Identifying Children at Risk of Malignant Bordetella pertussis Infection

Area of Science:

• Pediatric Infectious Diseases
• Critical Care Medicine
• Clinical Diagnostics

Background:

• Pertussis, a highly contagious respiratory infection, can present with severe, life-threatening complications in infants and children.
• Malignant pertussis is a severe form characterized by specific clinical and laboratory findings, often requiring intensive care.

Purpose of the Study:

• To identify clinical and laboratory factors that predict the development of malignant pertussis in children.
• To establish early warning signs for malignant pertussis within 48 hours of hospital presentation.

Main Methods:

• Retrospective review of medical records of 152 children diagnosed with pertussis between January 2003 and August 2013.
• Analysis of vital signs (heart rate) and white blood cell characteristics (total WBC count, neutrophil-to-lymphocyte ratio, absolute neutrophil and lymphocyte counts) within 48 hours of hospital admission.
• Receiver-operator characteristic (ROC) curve analysis to determine the predictive accuracy of identified factors.

Main Results:

• Eleven out of 152 children had malignant pertussis.
• Maximum heart rate > 180 beats/min (AUC 0.88) and absolute neutrophil count (AUC 0.92) were strong predictors.
• A multivariate model including heart rate > 180 beats/min, total WBC count > 25×10/L, and neutrophil-to-lymphocyte ratio > 1.0 achieved an AUC of 0.96 for predicting malignant pertussis.

Conclusions:

• Predictive clinical and laboratory markers for malignant pertussis are identifiable within 48 hours of hospital presentation.
• Early identification of at-risk children can facilitate prompt transfer to a Pediatric Intensive Care Unit (PICU).
• This early recognition may enable timely initiation of advanced life support and enrollment in investigational treatment trials.