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Pertussis detection in children with cough of any duration
Dan-Xia Wu1,2, Qiang Chen2, Kai-Hu Yao3
1Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan-Li-Shi Road, Beijing, 100045, China.
Insights
Pertussis diagnosis in children is challenging due to variable symptoms. Amoxicillin shows promise against macrolide-resistant pertussis, but local antibiotic sensitivities are crucial for effective treatment.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Diagnostics
Background:
- Pertussis (whooping cough) diagnosis remains a global challenge owing to its varied clinical presentations.
- Accurate diagnosis is hindered by non-specific symptoms, complicating early identification and treatment.
Purpose of the Study:
- To investigate the prevalence of pertussis in Chinese children, regardless of cough duration.
- To explore clinical characteristics associated with pertussis in pediatric patients with varying cough durations.
Main Methods:
- A prospective study involving 312 children aged 1 month to 11 years with diverse cough durations.
- Laboratory investigations included nasopharyngeal swabs, blood counts, CRP, serology, and sputum analysis for Bordetella pertussis.
- Antimicrobial susceptibility testing (AST) of B. pertussis isolates was performed using E-test strips.
Main Results:
- Laboratory-confirmed pertussis was identified in 31.1% (97/312) of the studied children.
- Few clinical characteristics differed significantly between pertussis-positive and pertussis-negative groups based on cough duration.
- A high prevalence of macrolide resistance was observed, with 72.2% of isolates resistant to erythromycin and azithromycin.
Conclusions:
- The current generalized clinical case definition for pertussis is inadequate for optimal diagnosis.
- Further comprehensive studies are needed to enhance pertussis diagnostic sensitivity and specificity for public health benefit.
- Amoxicillin may serve as an alternative treatment for macrolide-resistant pertussis, contingent upon local susceptibility patterns.
Background:
The diagnosis of pertussis in clinical practice continues to be a challenge worldwide as the symptoms are variable. We aimed to determine the prevalence of pertussis in Chinese children irrespective of cough duration and explore the clinical characteristics of children with pertussis with different cough durations.
Methods:
This was a prospective study of children 1 month to 11 years of age with different cough durations in one large Chinese hospital. Bilateral deep posterior nasopharyngeal swabs and venepuncture for full blood count, CRP and serology and sputum were obtained when possible for investigation. E-test strips were used for testing the susceptibility of the B.pertussis isolates against erythromycin, azithromycin, sulphamethoxazole/trimethoprim, levofloxacin, amoxicillin and doxycycline. Demographic, clinical and laboratory information on culture and antimicrobial susceptibility testing was collected from children, and analyzed using SAS v.10 (SAS Institute Inc., USA).
Results:
After exclusions we analyzed 312 children. Ninety-seven (31.1%) children had laboratory evidence of pertussis. When grouped by cough duration, few characteristics were significant between children with and without pertussis. Of the 36 isolates, 72.2% (26/36)could not be inhibited by erythromycin and azithromycin at all. The MIC50 and MIC90 to amoxicillin were 0.75 mg/L and 1 mg/L respectively, sensitive to amoxicillin by the EUCAST points.
Conclusions:
The "one-size-fits-all" clinical pertussis case definition is no longer optimal to recognize this disease. A large comprehensive study of children with all types of cough is required to make substantial inroads into increasing both the sensitivity and specificity in pertussis diagnosis, which will have a beneficial impact on public health. Amoxicillin maybe an alternative for children with marolide-resistant B.pertussis infection; however, local sensitivities are required to inform clinical practice.
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