Hydroxyurea for Malignant Pertussis in Critically Ill Children.

Area of Science:

• Pediatrics
• Infectious Diseases
• Critical Care Medicine

Background:

• Malignant pertussis, a severe form of Bordetella pertussis infection, presents with multi-organ failure and high mortality.
• Hyperleukocytosis is a critical feature of malignant pertussis, demanding immediate intervention.
• Whole blood exchange transfusion is a traditional leukoreduction method but carries significant risks.

Purpose of the Study:

• To evaluate the clinical experience of using hydroxyurea as a pharmacological alternative to whole blood exchange for leukoreduction in infants with malignant pertussis.
• To assess the efficacy and safety of hydroxyurea in managing hyperleukocytosis in this patient population.

Main Methods:

• A prospective case series was conducted in a French pediatric intensive care unit (PICU).
• Critically ill infants (n=27) with severe pertussis were analyzed.
• Treatment strategies included hydroxyurea therapy or whole blood exchange transfusion for managing hyperleukocytosis.

Main Results:

• Twelve infants had malignant pertussis; seven received hydroxyurea and five underwent whole blood exchange.
• Hydroxyurea successfully reduced leukocyte counts within 7 days.
• Overall mortality was 25% (3 of 12 infants), with hydroxyurea demonstrating effective leukoreduction.

Conclusions:

• Hydroxyurea serves as an effective alternative therapy for managing hyperleukocytosis in infants with malignant pertussis.
• This pharmacological approach offers a potentially safer option compared to whole blood exchange transfusion.
• The study highlights hydroxyurea's role in addressing a critical complication of severe pertussis infections.