Severe Pertussis Pneumonia managed with Exchange Transfusion

Hyperleukocytosis associated with pertussis: Two case reports

BACKGROUND

Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis. Although the diphtheria-pertussis-tetanus vaccine is widely administered, there are still a number of patients with severe pertussis each year, which can lead to death, especially in infants and young children. Hyperleukocytosis is a factor related to the severity of pertussis and a risk factor for death. Reducing the leukocyte number by plasma exchange is a treatment method in clinical practice.

CASE SUMMARY

Two children with pertussis with cough as the initial symptom, developed pneumonia during the course of the illness. White blood cell counts were significantly increased with the highest values of 87.34 × 10⁹/L and 55.46 × 10⁹/L. Following anti-infection, plasma exchange, and ventilator treatment, both children recovered.

CONCLUSION

Early identification of children with pertussis complicated with hyperleukocytosis and timely plasma exchange can improve the prognosis and reduce mortality.

Severe pertussis in infants: a scoping review

BACKGROUND

Pertussis (Whooping Cough) is a respiratory infection caused by Bordetella pertussis. Pertussis usually occurs in childhood; severe infections are most common in infants. It can be fatal with severe complications such as pulmonary hypertension, heart failure, and encephalitis.

OBJECTIVES

We sought to synthesize the existing literature on severe pertussis in infants and inform further study.

METHODS

A scoping review was performed based on the methodological framework developed by Arksey & O'Malley. Search in Pubmed and Embase databases, with no restrictions on the language and date of publication.

RESULTS

Of the 1299 articles retrieved, 64 were finally included. The selected articles were published between 1979 and 2022, with 90.6% (58/64) of the studies in the last two decades. The studies covered epidemiology, pathology, clinical characteristics, risk factors, treatments, and burden of disease.

CONCLUSION

The literature reviewed suggests that studies on severe pertussis in infants covered a variety of clinical concerns. However, these studies were observational, and experimental studies are needed to provide high-quality evidence.

Use and Waste of Reconstituted Whole Blood Exchange Transfusions: An 11-year National Observational Study

OBJECTIVES

To identify indications for exchange transfusions, assess the use and waste of exchange transfusion products (ie, reconstituted whole blood exchange transfusions), and determine nationwide distribution and prevalence of these transfusions in the Netherlands.

STUDY DESIGN

All 9 neonatal intensive care units and 15 non-neonatal intensive care unit hospitals participated in this retrospective, observational, cohort study. We retrieved data on the indications for and use of all exchange transfusion products ordered by participating centers over an 11-year period.

RESULTS

A total of 574 patients for whom 1265 products were ordered were included for analyses. Severe ABO (32.6%) and non-ABO (25.2%) immune hemolysis and subsequent hyperbilirubinemia were the most frequent indications. Rare indications were severe leukocytosis in Bordetella pertussis (2.1%) and severe anemia (1.5%). Approximately one-half of all ordered products remained unused. In 278 of 574 neonates (48.4%), ≥1 products were not used, of which 229 (82.7%) were due to the resolving of severe hyperbilirubinemia with further intensification of phototherapy. The overall prevalence of neonates who received an exchange transfusion was 14.6:100 000 liveborn neonates.

CONCLUSIONS

A considerable proportion of products remained unused, and annually a limited number of patients are treated with an exchange transfusion in the Netherlands, highlighting the rarity of the procedure in the Netherlands.

Critical pertussis: A multi-centric analysis of risk factors and outcomes in Oman

OBJECTIVES

To identify risk factors and outcomes of patients with critical pertussis.

DESIGN

Retrospective observational cohort study.

SETTING

Sultan Qaboos University Hospital and The Royal Hospital, Muscat, Oman.

SUBJECTS

Children aged <13 years presenting to the emergency departments and diagnosed with laboratory-confirmed pertussis by polymerase chain reaction between January 2013 and December 2018.

MEASUREMENTS AND MAIN RESULTS

In total, 157 patients were diagnosed with pertussis, of which 12% (n = 19) had critical pertussis. Patients with critical pertussis had a higher white blood cell count (WBCC) [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02-1.08; P = 0.003], absolute lymphocyte count (ALC) (aOR 1.08; 95% CI 1.03-1.15; P = 0.004) and absolute neutrophil count (ANC) (aOR 1.05; 95% CI 1.01-1.10; P = 0.032) than patients with non-critical pertussis, even after multi-variate adjustment. The area under the curve for discriminatory accuracy of laboratory variables was 0.75 (95% CI 0.65-0.85), 0.74 (95% CI 0.64-0.84) and 0.72 (95% CI 0.60-0.83) for maximum WBCC, ALC and ANC, respectively, with Youden's cut-off values of 31.5 × 10⁹/L, 19.9 × 10⁹/L and 5.0 × 10⁹/L, respectively.

CONCLUSIONS

In children, higher WBCC, ALC and ANC were significant predictors of critical pertussis. A cut-off level of 31.5 × 10⁹/L for WBCC was associated with critical pertussis.