Article Text

A NEW CASE OF SEVERE PERTUSSIS INFECTION: DO WE NEED TO CHANGE IMMUNIZATION SCHEDULE?
  1. L L ArcalaBares1,
  2. A AlegreAlvarenga1,
  3. A TahaYasin1,
  4. M Z LeonLozano1,
  5. E MaideuPuig1
  1. 1Pediatric Department, Hospital Comarcal Del Ripolles, Campdevanol, Girona, Spain

Abstract

Objective Pertussis (or whooping cough) is a major cause of significant morbidity and mortality among infants, toddlers and adolescents. Vaccination guidelines against Bordetella pertussis recommend a first-dose at 2 months of age. We describe a case of severe pertussis infection.

Clinical case A 2-month-old male infant from Morocco with normal perinatology period and no previous reported diseases presented to the emergency room with a 48-hour history of mild respiratory distress, cough and wheezing. He had received DTPa first dose vaccine. Nasopharyngeal swab test for RSV was negative. Oxygen, bronchodilatador therapy and supportive measures were started at hospital admission. Five days later, his clinical status worsened with persistent cough, tachypnea, hypoxemia and facial cyanosis. Leucocytosis and reactive lymphocytosis were noted in blood analysis. A nasopharyngeal test searching for Bordetella pertussis using polymerase chain reaction was positive. The infant was transferred to the Intensive Care Unit and needed mechanical ventilation. He received macrolide treatment and antiepileptic drugs due to seizures as well. He was discharged with normal neurologic development and no pulmonary complications. EEG study showed epileptic trends and valproic acid was given orally after neurologic consultation. The infant did well with good feeding and weight gain. Vaccines were administered according to routine immunization schedule.

Conclusions A high index of suspicion of pertussis infection in infants with persistent cough is recommended. Cyanosis or apnea are good predictors of the disease. Early vaccination is mandatory in all infants in order to prevent pertussis severity.

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