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Pertussis clinical case definition: Time for change in developing countries?

Sheila Gopal Krishnan1, Weng Hong Fun2, Malini Devi Ramadras1

  • 1Paediatrics Department, Hospital Kulim, Kedah, Malaysia.

Plos One
|July 11, 2019
PubMed

Insights

Early pertussis detection in developing countries can be improved by recognizing clinical signs like paroxysmal cough and facial congestion. These indicators are more effective than solely relying on cough duration for timely diagnosis.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Epidemiology

Background:

  • Pertussis (whooping cough) remains a significant cause of mortality in developing nations due to delayed diagnosis.
  • Existing clinical case definitions for pertussis often lack the sensitivity required for early detection.

Purpose of the Study:

  • To identify clinical characteristics that facilitate earlier detection of pertussis in sporadic cases within a developing country setting.
  • To evaluate the effectiveness of the World Health Organization (WHO) diagnostic criteria against other clinical indicators.

Main Methods:

  • A retrospective review of medical and laboratory records for hospitalized children with nasopharyngeal swabs for Bordetella pertussis.
  • Comparison of the sensitivity and specificity of WHO criteria with other clinical features, using polymerase chain reaction (PCR) as the gold standard.

Main Results:

  • The WHO criteria demonstrated low sensitivity (15%) but high specificity (92%).
  • Combinations of symptoms including paroxysmal cough, ill contact, and facial congestion showed improved sensitivity.
  • Extended cough duration increased specificity but reduced sensitivity for pertussis detection.

Conclusions:

  • Clinical signs such as paroxysmal cough, facial congestion, and history of contact with an ill individual are valuable for early pertussis detection.
  • Over-reliance on cough duration as a diagnostic criterion may impede timely identification of pertussis cases.
Abstract

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