Related Experiment Videos
[Malignant pertussis and exchange transfusion]
J Chantreuil1, N Fakhri2, F Labarthe3
1Réanimation pédiatrique et néonatologie, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France.
Insights
Malignant pertussis is a severe condition with high mortality. Exchange transfusion effectively reduced extreme leukocytosis in an infant, improving outcomes before hemodynamic collapse.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Malignant pertussis presents as a severe clinical state with high fatality rates (70%).
- Key severity criteria include lung infection, pulmonary hypertension, and extreme leukocytosis (typically >50 G/L).
Observation:
- A 2.5-month-old infant with malignant pertussis developed acute respiratory distress syndrome and pulmonary hypertension.
- A secondary Enterobacter cloacae infection complicated the clinical course, requiring high-frequency oscillatory ventilation and pulmonary vasodilatation therapy.
- Despite initial management, the infant's hyperleukocytosis reached 70 G/L.
Findings:
- Exchange transfusion was performed on day 9 to address severe hyperleukocytosis.
- The procedure successfully reduced leukocyte count to below 40 G/L.
- Following exchange transfusion, the infant showed steady improvement in pulmonary function, enabling weaning from mechanical ventilation and eventual discharge.
Implications:
- Exchange transfusion is a viable therapeutic option for infants with malignant pertussis and extreme leukocytosis.
- Considering exchange transfusion before hemodynamic failure may improve survival prognosis in these critical cases.
Case Report:
Malignant pertussis is a critical clinical state associated with fatal outcome in 70% of cases. The severity criteria are a lung infection with pulmonary hypertension and hyperleukocytosis usually above 50 G/L. We report the case of a 2.5-month-old girl hospitalized with critical pertussis in a pediatric intensive care unit. She had acute respiratory distress syndrome with pulmonary hypertension complicated by a bacterial secondary infection with Enterobacter cloacae managed by high-frequency oscillatory ventilation associated with pulmonary vasodilatation therapy. In the absence of clinical improvement and before considering extracorporeal life support, exchange transfusion was performed at day 9 to reduce hyperleukocytosis at 70 G/L. Exchange transfusion was successfully performed with a reduction of leukocytes to under 40 G/L followed by steady improvement of pulmonary function. Weaning from mechanical ventilation and discharge took place at day 23 and 38, respectively.
Comments:
Exchange transfusion should be considered in infants suffering from malignant pertussis with extreme leukocytosis before hemodynamic failure to improve the survival prognosis.