Afebrile pneumonia (whooping cough) syndrome in infants at Hospital Universitario del Valle, Cali, 2001-2007

Abstract

Introduction: Afebrile pneumonia syndrome in infants, also called infant pneumonitis, pneumonia caused by atypical pathogens or whooping cough syndrome is a major cause of severe lower respiratory infection in young infants, both in developing countries and in developed countries. Objective: To describe children with afebrile pneumonia syndrome. Methods: Through a cross-sectional study, we reviewed the medical records of children diagnosed with afebrile pneumonia treated at Hospital Universitario del Valle, a reference center in southwestern Colombia, between June 2001 and December 2007. We obtained data on maternal age and origin, prenatal care, the child’s birth, breastfee­ding, vaccination status, symptoms, signs, diagnosis, treatment, and complications. Results: We evaluated 101 children with this entity, noting a stationary presentation: June-August and November- December. A total of 73% of the children were under 4 months of age; the most common symptoms were: cya­notic and spasmodic cough (100%), respiratory distress (70%), and unquantified fever (68%). The most common findings: rales (crackles) (50%), wheezing and expiratory stridor (37%); 66% were classified as mild and of the remaining 33%, half of them required attention in the intensive care unit. In all, there was clinical diagnosis of afebrile pneumonia syndrome in infants, but no etiologic diagnosis was made and despite this, 94% of the chil­dren received macrolides. Conclusions: These data support the hypothesis that most of these patients acquired the disease by airway, possi­bly caused by viral infection and did not require the indiscriminate use of macrolides.

Bordetella pertussis in children hospitalized with a respiratory infection: clinical characteristics and pathogen detection in household contacts

“…Latin America has experienced a resurgence of B. pertussis infections with high morbidity and mortality rates among infants younger than 6 months old, who represent up to 75% of pertussis cases [ 5 , 22 – 28 ].…”

“…It has been demonstrated that a whooping cough alone is not enough to start antibiotics immediately, especially in infants younger than 4 months [ 5 ]. However, in rural areas where laboratory resources are limited physician usually give macrolides when there is high suspicious of pertussis.…”

Clinical characteristics and molecular detection of Bordetella pertussis in hospitalized children with a clinical diagnosis of whooping cough in Peru

“…It has been demonstrated that a whooping cough alone is not enough to start antibiotics immediately, especially in infants younger than 4 months ( 30 ). However, in rural areas where laboratory resources are limited physician usually give macrolides when there is high suspicious of pertussis.…”

Tosferina: una mirada epidemiológica, clínica y del laboratorio

“…La principal causa de muerte en los pacientes infectados por Bordetella pertussis es la neumonía, siendo los menores de edad los más afectados y, en forma más crítica, aquellos en los primeros 12 meses de vida [19]. Otras complicaciones incluyen las neurológicas, como las convulsiones (2%) y la encefalopatía (0,5%), las nutricionales por deshidratación, emesis repetitiva y pérdida del apetito, las que son debidas a los efectos de la presión durante los accesos de tos, como el neumotórax, las atelectasias, las fracturas costales, las hernias y el prolapso rectal, y los sangrados como hematomas subdurales, hemorragias gastrointestinales, hemorragias subconjuntivales, epistaxis y petequias [5,19,21,32].…”

“…Las principales complicaciones del síndrome de coqueluche son las infecciones, en especial las respiratorias como la bronconeumonía, la bronquitis, la bronquiolitis, la neumonitis, las apneas, el empiema pleural y atelectasias residuales, así como otitis media, debidas principalmente a la sobreinfección con microorganismos como Streptococcus pneumoniae, Haemophilus influenzae y Staphylococcus aureus [32]. La neumonía afebril del lactante es una importante enfermedad exclusiva de los niños en este período, que suele llegar a ser grave y es causada por microorganismos atípicos y resistentes a los tratamientos convencionales.…”