Sensitivity and specificity of clinical case definitions for pertussis.

Patriarca, P.; Biellik, Robin; Sanden, Gary N.; Burstyn, Don G.; Mitchell, Paul D.; Silverman, Paul; Davis, Jeffrey P.; Manclark, C R

doi:10.2105/ajph.78.7.833

Cited by 77 publications

(35 citation statements)

References 8 publications

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“…Clinical case definitions of pertussis have limited specificity (162)(163)(164). Therefore, in the following, for assessment of the sensitivities of serodiagnosis methods, we used studies, as much as possible, in which clinical suspicion of pertussis was confirmed by positivity of culture and/or PCR for B. pertussis.…”

Section: Serodiagnosis Of Pertussismentioning

confidence: 99%

Laboratory Diagnosis of Pertussis

2015

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SUMMARYThe introduction of vaccination in the 1950s significantly reduced the morbidity and mortality of pertussis. However, since the 1990s, a resurgence of pertussis has been observed in vaccinated populations, and a number of causes have been proposed for this phenomenon, including improved diagnostics, increased awareness, waning immunity, and pathogen adaptation. The resurgence of pertussis highlights the importance of standardized, sensitive, and specific laboratory diagnoses, the lack of which is responsible for the large differences in pertussis notifications between countries. Accurate laboratory diagnosis is also important for distinguishing between the several etiologic agents of pertussis-like diseases, which involve both viruses and bacteria. If pertussis is diagnosed in a timely manner, antibiotic treatment of the patient can mitigate the symptoms and prevent transmission. During an outbreak, timely diagnosis of pertussis allows prophylactic treatment of infants too young to be (fully) vaccinated, for whom pertussis is a severe, sometimes fatal disease. Finally, reliable diagnosis of pertussis is required to reveal trends in the (age-specific) disease incidence, which may point to changes in vaccine efficacy, waning immunity, and the emergence of vaccine-adapted strains. Here we review current approaches to the diagnosis of pertussis and discuss their limitations and strengths. In particular, we emphasize that the optimal diagnostic procedure depends on the stage of the disease, the age of the patient, and the vaccination status of the patient.

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Section: Serodiagnosis Of Pertussismentioning

confidence: 99%

Laboratory Diagnosis of Pertussis

2015

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“…Therefore, diagnosis of pertussis infection usually depends on the presence of symptoms such as cough, paroxysms and Whooping inspiration (3). Patriarca et al (4) suggest 14 clinical case definitions with different sensitivity and specificity depending on the combination of symptoms used, Nevertheless, establishing a clinical diagnosis is becoming more difficult, because an increasing number of vaccinated and/or 1University Children's Hospital, University of Basel, ~Roemergasse 8 (8)(9)(10)(11)(12). These cases cannot be detected by conventional laboratory methods.…”

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confidence: 99%

Use of the polymerase chain reaction to detectBordetella pertussis in patients with mild or atypical symptoms of infection

Schlapfer

Senn

Berger

et al. 1993

Eur. J. Clin. Microbiol. Infect. Dis.

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Nasopharyngeal aspirates and nasopharyngeal swabs from 177 children exhibiting mild to severe clinical symptoms of whooping cough were tested by the polymerase chain reaction (PCR) and culture for the presence of Bordetella pertussis. In the PCR analysis amplifications of samples prepared with and without DNA extraction were compared. In 26% of samples prepared without DNA extraction, the PCR was found to be inhibited, whereas no inhibition was detected after DNA extraction. Twelve percent (21/177) of the samples were positive in both culture and the PCR, and an additional 49% (87/177) of the samples were positive exclusively in the PCR. Thirty-eight percent (8/21) of culture-positive patients and 63% (55/87) of the patients in whom infection was detected only by PCR had mild or atypical clinical symptoms. Of these groups 26% (5/19) and 50% (39/78), respectively, had been fully vaccinated with three or more doses of diphtheria, tetanus and pertussis vaccine.

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“…Possible explanations for this finding include a substantially larger inter-individual scatter than the within error in the paired experiments with and without pertussis toxin. Incorrect assignment of children to the pertussis group might be another reason although because of the high sensitivity and specificity of the clinical case definition of pertussis [18], together with the occurrence during a local endemic outbreak with documented positive cultures, this appears unlikely. Finally, pertussis infection itself might have altered histamine release from basophils either by direct action on the basophils or mediated by other activated cell types in the suspension.…”

Section: Discussionmentioning

confidence: 99%

“…The third group consisted of 33 children with pertussis infection (4.5 _+ 0.34 years old; range 0.7-8.5). Diagnosis of pertussis [18] was established by typical clinical features like cough for more than 14 days or whoop (positive in 100%), history of contact 586 with a known case (positive in 85%), leucocytosis (> 12000/gl in 37%), absolute lymphocytosis, increased specific serum IgA, IgG and IgM antibodies (ELISA) (positive in 58%) and in several cases by culture of B.pertussis from a nasopharyngeal swab (positive in 73%). All cases occurred during a local pertussis endemic from April to August 1989.…”

Section: Methodsmentioning

confidence: 99%

Histamine release from basophils in childhood: Age dependency and inhibition by pertussis infection and pertussis toxin

Griese

Feldmann

et al. 1993

Eur J Pediatr

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The influence of childhood pertussis infection and of purified pertussis toxin on histamine release from human basophil leucocytes was investigated. Three different stimuli, the peptide N-formyl-Met-Phe (NFMP), anti-IgE, and the calciumionophore A23187 were used to challenge the cells. When NFMP was the stimulus, histamine release in the control group (age 0.5-17 years) increased in an age-dependent fashion, whereas anti-IgE and A23187 stimulated release did not vary with age. During the convulsive state of pertussis infection there was a significant reduction of histamine release in response to 10 microM NFMP (from 9.5 +/- 1.4 [n = 21] to 6.7 +/- 1.5 [n = 19], P < 0.05) and in response to 800 and 80 U/ml anti-IgE (from 28.5 +/- 5 [n = 19] to 16.3 +/- 5 [n = 13], P < 0.05, and from 6.9 +/- 1.7 [n = 16] to 2 +/- 0.8 [n = 13], P < 0.01), whereas histamine release stimulated by A23187 was unchanged compared to release in control children. In vitro pretreatment of basophils from healthy children and adults with pertussis toxin also inhibited histamine release. When NFMP was the stimulus, release was completely blocked by pertussis toxin with an IC50 of about 11 ng/ml, whereas anti-IgE stimulated release was only inhibited by 20%-30% and release induced by A23187 was reduced to 40%-50% by toxin treatment. In conclusion we have demonstrated a functional impairment of histamine release during the convulsive state of pertussis and that this inhibition is likely to be mediated by pertussis toxin.

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Sensitivity and specificity of clinical case definitions for pertussis.

Cited by 77 publications

References 8 publications

Laboratory Diagnosis of Pertussis

Laboratory Diagnosis of Pertussis

Use of the polymerase chain reaction to detectBordetella pertussis in patients with mild or atypical symptoms of infection

Histamine release from basophils in childhood: Age dependency and inhibition by pertussis infection and pertussis toxin

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