Skip to main content
NCBI home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2020 Mar 30;57(3):228–231. doi: 10.1007/s13312-020-1756-3

Clinical Profile of Critical Pertussis in Children at a Pediatric Intensive Care Unit in Northern India

T K Kavitha 1,✉, Madhusudan Samprathi 1, Muralidharan Jayashree 1, Vikas Gautam 2, Lucky Sangal 3
PMCID: PMC7223409  PMID: 32198862

Abstract

Objective

To delineate the clinical profile, complications, intensive care needs, and predictors of mortality in children with critical pertussis.

Methods

Retrospective analysis of case records of children in the pediatric intensive care unit of a tertiary-care hospital, with a diagnosis of critical pertussis over 3 years. Diagnostic criteria included CDC case definition and confirmation by polymerase chain reaction (PCR), when available. Survivors and nonsurvivors were compared to identify predictors of mortality.

Results

36 records were analysed, most cases were infants (31, 86.1%). 10 (27.7%) were (below 6 weeks of age). In the rest, 16 (61.5%) were partially immunized or unimmunized against pertussis. Rapid breathing (88.9%), paroxysmal cough (86.1%) and apnea (41.7%) were common presenting complaints. Hypoxemia (97.2%), hyperleukocytosis (61.1%) and encephalopathy (52.8%) were common complications. Intensive care needs were mechanical ventilation in 11 (30.6%), vasoactive support in 7 (19.4%) and exchange transfusion in 3 (8.3%). Female gender, apnea, hyperleukocytosis, encephalopathy, need for vasoactive support, and mechanical ventilation predicted mortality.

Conclusion

Pertussis demands attention due to its varied presentation, increased complications and higher mortality.

Key words: Apnea, DPT vaccine, Immunization, Outcome

Footnotes

Contributors: TKK, MS: collected and analysed the data and prepared the initial draft of the manuscript; MJ designed the study, finalized the manuscript; VG and LS provided the laboratory support and gave critical inputs for the manuscript. All authors approved the final version.

Funding: None; Competing interests: None stated.

References

  • 1.Jackson DW, Rohani P. Perplexities of pertussis: Recent global epidemiological trends and their potential causes. Epidemiol Infect. 2014;142:672–84. doi: 10.1017/S0950268812003093. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.World Health Organization. Disease surveillance and Burden. 2019. [Google Scholar]
  • 3.Bisgard KM, Pascual FB, Ehresmann KR, Miller CA, Cianfrini C, Jennings CE, et al. Infant pertussis: Who was the source? Pediatr Infect Dis J. 2004;23:985–9. doi: 10.1097/01.inf.0000145263.37198.2b. [DOI] [PubMed] [Google Scholar]
  • 4.Kowalzik F, Barbosa AP, Fernandes VR, Carvalho PR, Avila-Aguero ML, Goh DY, et al. Prospective multinational study of pertussis infection in hospitalized infants and their household contacts. Pediatr Infect Dis J. 2007;26:238–42. doi: 10.1097/01.inf.0000256750.07118.ee. [DOI] [PubMed] [Google Scholar]
  • 5.Skoff TH, Kenyon C, Cocoros N, Liko J, Miller L, Kudish K, et al. Sources of infant pertussis infection in the United States. Pediatrics. 2015;136:635–41. doi: 10.1542/peds.2015-1120. [DOI] [PubMed] [Google Scholar]
  • 6.Burr JS, Jenkins TL, Harrison R, et al. The Collaborative Pediatric Clinical Care Research Network (CPCCRN) Critical Pertussis Study: Collaborative research in pediatric critical care medicine. Pediatr Crit Care Med. 2011;12:387–92. doi: 10.1097/PCC.0b013e3181fe4058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Borgi A. Predictors of mortality in mechanically ventilated critical pertussis in a low income country: new resurgence in 2013. Mediterr J Hematol Infect Dis. 2014;6:e2014059. doi: 10.4084/mjhid.2014.059. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Kazantzi MS, Prezerakou A, Kalamitsou SN, Ilia S, Kalabalikis PK, Papadatos J, et al. Characteristics of Bordetella pertussis infection among infants and children admitted to paediatric intensive care units in Greece: A multicentre, 11-year study. J Paediatr Child Health. 2017;53:257–62. doi: 10.1111/jpc.13427. [DOI] [PubMed] [Google Scholar]
  • 9.Palvo F, Fabro AT, Cervi MC, Aragon DC, Ramalho FS, Carlotti APCP. Severe pertussis infection. Medicine (Baltimore) 2017;96:e8823. doi: 10.1097/MD.0000000000008823. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Chong C-Y, Yung C-F, Tan N-H, Acharyya S, Thoon KC. Risk factors of ICU or high dependency requirements amongst hospitalized pediatric pertussis cases: A 10 year retrospective series, Singapore. Vaccine. 2017;35:6422–8. doi: 10.1016/j.vaccine.2017.09.085. [DOI] [PubMed] [Google Scholar]
  • 11.Straney L, Schibler A, Ganeshalingham A, Alexander J, Festa M, Slater A, et al. Burden and outcomes of severe pertussis infection in critically ill infants. Pediatr Crit Care Med. 2016;17:735–42. doi: 10.1097/PCC.0000000000000851. [DOI] [PubMed] [Google Scholar]
  • 12.Macdonald-Laurs E, Ganeshalingham A, Lillie J, McSharry B, Segedin ER, Best E, et al. Increasing incidence of life-threatening pertussis. Pediatr Infect Dis J. 2017;36:282–9. doi: 10.1097/INF.0000000000001441. [DOI] [PubMed] [Google Scholar]
  • 13.Berger JT, Carcillo JA, Shanley TP, Wessel DL, Clark A, Holubkov R, et al. Critical Pertussis Illness in Children. Pediatr Crit Care Med. 2013;14:356–65. doi: 10.1097/PCC.0b013e31828a70fe. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Rauf A, Sachdev A, Gupta D. Exchange transfusion as a treatment strategy in severe pertussis with hyperleukocytosis in an infant — A case report. Critical Care Pediatrics. 2018;1:1–3. [Google Scholar]
  • 15.Mikelova LK, Halperin SA, Scheifele D, Smith B F-, Jones E, Vaudry W, et al. Predictors of death in infants hospitalized with pertussis: a case-control study of 16 pertussis deaths in Canada. J Pediatr. 2003;143:576–81. doi: 10.1067/S0022-3476(03)00365-2. [DOI] [PubMed] [Google Scholar]
  • 16.van der Maas NAT, Mooi FR, de Greeff SC, Berbers GA, Spaendonck MA, de Melker HE. Pertussis in the Netherlands, is the current vaccination strategy sufficient to reduce disease burden in young infants? Vaccine. 2013;31:4541–7. doi: 10.1016/j.vaccine.2013.07.060. [DOI] [PubMed] [Google Scholar]
  • 17.Etkind P. Pertussis outbreaks in the United States. Am Fam Physician. 1991;44:1622–3. [PubMed] [Google Scholar]
  • 18.Dahiya S, Kapil A, Kabra SK, Mathur P, Sood S, Lodha R, et al. Pertussis in India. J Med Microbiol. 2009;58:688–9. doi: 10.1099/jmm.0.47847-0. [DOI] [PubMed] [Google Scholar]
  • 19.Takum T, Gara D, Tagyung H M, M V. An outbreak of pertussis in Sarli Circle of Kurung-kumey district, Arunachal Pradesh, India. Indian Pediatr. 2009;46:1017–20. [PubMed] [Google Scholar]
  • 20.Vashishtha VM. Adolescent immunization schedule: Need for a relook. Indian Pediatr. 2019;56:101–04. doi: 10.1007/s13312-019-1479-5. [DOI] [PubMed] [Google Scholar]
  • 21.Peters MJ. Mechanisms of pulmonary hypertension in Bordetella pertussis: Authors’ reply. Arch Dis Child. 2003;88:92-b-93. [DOI] [PMC free article] [PubMed]
  • 22.Donoso AF, Cruces PI, Camacho JF, Len JA, Kong JA. Exchange transfusion to reverse severe pertussis-induced cardiogenic shock. Pediatr Infect Dis J. 2006;25:846–8. doi: 10.1097/01.inf.0000232630.70138.a2. [DOI] [PubMed] [Google Scholar]
  • 23.Nieves D, Bradley JS, Gargas J, Mason WH, Lehman D, Lehman SM, et al. Exchange blood transfusion in the management of severe pertussis in young infants. Pediatr Infect Dis J. 2013;32:698–9. doi: 10.1097/INF.0b013e31828c3bb3. [DOI] [PubMed] [Google Scholar]

Articles from Indian Pediatrics are provided here courtesy of Nature Publishing Group

RESOURCES