Perinatal pertussis

Pertussis (whooping cough), a highly contagious disease of childhood, is increasingly recognized among reproductive-age adults and neonates. Described are three cases of maternal-infant pairs in which mother-to-newborn transmission probably occurred and was the cause of extensive morbidity and cost. Means of recognition, treatment, handling, and prevention of this potentially lethal childhood illness are discussed.

Severe neonatal pertussis treated by salbutamol

Two neonates with severe culture proven pertussis were successfully treated with salbutamol 0.5 mg three times daily. There was a demonstrable decrease in the total number of coughing spasms, their mean duration and severity. In one baby this was shown by the transcutaneous oxygen tension measurements.

Pertussis epidemic in Oklahoma. Difficulties in preventing transmission

From Jan 1 to Dec 31, 1983, 351 cases of pertussis were reported in Oklahoma. Overall, 59% of the cases were among children 3 months to 6 years of age, the target age group for pertussis vaccination; only 42% of the patients in this age group were appropriately immunized for age with diphtheria and tetanus toxoids and pertussis vaccine (DTP). A survey of 185 households in the neighborhoods of three cases found that only 65% of 57 children 3 months to 6 years of age were appropriately immunized for their age. Aggressive control of the outbreak was attempted in Oklahoma County with recommendations for widespread vaccination against pertussis. However, the effort failed to immunize 82% of the 931 children in the initial target group. Nonetheless, analysis of the reported cases suggested that less than one fourth of the cases were potentially preventable by a single additional dose of DTP, ie, in individuals 3 months to 6 years of age with a history of at least one prior dose of DTP who were not appropriately immunized for age. The optimal solution to outbreak control is outbreak prevention by ensuring that the maximal number of children younger than 7 years of age receive routine age-appropriate DTP vaccination.

Salbutamol in the treatment of whooping cough

A double blind placebo-controlled study was performed to evaluate the efficacy of salbutamol in the treatment of 25 pertussis patients. The diminishing of paroxysmal cough in the treatment group did not differ significantly from that of the control group.

Salbutamol vs. placebo for treatment of pertussis

The efficacy of salbutamol was assessed in a double blind placebo controlled crossover study in nine hospitalized children with whooping cough in the convulsive stage verified by culture or serology. The children were 1.5 to 27 months old (median, 4 months). The dosage of salbutamol was the one normally used and supplementary treatment was standardized. Salbutamol was found to give no significant effects on the course or severity of whooping cough in the children treated.

The severity of whooping cough in hospitalised children--is it declining?

Four hundred and sixty admissions for whooping cough to three hospitals between 1974-9 were reviewed. Many children had a long illness. More than half of them had severe or moderately severe coughing spasms and a quarter had pronounced feeding difficulties. The incidence of clinical pneumonia and convulsions was low and there were no deaths. The disease continues to be much more severe in infancy. There was some evidence that the disease declined in severity over the period studied. A number of factors including increased use of erythromycin may have contributed to this change.

[Study on a new cephamycin preparation cefminox in the field of pediatrics]

Cefminox (CMNX, MT-141) was studied both fundamentally and clinically in the field of pediatrics with following results. The MIC of CMNX for Bordetella pertussis was 0.10 micrograms/ml in inoculum size 10(6) cells/ml. Following administration of 10 and 20 mg/kg of CMNX as drip infusion over 1 hour, the blood levels of the drug were 49.0 +/- 18.1 and 69.1 micrograms/ml at completion of infusion, 28.8 +/- 7.7 and 61.6 micrograms/ml at 1.5 hours, 23.6 +/- 9.3 and 44.1 +/- 3.8 micrograms/ml at 2 hours and 1.4 +/- 1.4 and 4.0 +/- 0.6 micrograms/ml at 7 hours, with T1/2 of 1.03 and 1.41 +/- 0.03 hours, respectively. Within the first 7 hours after administration, 61.4 +/- 8.2 and 55.9 +/- 0.8% of the drug dosed were excreted at active form in urine. In child with encephalitis, drug considered to be good as a cephem antibiotic was achieved in the cerebrospinal fluid (the ratio of the level in the cerebrospinal fluid to that in the serum was 7.3%). In addition, in the pus in empyema also high level was reached (its ratio against blood level was 53%). In the treatment of 31 cases of acute infections of pediatric field including upper and lower airway infections, empyema, whooping cough, acute urinary tract infections and phlegmon, CMNX was administered intravenously either as one shot injection as drip infusion. The clinical results obtained were rated as good or more in 93% of the cases and as fair or more in 100% of the cases. The main dosage of CMNX in these cases was about 60 to 70 mg/kg per day in 2 or 3 divided doses. S. aureus, S. pyogenes, S. pneumoniae, H. influenzae and ABPC resistant strain of E. coli demonstrated in various materials could be eradicated after intravenous injection of CMNX. CMNX was administrated for a period of 2 to 16 days to a total amount of 1.5 to 26.5 g. In none of these cases side effects developed nor any abnormality was revealed by hematological findings or results of renal or liver function.

Comparative clinical study of josamycin and erythromycin in pertussis

Forty children with pertussis were treated in a randomized trial with josamycin or erythromycin. The pathogen was isolated in 15 cases by immunofluorescent antibody (IFA) technique. The clinical response of both groups was good and comparable. A 15-day course of therapy was able to eradicate the pathogen in all but one patient. Three patients showed minor side effects: diarrhea (2), rash (1).

An analysis of resistance times to infection under treatment

A general model is proposed for the time taken by a subject to catch an infectious disease when there may be treatment intervention during the exposure time. Particular specifications are then made in order to apply the model to some recent data on the infectivity of whooping cough within the family.

[Experimental and clinical evaluation of latamoxef in newborn and premature infants]

Fundamental and clinical studies in infants including neonates on latamoxef (LMOX) were carried out, and following results were obtained. In fundamental studies, half-lives of LMOX were 5.79, 4.38 hours, at dose 10 mg/kg by intravenous injection and intravenous drip infusion in neonates, respectively. And urinary excretions were 6.8, 15.6% for 6 hours, respectively. In 28--50 day-old neonates, half-lives were 2.26--4.3 hours at dose 20 mg/kg, and urinary excretions were ranged from 14.3 to 37.0%. Clinical results were following. In 8 cases of bronchopneumonia and 2 cases of pertussis, the clinical efficacy rate was 100% at daily dose 38--100 mg/kg twice or third a day by intravenous injection or intravenous drip infusion for 6--9 days duration. All causative organisms (K. pneumoniae 1, S. aureus 1) were eliminated after LMOX 43 or 38 mg/kg/day dose administration. Side effect and laboratory abnormal value were not noticed in all cases. We finally have a conclusion that LMOX should be administered 40--70 mg/kg/day, and given twice or third a day by intravenous injection or intravenous drip infusion.

Intrafamilial spread of pertussis

Intrafamilial spread of pertussis was evaluated in 21 families (97 individuals) of patients with whooping cough diagnosed by culture or by ELISA serology. During follow-up (average six months), an infectivity rate of 83% was established by an ELISA within these families. However, 46% of the secondary cases were asymptomatic. Most of the asymptomatic cases were in adults or vaccinated children. Unvaccinated infants had classic whooping cough and were exposed to pertussis by their vaccinated siblings or parents. The incidence of classic symptoms of pertussis decreased with age, and atypical pertussis was usually culture negative but rapidly diagnosed by measurement of the IgM- and IgA-class antibodies by ELISA.

Bordetella pertussis isolation in general practice: 1977-79 whooping cough epidemic in West Glamorgan

Some of the factors influencing the isolation rate of Bordetella pertussis during a whooping cough epidemic in West Glamorgan, Wales, are reported. The organism was isolated from 39% of patients with clinical whooping cough, pernasal swabbing being much more successful than cough plates. Isolation rates were increased in the non-immunized, particularly in the first year of life. Erythromycin and co-trimoxazole significantly reduced the isolation rate of B. pertussis but this did not occur with penicillin. In this study 20% of patients were culture positive 6 weeks after the onset of their infection. It is suggested that the Department of Health and Social Security recommendation of a minimum period of three weeks exclusion of children from school is inadequate. During the epidemic, the proportion of strains of B. pertussis containing antigen 2 more than doubled.

[Salbutamol combined with erythromycin and sobrerol in the therapy of pertussis]

The results of treatment carried out with salbutamol, erythromycin and fluidifiers in 20 children with whooping cough are reported. Results in all cases were much superior to those that have been obtained up to the present with the use of antibiotics alone or associated with hyperimmune gammaglobulins and/or sedatives. A speedier and more complete resolution of symptomatology was observed in the group where treatment was instituted earlier.

ABC of 1 to 7: whooping cough

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Efficacy of salbutamol in treatment of infant pertussis demonstrated by sound spectrum analysis

The value of sound spectrum analysis (sonography) as an indicator of the severity of symptomatic pertussis was assessed in four infants aged 3 weeks to 5 months. Coughing paroxysms and whooping could be clearly distinguished and measured on the sonogram. Sonography was then used to evaluate the effects of oral salbutamol on pertussis. The drug reduced the frequency and shortened the duration of the whoops; however, it did not have corresponding effect on the cough. Salbutamol seemed to relieve the laryngeal spasms and consequently eased the infant's breathing difficulties.

Whooping cough in adults

During the 1970s whooping cough returned in Sweden after an absence of more than 10 years and is now seen in all age groups, During a three-year period 174 adults with culture-verified whooping cough were identified in Gothenburg. Most of the patients had typical symptoms with whooping attacks and often vomiting. The disease was long lasting but complications were rare. Physicians should be aware that whooping cough may occur in adults, since adults may be an important source of infection for infants and erythromycin given in the catarrhal phase may modify the clinical course.

Antimicrobial therapy in whooping cough

We compared the ability of erythromycin and co-trimoxazole in clearing Bordetella pertussis from the nasopharynx of 22 children admitted to hospital with whooping cough. Both agents appeared effective. Nevertheless, 10 of the 22 patients gave positive cultures four or more days after antimicrobial administration was begun.

Pharmacokinetics of erythromycin ethylsuccinate and estolate in infants under 4 months of age

We studied the pharmacokinetics of erythromycin estolate and ethylsuccinate suspensions in infants under 4 months of age who were being treated for chlamydial infections or pertussis. We conducted our studies after the initial dose of 10 mg/kg and subsequently during steady-state treatment. The estolate preparation resulted in higher peak concentrations in sera, and its absorption and elimination half-lives were longer. Peak concentrations occurred 3 h after a dose with the estolate preparation and 1 h after a dose with the ethylsuccinate preparation. The area under the curve for the estolate preparation was about three times greater than that for the ethylsuccinate preparation. Based on these findings, we recommend that erythromycin estolate suspensions be given to young infants at 8- or 12-h intervals (30 mg/kg per day in three divided doses or 20 mg/kg per day in two divided doses) and that erythromycin ethylsuccinate is best given at 6-h intervals (40 mg/kg per day in four divided doses).

[Treatment of whooping cough and whooping cough syndrome by cefoperazone (author's transl)]

Clinical trial of cefoperazone (CPZ) for the treatment of whooping cough and whooping cough syndrome was performed and the following results were obtained. 1) In 18 cases suffering from whooping cough, CPZ was given 47 approximately 106 mg/kg/day (average 72 mg/kg/day) by intravenous route. The clinical efficacy rates judged by doctors in charge were 44% on the 3 rd day, 75% on the 7 th day, 86% on the period day. And in these cases, the clinical efficacy rates judged by committee members were 56%, 83% and 86%. 2) In 6 cases diagnosed as whooping cough syndrome, CPZ was given 49 approximately 96 mg/kg/day (average 59 mg/kg/day) by the same route. The clinical efficacy rates judged by doctors in charge were 67% on the 3 rd day, 80% on the 7 th day and 75% on the period day. And in these cases, those judged by committee members were 83%, 80% and 100%. 3) In 1 case, Bordetella pertussis was searched and showed 0.012 mcg/ml of MIC. It was eliminated on the 1 st day after administration. 4) Doctors in charge judged the utility of CPZ for whooping cough. Twelve cases were useful and 6 cases were slightly useful. 5) No side effects were observed except for elevation of GOT and LDH. These results suggest that CPZ might be useful drug against whooping cough.

[Treatment of pertussis with cefoperazone (author's transl)]

Clinical trial of cefoperazone (CPZ) for the treatment of 15 cases suffering from pertussis was performed and the results were as follows. The method of administration, as a rule intravenous infusion was performed at 100 approximately 200 mg/kg/day. (1) Seventeen strains of Bordetella pertussis showed under 0.006 mcg/ml of MIC. It was similar to PIPC. (2) Any effect to hepatic or renal function was not observed. (3) Clinical response obtained in these cases was excellent in 13 cases (86.7%), good in 2 cases (13.3%) and none of poor case.