LETTER

Mechanisms of pulmonary hypertension in Bordetella pertussis

M J Peters¹, C M Pierce¹, N J Klein²

¹ Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
² Infectious Diseases and Microbiology Unit, Institute of Child Health, London, UK

Correspondence to:
Correspondence to:
Dr Peters;
m.peters@ich.ucl.ac.uk

Keywords: Bordetella pertussis; pulmonary hypertension

The first 150 words of the full text of this article appear below.

Casano et al describe a case of refractory pulmonary hypertension with severe Bordetella pertussis infection.¹ Their description of the literature is incomplete. We described four cases of fatal pulmonary hypertension (PHT) in a series of 13 critically ill infants with B pertussis.² The cases that developed PHT all presented with severe hyperleukocytosis (WCC>100 x 10⁹/l) which was unresponsive to all currently available modalities including extra-corporeal membrane oxygenation. Hyperleukocytosis was an independent predictor of death when corrected for presentation severity of illness. We suggested the existing histological evidence³ was such that extreme leukocytosis prediposes to the formation of lymphocyte aggregates in the pulmonary vasculature and increased pulmonary vascular resistance via obstruction rather than hypoxic vasoconstriction. Therefore Dr Casano’s recommendation for the early use of pulmonary vasodilators is unlikely to be sufficient in this context. We are assessing the impact of strategies aimed at reducing lymphocyte numbers and adhesion in . . . [Full text of this article]

M Pons³, P Casano³

³ Hospital Sant Joan de Déu, Unidad de Cuidados Intensivos Pediátricos, Passeig de Sant Joan de Déu, 2 080950, Esplugues de Llobregat, Barcelona, Spain

Correspondence to:
Correspondence to:
Dr Pons;
mpons@hsjdbcn.org

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