Clinical study on 45 cases of adult and adolescent pertussis

We studied 45 cases of adult and adolescent pertussis. The diagnosis of pertussis was made by two criteria. 1) 4-fold increase in antibody against B. pertussis with paired sera (A group: 15 cases). 2) Titer of anti PT antibody above 100 EU/ml (B group: 30 cases). Paroxysmal cough was 100% in A and B group, whooping cough was present 93% in A group, 92% in B group, posttussive vomiting was 78% in A group, 67% in B group. Familial infection was 18 cases of 15 families (33%). Marked lymphocytosis was not detected in any stage of pertussis. When initial examination was made 3-4 weeks after cough onset, the proof of 4-fold increase in antibody against B. pertussis with paired sera was low. Nine cases (20%) of 45 adult and adolescent pertussis cases had bronchial asthma, but bronchial asthma did not prolong the duration of cough. As proof of 4-fold increase in antibody against B. pertussis with paired sera in adult and adolescent pertussis is difficult, it is expected that the cut-off point of antibody titer against B. pertussis in single sera is determinated rapidly.     

Acute eosinophilic pneumonia in a patient infected with the human immunodeficiency virus

A 24-year-old man infected with the human immunodeficiency virus (HIV) developed cough and progressive dyspnea over a period of 4 weeks. Absolute blood eosinophil count was 3360/mm³. Chest X-ray revealed alveolointerstitial infiltrates in both lower lobes. Eosinophilia was also found in bronchoalveolar lavage fluid. The clinical picture improved dramatically with steroids. Other causes of acute eosinophilic pneumonia were excluded.     

Frequency of pertussis in children with prolongued cough

To determine the frequency of pertussis in children < or = 16 y who had prolonged cough (> or = 14 d), a prospective study was conducted at an outpatient clinic of a paediatric hospital. Nasopharyngeal swabs were taken for culture and nucleic acid testing by polymerase chain reaction (PCR) for Bordetella pertussis. Immunoglobulin A and immunoglobulin G antibodies against pertussis toxin (PT) were tested by ELISA in paired serum samples. A total of 148 patients were recruited during 1 y. Pertussis was detected in 25 (16.9%) patients with at least 1 of the tests. PCR was positive in 12 patients, and 9 cases was diagnosed serologically. Both PCR and serology were positive in 4 children. Duration of cough was longer in the patients with pertussis (median 33 vs 20, p = 0.03). Seropositivity of pertussis toxin was higher in pertussis negative patients during enrollment (24% vs 65%, p = 0.005). From the results of this study, B. pertussis seems to be common in our population despite high immunization rates with whole cell vaccine. Although the duration of cough is defined as longer than 21 d in some studies for pertussis case definition criteria, it was shorter than this in 3 of our cases.     

Pertussis encephalopathy in an adult: case report and review.

A 39-year-old man developed paroxysmal cough, occasional vomiting after cough, and subconjunctival hemorrhage. His illness was complicated by episodes of seizure, with clonic movements of the arms and legs, brief loss of consciousness, and confusion. The episodes were triggered by mild, unremarkable coughing paroxysms. A diagnosis of pertussis was confirmed serologically by measurement of IgG, IgA, and IgM antibodies to pertussis toxin and filamentous hemagglutinin. Serologic studies confirmed the presence of Bordetella pertussis infection in the patient's 10-year-old daughter and suggested that his wife was infected as well. This case report illustrates the occurrence of typical pertussis with serious complications in an adult. Further research is required to determine the scope of this problem and the need for a program of adult immunization against pertussis.     

Cough symptoms in children aged 5–14 years in Sydney,Australia: non‐specific cough or unrecognized pertussis?

OBJECTIVE: The aim of this study was to estimate the community prevalence of coughing symptoms, consistent with surveillance definitions for pertussis, and doctor-diagnosed pertussis in children aged 5-14 years. METHODOLOGY: A telephone survey of a cross-sectional community sample of parents regarding their child's cough symptoms in the previous 12 months was undertaken in a representative Australian urban region. RESULTS: In 2020 interviews, parents reported that 22% of children had a cough lasting 2 weeks or longer in the preceding 12 months, and 14% (283) had additional symptoms meeting the Centers for Disease Control (CDC) case definition for pertussis. A cough meeting the case definition was significantly more commonly reported by parents of children aged 5-9 years (17%; P < 0.001) but reported exposure to diagnosed pertussis in such cases was significantly more common in children aged 10-14 years (4.3%; odds ratio 12.8; P < 0.01). Parents of 90% of children meeting the CDC case definition sought medical advice. A diagnosis of pertussis was reported in only 1.2% of cases, which extrapolates to an annual incidence of doctor-diagnosed pertussis of 347/100,000 (95% confidence interval, 140-714 per 100,000). This contrasts with 29/100,000 notified cases in the same age group, time period and geographic area. CONCLUSION: Cough episodes meeting a clinical case definition for pertussis commonly used in surveillance are reported by a high proportion of carers of school-aged children in Australia. The majority of children who met the CDC and Australian case definitions for pertussis and sought medical attention were not identified as potentially having pertussis, suggesting underdiagnosis of pertussis. Even if less than half of this is true pertussis, the potential impact in terms of transmission of pertussis in the community is likely to be high. The reported incidence of doctor-diagnosed disease estimated from this survey was at least five and up to 20 times the official notification rate. More work needs to be done in raising awareness among medical practitioners of pertussis as a differential diagnosis in older children and adolescents with cough.     

A pertussis outbreak in a ward for severely retarded]

In June 2000, many cases with persistent cough were observed among inpatients and the staff of a ward for severely retarded. Some of them had symptoms suggestive of pertussis, such as whooping, post-tussive apnea. We performed a retrospective investigation to assess symptoms and serological findings suspicious of pertussis. There were a total of 14 cases of persistent cough over 3 weeks (4 to 9 weeks). 6 cases were inpatients and 8 were hospital staff. Of those, serological test for pertussis infection was performed in 10 cases and 6 cases were diagnosed as serologically confirmed pertussis. The other cases with persistent cough were also considered to be probable pertussis as they have had intensive contact with serologically confirmed cases. 12 cases were treated by antibiotics, but they all failed to respond. It was suggested that Bordetella pertussis must be considered as a causal organism of persistent cough even in adults. To prevent nosocomial transmission of pertussis, droplet precautions and macrolide treatment should be provided for patients with symptoms highly suggestive of pertussis.     

Pertussis-induced cough

Pertussis (whooping cough) is one of the commonest vaccine preventable diseases in the UK, despite vaccination coverage being maintained for the last 15 years at over 90% among infants and the addition of a pre-school booster to the UK national immunisation programme in 2001. However, it is known that pertussis vaccine does not confer long-term immunity to clinical infection. Evidence of pertussis infection has been reported in 37% of children presenting in UK primary care and 20% of adolescents and adults presenting in Canadian health centres with persistent cough. In children and adults with persistent cough, paroxysmal coughing is the most sensitive indicator of pertussis, but has poor specificity and limited diagnostic value. Vomiting and whooping, particularly in combination, are stronger predictors of pertussis. Cough duration is longer in children than in adults with pertussis (median cough duration 112 days versus 42 days); individuals may take even longer to recover fully and regain previous levels of exercise tolerance. A diagnosis of pertussis may be confirmed by culture, Polymerase Chain Reaction (PCR) or serology. Single estimates of anti-pertussis toxin (PT) antibody titres in blood or oral fluid samples are highly specific. There are currently no proven efficacious treatments for pertussis-induced cough. Treatment with macrolide antibiotics reduces the duration of an individual's infectious period, but does not alter the duration of cough. Further research is needed to re-examine the epidemiology of pertussis in countries with different vaccination schedules, find efficacious treatments and develop methods of measuring cough frequency and severity in patients with pertussis-induced cough.     

人类免疫缺陷病毒(HIV)感染合并肺结核34例临床分析

目的　分析人类免疫缺陷病毒阳性合并肺结核感染的临床表现 ,探讨诊断方法。方法 对117例人类免疫缺陷病毒阳性合并肺结核感染 34例的临床表现、胸部X线及其他实验室检查进行分析。结果 117例人类免疫缺陷病毒阳性合并肺核感染 34例 ,感染率 2 9.1%。共用注射器静脉吸毒是主要原因。中等度发热、咳嗽、盗汗、消瘦 ,部分病例伴咯血、呼吸困难等与结核中毒症状相似。胸部X线检查以继发性肺结核为主 6 1.8%。多重感染中主要为念珠菌感染。住院期间病死率 17.6 %,死因为呼吸功能衰竭和多脏器功能衰竭。抗结核治疗对改善病情有帮助。因表现复杂 ,临床误诊较高。结论 肺结核合并机会性感染尤念珠菌感染 ,流行病学资料有静脉吸毒行为 ,应作HIV抗体检查有利诊断。     

Pertussis is a frequent cause of prolonged cough illness in adults and adolescents.

Although pertussis is increasingly recognized as a cause of prolonged cough illness in adolescents and adults, its prevalence is not well established. We evaluated pertussis infection in 442 adolescents and adults > or = 12 years old (mean age, 41.3 years) who had a cough-related illness of 7--56 days' duration. For 4 patients (0.9%), results of nasopharyngeal culture or PCR were positive for Bordetella pertussis; for 10 patients (2.3%), either results of culture or PCR were positive or pertussis antibody titers increased 4-fold. Eighty-eight patients (19.9%) had either laboratory-confirmed pertussis or laboratory evidence of pertussis. These patients had significantly longer duration of cough than did patients without laboratory evidence of pertussis (56 days vs. 46 days), and more of them had vomiting with cough (45.5% vs. 28.5%, respectively). Pertussis is a common cause of prolonged cough illness in adolescents and adults and is frequently associated with other symptoms of whooping cough.     

Human parainfluenza virus type 3 (HPIV 3) community-acquired pneumonia (CAP) mimicking pertussis in an adult: the diagnostic importance of hoarseness and monocytosis

Background

There are relatively few causes of acute community-acquired pneumonias (CAPs) in adults associated with prolonged cough. In adults the most common acute CAPs with a prominent and persistent nonproductive cough are due to Mycoplasma pneumoniae, Chlamydophilia (Chlamydia) pneumoniae, or Bordetella pertussis (pertussis). Pertussis is an underrecognized and underappreciated cause of CAP in adults. Different from classic pertussis in children, pertussis in adults presents with prolonged dry cough, that is, the “100-day cough.” In pertussis, the characteristic nonspecific laboratory findings are leukocytosis and relative lymphocytosis. Dry cough accompanied by hoarseness with CAP in an adult should suggest C. pneumoniae or a respiratory virus (eg, influenza, parainfluenza, respiratory syncytial virus).

Methods

We present the case of a young woman who presented with a prominent and persistent pertussis-like cough with hoarseness. She had no leukocytosis or relative lymphopenia, which argued against the diagnosis of pertussis. Notably, she had persistent monocytosis. Her protracted pertussis-like cough that persisted during her hospitalization was so impressive that the diagnostic impression was pertussis. Direct fluorescent antibody (FA) and throat cultures were negative for pertussis. Furthermore, her hoarseness suggested the possibility of C. pneumoniae, but her C. pneumoniae immunoglobulin-M titer was negative.

Results

Because C. pneumoniae was ruled out, her hoarseness suggested a respiratory viral cause. A respiratory FA viral panel and viral throat cultures were obtained. The respiratory FA viral panel was negative for influenza A/B, respiratory syncytial virus, metapneumovirus, adenovirus, cytomegalovirus, and parainfluenza viruses. However, her viral throat cultures grew parainfluenza virus type 3 (HPIV 3), confirming the diagnosis.

Conclusion

To the best of our knowledge, this is the first case of HPIV 3 CAP presenting with a prominent and persistent pertussoid cough in an adult mimicking pertussis with hoarseness and monocytosis.     

Bordetella pertussis and chronic cough in adults.

To evaluate Bordetella pertussis as a cause of persistent cough in adults, we examined 201 patients who had a cough for 2-12 weeks and no pulmonary disease. We obtained the following at presentation: medical history, chest radiograph, respiratory function measurement, nasopharyngeal aspirate for polymerase chain reaction (PCR), nasopharyngeal swab specimen for culture, and a blood sample (acute serum). Four weeks later a second blood sample (convalescent serum) was obtained. Control sera were obtained from 164 age-matched healthy blood donors with no history of cough during the previous 12 weeks. Four patients were B. pertussis culture-positive; 11 (including the culture-positive patients) were B. pertussis PCR-positive; and 33, including 10 of the 11 PCR-positive patients, had serological evidence of recent B. pertussis infection. Pertussis-positive and -negative patients could not be discriminated by a history of cough. We conclude that B. pertussis infection is a common cause of persistent cough in adults. This is of concern, because these patients may be B. pertussis reservoirs from which transmission may occur to infants, in whom the disease can be devastating.     

Outbreak of pertussis on a college campus

Background

Pertussis is increasing among adolescents and adults despite universal childhood vaccination. This investigation describes an outbreak of pertussis among undergraduate students and assesses the burden of cough illness on a college campus.

Methods

Students presenting with prolonged cough were evaluated with culture, polymerase chain reaction (PCR), and serology. An e-mail survey was performed to determine the burden of cough illness on campus.

Results

Thirty-seven undergraduates were evaluated. Their mean duration of cough was 28 days. No student had cultures positive for B. pertussis; one was PCR positive. Ten (27%) had serologic values consistent with acute pertussis infection. The e-mail survey was returned by 225/500 (45%) students. Of these, 66 (29%; 95% confidence interval [CI], 23%-36%) reported a cough of 2 weeks or longer duration during the fall semester. A conservative estimate showed that the campus-wide incidence of a cough illness meeting the Centers for Disease Control and Prevention case definition for pertussis was 13% (95% CI, 10%-16%) during the fall semester.

Conclusions

Adolescents and young adults are susceptible to pertussis infection. This study demonstrates that there was a substantial rate of pertussis infection during an outbreak on a college campus. Our findings support the routine use of the acellular pertussis vaccine in adolescents and adults.     

Bordetella pertussis, Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae and persistent cough in children.

Material collected during a prospective pertussis vaccine trial in 1992-95 was examined for Bordetella pertussis (culture and serology), Bordetella parapertussis (culture), Mycoplasma pneumoniae and Chlamydia pneumoniae (PCR). From 64% (99/155) of episodes with cough for less than 100 d, 115 aetiological agents were identified in one southern and one northern subset of DT-recipients. The most common single agent was B. pertussis, representing 56%(64/115), with a median cough period of 51 d, followed by M. pneumoniae 26%(30/115), 23 d, C. pneumoniae 17% (19/115), 26 d, and B. parapertussis 2% (2/115). For co-infections, the median duration of cough was about 60 d. Spasmodic cough for 21 d or more (clinical WHO criteria for pertussis) was present in 82% (41/50) of infections with B. pertussis as single agent, 38% (17/45) with B. parapertussis, 38% (5/13) with C. pneumoniae, 26% (5/19) with M. pneumoniae and 30%(17/56) in cases where no aetiology was found. In children with cough for more than 100 d (n = 78) using all vaccine arms, B. pertussis was responsible in 83% (65/78), in 21%(16/78) together with other agents. Acellular vaccines were more efficient against serious disease than whole cell vaccine. Antibiotic treatment was more common at the southern (34%) study site than at the northern one (12%). The findings indicate that diagnosis should rely on laboratory confirmation, both for rational treatment of an individual case and for monitoring outbreaks.     

Isolation of Bordetella pertussis in blood culture from a patient with multiple myeloma

Bordetella pertussis is a fastidious aerobic, Gram-negative coccobacillus that causes the classical disease of whooping cough. We present a 63 years old man with multiple myeloma who was admitted to the medical department with cough, hoarseness and fever. Bronchopneumonia was suspected and two courses of beta-lactam antibiotics had beneficial effect on his clinical condition, but his respiratory symptoms persisted. Eventually, B. pertussis grew in an aerobic blood culture. Delayed treatment with clarithromycin had little or no effect on his cough. To our knowledge this is the third reported case of B. pertussis bacteraemia. All three patients have been immunocompromized. Growth in blood culture may be slow, and prolonged incubation (at least 6 days) of the blood culture bottles and subculture to a special culture medium is necessary for isolation of B. pertussis.     

Effects of Early Administration of Macrolides on Whooping Cough in Adolescents and Adults: A Single-center Retrospective Cohort Study

Objective This study aimed to elucidate the effects of early macrolide administration on genetically confirmed pertussis-induced cough in adolescents and adults. Methods This single-center, retrospective cohort study examined the effects of the early administration of macrolides and antitussive agents on cough secondary to pertussis. We divided the patients into two groups based on the median duration from the beginning of the cough to the initiation of macrolide administration: early macrolide administration group (EMAG) and non-early macrolide administration group (NEMAG). The clinical improvement of cough was defined as maintaining a cough awareness score of ≤3 points for 3 consecutive days. Patients The medical records of 40 patients diagnosed with pertussis (≥12 years old) who were able to maintain a cough diary and received no other antibiotics aside from macrolides were included in the study. A diagnosis of pertussis was made using the loop-mediated isothermal amplification (LAMP) test. Results The EMAG (24 patients) showed a significantly shorter total cough period than the NEMAG [16 patients; 20.0 (95% confidence interval (CI), 16-28) vs. 30.5 (95% CI, 27-40) days; log-rank test, p=0.002]. There was no significant difference in the post-administration cough periods between the EMAG and NEMAG [11.0 (95% CI, 7-19) vs. 13.0 (95% CI, 5-23) days; log-rank test, p=0.232]. Antitussive agents did not affect the cough. Conclusion The early administration of macrolides, but not antitussive agents, is effective for treating pertussis. Therefore, macrolides should be administered as soon as possible for this disease.     

A pertussis outbreak in a Wisconsin nursing home

The epidemiologic features and clinical spectrum of pertussis in the elderly are poorly understood. In October 1985, the Wisconsin Division of Health investigated an outbreak of pertussis in residents of a nursing home in rural Wisconsin. Clinical information and nasopharyngeal swab and acute- and convalescent-phase serum specimens were obtained from all consenting residents and employees. Of 105 residents, 38 (36.2%) were seropositive, including four who were culture-positive for Bordetella pertussis. Culture-positive residents (age range, 52-81 years) had cough lasting 43-54 days. Three of these residents had paroxysmal cough, and all four had cough that interrupted sleep; none of the residents had cough with apnea or vomiting, and all recovered without sequelae. Of six seropositive residents with clinical pertussis, five lived on the south wing of the facility. Of 104 employees, 8 (7.7%) were seropositive, but none were culture-positive for B. pertussis. The higher attack rate for residents and the clustering of clinical cases were consistent with ongoing transmission within the nursing home.     

Correlation between pertussis toxin IgG antibodies in postvaccination sera and subsequent protection against pertussis

All acellular pertussis vaccines contain pertussis toxoid and induce protection against pertussis. This study investigated the relation between the postvaccination levels of pertussis toxin (PT) serum IgG and protection against pertussis. PT IgG was determined in sera obtained 21-77 days after the third vaccination from 813 children who received 3 doses of pertussis toxoid. The children were followed for 21-33 months after vaccination for the occurrence of pertussis. Of the children, 126 were exposed to pertussis in their households. The median PT IgG concentration was 79 U/mL in those who developed severe pertussis (>/=21 day of paroxysmal cough), 156 U/mL with mild pertussis (<21 days of paroxysmal cough), and 246 U/mL in those who did not develop pertussis (79 vs. 246, P<.0001). Corresponding values in the 687 children with no household exposure were 99, 124, and 155 U/mL, respectively (99 vs. 155, P<.0001). Thus, there is a highly significant correlation between the level of vaccine-induced serum PT IgG and protection against pertussis.     

Lymphocytic interstitial pneumonia

Lymphocytic interstitial pneumonia is a common complication of HIV infection in children, but uncommon in adults. It is characterized clinically by the presence of cough and dyspnea, diffuse pulmonary infiltrates on chest x-ray, restrictive pulmonary dysfunction, and hypoxemia. This constellation of findings usually erroneously suggests PCP, and a lung biopsy is necessary to establish the diagnosis. Typical microscopic findings include diffuse infiltration of the pulmonary interstitium with a mixture of lymphocytes and plasma cells; immunohistologic studies reveal that in association with HIV infection, these lymphocytes are T cells. The pathogenesis of LIP in patients with HIV infection is not known. It is believed that it represents a tissue response to EBV infection, HIV infection of the lung, or both. Although patients with LIP may respond dramatically to corticosteroid therapy, others may improve with no treatment. Unfortunately, most patients eventually succumb to other complications of HIV infection.     

Incidence of pertussis in persons < or =15 years of age in Valencia, Spain: seroprevalence of antibodies to pertussis toxin (PT) in children, adolescents and adults

PURPOSE: To determine the incidence of pertussis in persons < or =15 years in age in Valencia, Spain. To assess the prevalence of IgG antibodies to pertussis toxin (PT) in children, adolescents and adults. METHODS: Prospective study conducted at paediatric primary care centres. All persons < or =15 years in age presented with persistent cough were enrolled. Parents completed a brief questionnaire and immunization history was obtained from paediatrician records. A blood sample was obtained, for determination of IgG antibodies to Bordetella pertussis toxin (PT) by an ELISA method. A study confirmed-case was the presence of two conditions: (1) cough illness of > or =14 days duration; and (2) ELISA absorbance value of IgG to PT > or =2. Two subjects per clinical-case (same centre and range of age) and parents were asked to participate in the prevalence study. RESULTS: Sixty-one children < or =15 years in age presented with symptoms leading to a clinical diagnosis of pertussis were detected. Serological evidence of recent pertussis was found in five of these patients (incidence of 46.0/100,000 persons < or =15 years in age). Prevalence of antibodies to B. pertussis (> or =0.3) in children < or =15 years in age and adults was 39 and 33%, respectively. Only a minority of children, adolescents and adults had absorbance values indicative of immunity (> or =1). CONCLUSIONS: These incidence and seroprevalence results show that despite high immunization rates in infancy, B. pertussis is circulating in Spain.