Virus Coinfection is a Predictor of Radiologically Confirmed Pneumonia in Children with Bordetella pertussis Infection

Abstract

Introduction This study aimed to prospectively investigate the burden of pertussis in southeast Chinese children hospitalized with lower respiratory tract infection (LRTI) during a pertussis outbreak and to compare the outcomes of Bordetella pertussis infection with or without virus coinfections. Methods Children < 24 months of age hospitalized with LRTI were prospectively enrolled from January 2017 to December 2019. Demographic and clinical information were recorded, and respiratory tract samples were tested for the presence of B. pertussis and ten common viruses by polymerase chain reaction (PCR). Results Bordetella pertussis PCR was positive in 6.1% (202/4287) of the patients. Only 146 (72.3%) B. pertussis infections met the Centers for Disease Control and Prevention case definition for pertussis. Among the 202 subjects with B. pertussis infections, 81 (40.1%) were coinfected with at least 1 respiratory virus, with human rhinovirus being the most commonly detected virus (25.7%). No differences in clinical severity were observed between children with single B. pertussis infection and those with virus coinfection [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.39–1.44]. However, children with virus coinfection were significantly more likely to present with radiologically confirmed pneumonia than those with a single B. pertussis infection (OR 2.62; CI 1.39–4.91). Conclusions Bordetella pertussis infection contributed to a high proportion of LRTI hospitalizations among southeast Chinese children. There were no significant differences in clinical severity between children with virus coinfection and single B. pertussis infection, although children coinfected with virus coinfection presented with pneumonia more frequently than those with single B. pertussis infection. Electronic supplementary material The online version of this article (10.1007/s40121-020-00376-5) contains supplementary material, which is available to authorized users.

Clinical Evaluation of the BIOFIRE SPOTFIRE Respiratory Panel

“…For instance, Esper and co-authors reported that influenza patients co-infected with rhinovirus tended to have milder disease [ 27 ]. On the other hand, co-infection of rhinovirus might be associated with refractory M. pneumoniae pneumonia and a higher frequency of B. pertussis LRT infection among hospitalized children [ 28 , 29 ]. Furthermore, concomitant infection of M. pneumoniae or parainfluenza virus 4 in COVID-19 patients was associated with worse clinical outcomes [ 30 , 31 ].…”

Whooping Cough Cases Increase in Central Italy after COVID-19 Pandemic

“…Differently, in our case a co-infection with Rhinovirus/Enterovirus and Staphylococcus epidermidis was also observed. On one side, this coinfection might have played a role in the clinical complication; nevertheless, several studies have shown so far only positive associations between B. pertussis with co-infection and pneumonia, but not with severe disease and outcome [7,8]. Patients with severe clinical situation broad-spectrum antibiotic therapy (prior to any specific diagnosis) should consider drugs that can also control Bordetella.…”

“…In fact, evidence confirms the presence of coinfections between B. pertussis and other pathogens, particularly viruses, although the impact of these on clinical outcome remains unclear. Some studies have observed a positive association between B. pertussis with viral co-infection and the development of pneumonia, but not with severe disease [7,8].…”

Etiologies of Hospitalized Acute Bronchiolitis in Children 2 Years of Age and Younger: A 3 Years' Study During a Pertussis Epidemic

“…This is a novel report explaining such associations. Several other studies (9,14,15,18,(20)(21)(22) assessed the influence of B. pertussis on acute bronchiolitis, but they could not exclude the possibility of other respiratory pathogens contributing to the illness. In the present study, the leukocyte count was higher in patients with B. pertussisonly bronchiolitis infection than that in patients with RSVonly infection, MP-only infection, and infections with other pathogens (p < 0.008 for all comparisons), which could also help distinguish B. pertussis-associated acute bronchiolitis from other acute bronchiolitis etiologies.…”