Coqueluche grave,e volución y exanguino transfusión como tratamiento alternativo. Serie de casos

Abstract

Pertussis is a contagious disease that may develop a serious clinical picture by hypoxemia and pulmonary hypertension refractory to treatment. The syndrome of hyperviscosity and arteriolar thrombosis is responsible for the cardiocirculatory collapse. Our objective is to describe the evolution of a series of patients with severe pertussis, some of whom received exchange transfusion (ET) as an alternative treatment. We analyzed 41 patients' clinical charts with diagnosis of pertussis treated in the Pediatric Intensive Care Units during the 2003-2011 period. The mean age was 2.38 months. In the 90.2% of cases, the cause of admission to PICU was respiratory failure; 75% required mechanical respiratory support and 39% developed pulmonary hypertension. The overall mortality was 41.4%. Nine patients were treated by ET, 5 died. Conclusion. Severe pertussis is associated with high mortality. ET reduced the mass of circulating leukocytes in 53.5%; ET could be an alternative to conventional treatment, although controlled studies are required to assert it.

Epidemiology of Bordetella pertussis in a children‘s hospital

“…32,33 The case fatality rate in our series of patients was 6.8%, with a median age of 2 months old; these data are consistent with those provided by other tertiary care facilities from Argentina. 34 In all cases, deceased patients had a leukocyte count higher than 20 000/mm 3 at pertussis onset, with a median count of 43 150/mm 3 . Such finding supports the validity of using a hyperleukocytosis parameter as a predictor of mortality, as described by other authors.…”

Actualización en terapias de leucorreducción como alternativas para el tratamiento de coqueluche grave

“…En 2012, parte de los autores responsables d e e s t e m a n u s c r i t o p u b l i c a n u n t r a b a j o retrospectivo 29 35,37 39 GB: glóbulos blancos; Pte. : paciente; ETDV: exanguinotransfusión doble volumen; ETUV: exanguinotransfusión único volumen; HTP: hipertensión pulmonar; ECMO: oxigenación por membrana extracorpórea; BGC: bajo gasto cardíaco; FMO: falla múltiple de órgano; NE: no especifica; PCR: proteína C reactiva.…”

“…Luego de estas 4 grandes series 23,29,30,32 publicadas, aparecen en la literatura reportes de casos [33][34][35][36][37] (Tabla 2), con un total de 6 exanguinotransfusiones y una supervivencia en los pacientes expuestos a dicho tratamiento del 100%.…”