1/39. Pertussis is increasing in unimmunized infants: is a change in policy needed?The proportion and trend in absolute number of pertussis notifications in young infants has increased each year in england and wales since the accelerated immunization schedule was introduced. We report five infants all less than 3 months of age admitted with life threatening pertussis infection to two paediatric intensive care units. Despite aggressive cardiorespiratory support measures, three of the infants died. Pertussis remains a significant cause of morbidity and mortality in unimmunized infants. In this age group presentation is likely to be atypical and infection more severe. public health measures to prevent the disease could be strengthened. Chemoprophylaxis should be offered to susceptible contacts and booster vaccinations against pertussis considered.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/39. cerebellar ataxia following whooping cough.bordetella pertussis (BP), the agent of whooping cough, has not been recognized so far as a cause of permanent cerebellar ataxia in human. We describe three patients who developed a disabling and permanent cerebellar syndrome soon after whooping cough. In two patients, diagnosis of BP infection was confirmed by culture of nasopharyngeal secretions. The infection occurred between the age of 13 and 15 years, with neurological symptoms beginning after a delay varying from 3 weeks to 3 months. In our three patients, the cerebellar syndrome was characterized by dysmetria of ocular saccades, scanning speech and ataxic gait. brain MRI demonstrated a pancerebellar atrophy. The pathogenesis of this cerebellar degeneration is not established. Experimental studies have demonstrated that the cerebellum is particularly vulnerable to lymphocytosis-promoting factor (LPF), one of the exotoxins from BP. The mechanism of this toxicity might be a marked increase in the cellular levels of 3',5'cyclic guanosine monophosphate (cGMP). Since whooping cough is a bacterial exotoxin-mediated disease, this is the first report of a cerebellar syndrome triggered by a bacterial exotoxin.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
3/39. prenatal diagnosis of tracheal obstruction: possible association with maternal pertussis infection.A fetus with the sonographic appearance of echogenic and enlarged lungs and dilated trachea and bronchi, indicating laryngotracheal obstruction, is reported. Additionally, the fetus had ascites and subcutaneous edema and the amniotic fluid volume was reduced. Doppler flow investigation of the systemic venous circulation revealed signs of heart failure, and color Doppler visualized possible increased pulmonary flow. Following termination of pregnancy, autopsy confirmed the sonographic observations and revealed a hypoplastic thymus. During the present pregnancy the mother suffered from sustained cough, and serological tests revealed acute pertussis infection. polymerase chain reaction investigation for bordetella pertussis in the amniotic fluid was negative. The possibilities of pertussis toxins as noxious factors and of an atypical presentation of DiGeorge anomaly are discussed.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
4/39. Early infantile pertussis; increasingly prevalent and potentially fatal.We report nine cases of severe early pertussis in infants less than 7 weeks of age. Clinical features at this age are atypical and may be confused with more common illnesses such as bronchiolitis. All were very difficult to manage. ventilation was required for apnoeas in five cases, seizures in two or respiratory failure in two. Complications included hypotension in seven cases, pulmonary hypertension in one, pneumothoraces in two, seizures in five and co-infection in five. Two cases were referred for extracorporeal membrane oxygenation and six died. infection was confirmed either at post mortem or by culture from pernasal swabs. The mother or other close family members were symptomatic at the time and thought to be the source of infection. CONCLUSION: The nine cases suggest a significant resurgence of the infection, which may be fatal in early life. If reporting continues to increase, the immunisation schedule will need to be reviewed and secondary transmission prevented where possible, to protect this vulnerable pre-immunisation group.- - - - - - - - - - ranking = 1.5keywords = infection (Clic here for more details about this article) |
5/39. Fracture of the first rib as a consequence of pertussis infection.We report the first described case of a first rib fracture secondary to pertussis infection. An 11-year-old boy presented with sudden onset of severe right-sided pleuritic chest pain on a background of a 6 week history of a coughing illness and considerable weight loss. Pertussis was clinically suspected and proven on serology. A cause for the severe pain was initially difficult to confirm, causing some concern regarding possible underlying pathology, but was later demonstrated to be due to a first rib fracture. The anatomy of the first rib, and the biomechanical forces placed upon it that are exacerbated during a coughing illness are described.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
6/39. Laboratory-confirmed reinfections with bordetella pertussis.Susceptibility to infection with bordetella pertussis re-emerges several years after pertussis vaccination. However, the duration of immunity after natural infection with B. pertussis, postulated to be lifelong, is not known. In an ongoing study, the longitudinal course of pertussis antibodies in patients who have had laboratory-confirmed pertussis is being followed using sera obtained at irregular intervals. In 4 patients a reinfection with bordetella pertussis is described respectively 7 (patient A), 12 (patients B and C) and 3.5 (patient D) y after the first infection. It seems that the longer the interval between the infections the more severe the complaints. Conclusion: To the authors' knowledge. these are the first patients in whom symptomatic reinfection with B. pertussis has definitely been proven by laboratory confirmation of both episodes. bordetella pertussis infection should be considered in patients with symptoms of typical or atypical whooping cough, irrespective of their vaccination status or previous whooping cough.- - - - - - - - - - ranking = 5.5keywords = infection (Clic here for more details about this article) |
7/39. Pertussis in a military and military beneficiary population: case series and review of the literature.Three cases of pertussis (whooping cough) identified in a military emergency department are reported. Two of these cases involved infants with typical presentations. One of these infants was too young to have received immunizations, and the other child was only partially immunized. The third case involved an active duty soldier with a chronic cough. Pertussis has become increasingly important as a cause of chronic cough in adults. As a result of the infectivity of this organism, close-quarter situations, such as day care centers and military barracks, create the opportunity for substantial person-to-person transmission. Typical and atypical clinical presentations of pertussis are discussed, with an emphasis on currently available diagnostic modalities. The epidemiology and pathophysiology of this disease are also reviewed. The medical management of active duty soldiers and their dependents (both pediatric and adult) with this largely underappreciated infection and their close contacts is presented.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
8/39. Hemolytic uremic syndrome due to an altered factor H triggered by neonatal pertussis.We report on a previously healthy newborn suffering from severe bordetella pertussis infection who developed hemolytic uremic syndrome (HUS) a few weeks after the onset of whooping cough, with a fatal outcome. A factor H protein with abnormal mobility was found in the serum of the patient as analyzed by Western blotting, indicating that B. pertussis infection might have triggered HUS in a genetically predisposed patient.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
9/39. Pertussis deaths--united states, 2000.Pertussis (i.e., whooping cough) is associated typically with an inspiratory "whoop," prolonged paroxysmal cough, and posttussive vomiting; however, persons infected with bordetella pertussis sometimes experience atypical symptoms, making prompt recognition difficult and probably increasing infection transmission. All infants aged <6 months and any infants who have not yet received 3 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine are especially vulnerable to B. pertussis infection. This report summarizes the investigations of two pertussis deaths that occurred in 2000. Clinicians should consider pertussis as a cause of illness, especially among vulnerable infants who present with cough illness, respiratory distress, or apnea. Timely diagnosis of pertussis in caregivers and other contacts of infants could prevent infant pertussis fatalities.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
10/39. Swyer-James (MacLeod's) syndrome following pertussis infection in an infant.Pertussis is a potentially severe disease, especially in infancy. The case of an 8-month-old infant is described who presented the typical radiographic image of unilateral hyperlucent lung or Swyer-James (MacLeod's) syndrome. The infant suffered from pertussis at 20 d of age. A rare postinfectious complication of pertussis is reported.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
| | Next -> |