Hospital-Diagnosed Pertussis Infection in Children and Long-term Risk of Epilepsy

Olsen, Morten; Thygesen, Sandra Kruchov; Østergaard, John R.; Nielsen, Henrik; Henderson, Victor W.; Ehrenstein, Véra; Nørgaard, Mette; Sørensen, Henrik Toft

doi:10.1001/jama.2015.13971

Cited by 20 publications

(22 citation statements)

References 21 publications

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“…Long term follow-up data do not suggest an increased asthma risk in adulthood 525354. Small studies have suggested possible intellectual impairment55 and slight increased risk of developing epilepsy56 after childhood pertussis, but these studies are underpowered and lack long term follow-up.…”

Section: What Are the Risks?mentioning

confidence: 99%

Pertussis (whooping cough)

Gopal

Barber

Toeg³

2019

BMJ

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Section: What Are the Risks?mentioning

confidence: 99%

Pertussis (whooping cough)

Gopal

Barber

Toeg³

2019

BMJ

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“…It is important to note that although apneic episodes are frightening, they do not cause death. However, the hypoxia associated with an apneic episode may be a causative factor in later epilepsy and subsequent intellectual impairment [16, 17]. …”

Section: Clinical Characterisitcs Of Bordetella Pertussis Infection Imentioning

confidence: 99%

Pertussis in Young Infants Throughout the World

Cherry

2016

Clin Infect Dis.

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In typical pertussis in young infants, the child will appear deceptively well; he or she will have coryza, sneezing, and a mild cough. There is no fever. This progresses to gagging, gasping, eye bulging, bradycardia, cyanosis, and vomiting. There is leukocytosis with lymphocytosis and apneic episodes. Deaths relate to leukocytosis, pulmonary hypertension, and pneumonia. The source of pertussis in young infants is most often a family member with cough illness that is not recognized as pertussis. Diagnosis is based on culture/polymerase chain reaction and leukocytosis with lymphocytosis. Treatment depends on macrolide antibiotic therapy and intubation, with assisted ventilation and oxygen. Prevention is based on prophylactic macrolide treatment, immunization starting at 6 weeks of age, and immunization of all pregnant women in the second or third trimester.

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“…Few studies have looked into the association between a wide range of infections and the subsequent risk of epilepsy, but a number of studies have examined the risk of epilepsy after specific infections. A previous Danish register–based study looking specifically at Bordetella pertussis infections found a subsequent HR for epilepsy of 1.7 (95% CI 1.3‐2.2), with higher risk for those with a longer duration of admission for infection and a similarly increased risk across different age groups of infections . The risk of epilepsy after toxoplasmosis was systematically reviewed in an article from 2015, which reported a pooled odds ratio for epilepsy of 2.25 (95% CI 1.27‐3.98) .…”

Section: Discussionmentioning

confidence: 99%

“…1,3 Immunologic hypotheses about subgroups of epilepsy have gained growing attention in recent years, with several studies suggesting a connection between infections and the development of epilepsy. [4][5][6][7][8] Infection of the central nervous system (CNS), in particular, is a well-known risk factor for epilepsy and is considered "the main cause of seizures and acquired epilepsy in the developing world." 4 However, infections outside of the CNS can also harm the brain, for example, through induction of inflammatory responses affecting the brain, including the development of autoantibodies that can cross-react with brain antigens.…”

Section: Introductionmentioning

confidence: 99%

Infections and risk of epilepsy in children and young adults: A nationwide study

et al. 2018

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Summary Objective The development of epilepsy has been linked to infections of the central nervous system, but recently also to infections and inflammation outside of the central nervous system. Thus we investigated the association between infections and the risk of subsequent epilepsy. Methods This was a Danish nationwide population‐based cohort study comprising a total of 1 938 555 individuals born between 1982 and 2012. Individuals were followed from birth until December 31, 2012, death, disappearance, emigration, or epilepsy diagnosis, whichever came first (28 512 666 person‐years of follow‐up). The exposure was hospital contacts for infection and the outcome was a diagnosis of epilepsy as recorded in the Danish National Hospital Register. Hazard ratios were calculated using Cox proportional hazards models adjusted for age, sex, calendar period, Apgar score, gestational age, birth weight, and parental history of epilepsy. Results A total of 25 825 individuals received an epilepsy diagnosis during the study period, among whom 8235 (32%) had a previous hospital contact for infection. A hospital contact for infection was associated with a 78% increase in the risk of subsequently receiving an epilepsy diagnosis (hazard ratio 1.78, 95% confidence interval [CI] 1.73‐1.83) compared with those without infection. The highest risk was observed after central nervous system infections (hazard ratio 4.97, 95% CI 4.42‐5.59), but increased risks were identified across all infected organ systems and types of pathogens. The risk of receiving an epilepsy diagnosis was correlated with the temporal proximity of the infection (P < 0.001) and increased with the number of hospital contacts for infection (P < 0.001) and with the severity of infection (P < 0.001). Significance The risk of receiving an epilepsy diagnosis was increased after a wide range of infections, suggesting that systemic inflammatory processes may be involved in the development of epilepsy.

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Hospital-Diagnosed Pertussis Infection in Children and Long-term Risk of Epilepsy

Abstract: In Denmark, risk of epilepsy was increased in children with hospital-diagnosed pertussis infections compared with the general population; however, the absolute risk was low.

Cited by 20 publications

References 21 publications

Pertussis (whooping cough)

Pertussis (whooping cough)

Pertussis in Young Infants Throughout the World

Infections and risk of epilepsy in children and young adults: A nationwide study

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