[Clinical characteristics and outcomes of pertussis encephalopathy in 17 children]

Objective: To investigate the clinical characteristics, treatment, and prognosis of pertussis encephalopathy in children. Methods: A case-series study was conducted on 17 children diagnosed with pertussis encephalopathy at the Department of Infectious Diseases and Pediatric Intensive Care Unit (PICU), Guangzhou Women and Children's Medical Center from January 2020 to December 2024. General data, clinical manifestations, laboratory and imaging findings, treatments, and outcomes were retrospectively analyzed. Results: Among the 17 children, 8 were boys and 9 were girls. The age at disease onset was 60 (37, 80) days. None of these infants had received diphtheria-tetanus-pertussis vaccination, and 15 infants were ≤3 months old. Encephalopathy developed 2-4 weeks after pertussis onset in 13 infants. Seizures occurred in 16 infants, and impaired consciousness was present in all 17 infants. Peripheral leukocytosis was observed in 15 infants. Cerebrospinal fluid (CSF) analysis revealed elevated white blood cell counts in 3 infants, elevated protein levels in 15 infants, and albumin quotient >10 in 16 infants. Bordetella pertussis nucleic acid was detected in the CSF in 2 out of 6 tested infants. Abnormalities were found on electroencephalography in 10 of 14 infants, on auditory evoked potentials in 10 of 12 infants, and on visual evoked potentials 1 of 6 infants. Brain magnetic resonance imaging was abnormal in 3 of 14 infants. All infants received macrolide antibiotics, and 11 also received additional antimicrobial agents. Fifteen infants were admitted to the PICU, 13 infants required mechanical ventilation, 8 infants received vasoactive agents, 5 infants underwent exchange transfusion, and 13 infants received intravenous immunoglobulin. Two infants died of cardiopulmonary failure, and 15 infants were discharged with clinical improvement. By June 2025, 1 infant developed post-encephalopathic epilepsy and cognitive impairment. Conclusions: Pertussis encephalopathy predominantly affects unvaccinated infants under 3 months of age, typically emerging 2-4 weeks after pertussis onset. Seizures and impaired consciousness are the predominant neurological manifestations. Management consists of antimicrobial therapy combined with supportive care and complication management. While the short-term prognosis of survivors is relatively favorable, a subset of patients may experience neurological sequelae.