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Published on: August 30, 2014
[Update on leukoreduction therapies as alternatives for the treatment of severe pertussis]
Pedro Taffarel1, Facundo Jorro Barón1, Germán Bonetto2
1Servicio de Terapia Intensiva, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Buenos Aires.
Insights
Severe pertussis in infants can be lethal due to pulmonary hypertension. Leukodepletion is a proposed treatment, but current evidence for its effectiveness in pertussis remains limited.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Pertussis (whooping cough) is a severe bacterial infection, particularly dangerous for infants under one year old.
- Complications include hypoxemia, refractory pulmonary hypertension, and cardiovascular collapse.
- Pathophysiology involves bacterial toxins, altered vascular tone, hyperviscosity, and thrombosis due to hyperleukocytosis.
Purpose of the Study:
- To review the existing literature on leukodepletion as a treatment for severe pertussis.
- To assess the efficacy and safety of leukodepletion in pediatric patients with severe pertussis.
Main Methods:
- Systematic review of publications on leukodepletion in severe pertussis.
- Analysis of patient data, cytoreduction procedures, and mortality rates from 18 identified studies.
- Evaluation of study design limitations and overall evidence quality.
Main Results:
- 18 publications reviewed, encompassing 288 patients and 68 cytoreduction procedures.
- A mortality rate of 28% was observed in patients who underwent leukodepletion.
- Published studies exhibit significant design limitations.
Conclusions:
- Leukodepletion has been explored as a treatment for severe pertussis since 2004.
- Despite its use, the evidence supporting leukodepletion in severe pertussis remains low due to study limitations.
- Further high-quality research is needed to establish the role of leukodepletion in managing severe pertussis.
Abstract:
Pertussis is a contagious disease that in patients under 1 year of age may evolve to a highly lethal course characterized by hypoxemia and refractory pulmonary hypertension, being this responsible for cardiovascular collapse. Pulmonary hypertension occurs by direct action of bacteria and its toxins, responsible for the vascular tone alteration associated with hyperviscosity syndrome and arteriolar thrombosis due to hyperleukocytosis. Since 2004, leucodepletion has been proposed as a treatment option; there are currently 18 publications on leucodepletion in patients with severe Pertussis, with a total of 288 patients, 68 cytoreduction procedures and a mortality rate of 28% in those exposed to the mentioned treatment. Published studies have design limitations, so the evidence for using leukoreduction in patients with severe pertussis remains low.
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