quantitative culture results in 43 samples.
- Statistical analysis, including multivariate logistic regression, to assess correlations.
Main Results:
- Real-time PCR demonstrated significantly higher sensitivity compared to conventional culture (41% for culture).
- The PCR assay reliably and reproducibly quantified pertussis bacterial load.
- Higher bacterial loads quantified by PCR significantly correlated with longer hospitalization durations (P = 0.0003).
Conclusions:
- Real-time PCR is a superior diagnostic method for pertussis compared to culture.
- PCR quantification of bacterial load at diagnosis serves as a valuable prognostic tool, predicting clinical disease severity.
- This study supports the use of PCR for both diagnosis and prognosis in pertussis management.
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