Pertussis

Olson, Lloyd C.

doi:10.1097/00005792-197511000-00001

Cited by 95 publications

(70 citation statements)

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“…In fact, for unknown reasons, women of all ages have an increased susceptibility to pertussis. 5,6 If a pregnant women contracts pertussis, transplacental antibodies do not protect the infant. Therefore, disease is more likely to be severe in younger children often requiring perinatal intensive care unit support and leading to higher mortality.…”

Section: Epidemiologymentioning

confidence: 99%

Perinatal/Neonatal Transport Casebook: A 3-Week-Old Infant With a Cough and Limp Spells

1999

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A 3-week-old female infant born at 39 weeks' gestation presented with a 2-day history of cough. The cough was described as episodic and lasting for up to 1 minute. She would occasionally turn reddish-blue around the lips and was intermittently pale by the end of the episode. In addition, she had spells not precipitated by cough where she would become pale and limp. One day before admission, she was seen by her pediatrician and had a chest radiograph examination that was normal and a complete blood count that was remarkable for a total white blood cell count of 20,700 with a differential with 28% neutrophils and 58% lymphocytes. She returned to the pediatrician on the day of admission with worsening episodes and decreased oral intake, decreased urine output, and post tussive emesis. Her mother reported a chronic episodic cough beginning 2 weeks before delivery of this infant.This baby was born by the spontaneous vaginal delivery route, and her birth weight was 3740 gm (75th percentile). She had been breast feeding without problems and was gaining weight. She had received the first dose of hepatitis B vaccine but had not received any other vaccines.On presentation, the physical examination revealed a sleeping infant with a weight of 4218 gm (50th percentile). Her temperature was 97.1°F (axillary) with a heart rate of 148 beats per minute, a respiratory rate of 34 breaths per minute, and a blood pressure of 76/40 mm Hg. Her extremities were cool and mucous membranes were tacky. Her chest was clear to auscultation. The rest of the physical examination was unremarkable. The baby was given intravenous fluids, which improved her cardiovascular status significantly.She was admitted to the pediatric unit and placed on an apnea monitor and a pulse oximeter. Over the next few hours, the infant had bradycardic episodes as frequently as every 5 minutes with heart rates down to approximately 60 beats per minute; following the episodes she was also noted to be pale and limp. Coughing preceded very few of these episodes. The decision was made to transport. The infant was intubated before transporting and remained stable during the transport. She was admitted to the pediatric intensive care unit and remained intubated for 4 days. She was extubated and weaned to room air over the next 4 days. The infant was "back transported" to us and continued to have episodes of apnea and bradycardia requiring vigorous stimulation up to 12 times per day, usually triggered by coughing and gagging. However, her oral intake improved and she gained weight appropriately. She was discharged home 5 weeks after the initial presentation. DENOUEMENT AND DISCUSSION A 3-Week-Old Female Infant With a Cough and Limp SpellsPerinatal pertussis is not a common problem in the first month of life; however, it is beginning to be diagnosed more frequently. Over 40% of reported pertussis cases occur in infants less than 6 months of age. In most cases, the source of infection is a close household contact, most frequently the mother. The mother is the most common inf...

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Section: Epidemiologymentioning

confidence: 99%

Perinatal/Neonatal Transport Casebook: A 3-Week-Old Infant With a Cough and Limp Spells

1999

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“…Various biologic activities and factors, formerly considered to be independent entities, have PT as their common substrate. These include the histamine sensitizing factor (5,6), lymphocytosis-promoting factor (4), islet-activating protein (7,8), adjuvant effect (9), and mitogenic effect (10). Although well characterized in animal and cell culture models, almost nothing is known about the relevance of these factors and their mechanisms of action within the human system under in vivo conditions.…”

Section: 'mentioning

confidence: 99%

Impaired Formation of the Second Messenger cAMP in Mononuclear Blood Cells of Children with Pertussis

1989

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ABSTRACT. To determine the pathophysiologic significance of pertussis toxin (PT) on the human P-adrenergic system, P-adrenoceptor (P-R)-density and cyclic AMP response of peripheral mononuclear blood cells (MN leukocytes) were studied in children during the paroxysmal stage of natural pertussis infection, after vaccination with pertussis monovaccine, and in controls. Isoprenaline-induced cAMP accumulation, measured in a protein-binding assay, was significantly reduced to about 25-50% in children during the first week of paroxysmal pertussis, compared with controls. In contrast, cAMP accumulation after stimulation of the adenylyl cyclase by forskolin was unaffected. The density and affinity of P-R, estimated by lZSI-cyanopindolol-binding studies, were not significantly altered. The suggestion that PT might impair the coupling of the P-R signals to the adenylyl cyclase was confirmed by parallel in vitro studies on MN leukocytes from adults. These cells, when incubated with purified PT, showed a significantly diminished cAMP response to isoprenaline, whereas that to forskolin remained unaffected. As cAMP accumulation in response to prostaglandin El and hydrocortisone was also reduced, it appears that PT may directly affect Gproteins serving as signal transducers for several stimulatory receptors. In contrast to the actual disease, in children treated with pertussis monovaccine, cAMP accumulation as well as the P-R were unaffected. It is concluded that in MN leukocytes obtained from children during the natural course of pertussis, as well as after incubation of normal MN leukocytes with PT, the stimulatory signal-transducing system for cAMP generation is inhibited. 20'The major virulence determinant is PT, which is assumed to be responsible for some of the clinical manifestations of the disease (2), in particular lymphocytosis (4). Various biologic activities and factors, formerly considered to be independent entities, have PT as their common substrate. These include the histamine sensitizing factor (5, 6), lymphocytosis-promoting factor (4), islet-activating protein (7,8), adjuvant effect (9), and mitogenic effect (10). Although well characterized in animal and cell culture models, almost nothing is known about the relevance of these factors and their mechanisms of action within the human system under in vivo conditions.PT affects regulatory G-proteins of the membranous adenylyl cyclase system via ADP-ribosylation (7). Within the adrenergic system, PT has been shown to inhibit the inhibitory G-protein of az-adrenoceptors (1 1). However, whereas much information has accumulated concerning the effect of PT on inhibitory receptor systems linked to adenylyl cyclase in various cell types, insufficient information is available as to whether PT might also influence processes involving G-proteins that are stimulatory coupled to adenylyl cyclase. As &R-mediated activation of the adenylyl cyclase in MN leukocytes involves the action of stimulatory G-proteins, the present investigation was performed on these cells which are...

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“…2 The severe and potentially fatal complications include convulsions, bronchopneumonia and encephalopathy. 3 Protection, albeit claimed as variable in duration, can be conferred by vaccination with killed whole cell vaccines. As the recommended vaccination schedule does not commence until 2 months of age and the immune system remains immature throughout the first year of an infant's life, children less than 1 year-old being the highest risk group.…”

Section: Introductionmentioning

confidence: 99%

“…However, the severe cough can re-emerge in the presence of an opportunistic infection. 3 Apart from the classical pertussis syndrome, there are several forms of an atypical infection. Although the cough is the defining symptom of pertussis, it has been reported that culturepositive neonates and infants have presented with symptoms such as apnea and seizures in the absence of paroxysms.…”

Section: Introductionmentioning

confidence: 99%