Title : Clinical characteristics analysis of bordetella pertussis Infection in adult cough patients
Abstract:
Purpose: In contemporary epochs, the prevalence of pertussis has been progressively on the rise, persisting as a formidable health concern. The manifestations following pertussis infection lean towards the atypical, making them easily disregarded or subject to misdiagnosis. Our aim is to ascertain the pertussis infection rate among individuals presenting with a cough and scrutinize the clinical attributes of the infected.
Materials and methods:Screening transpired between July 1, 2023, and September 20, 2023, at Tianjin Chest Hospital and the Second People's Hospital of Tianjin. It focused on individuals seeking medical attention due to cough symptoms or those in contact with presumed pertussis cases. A cohort of 1025 patients was assembled, and nasopharyngeal swabs were procured for polymerase chain reaction (PCR) analysis.
Results:?In accordance with the pertussis case definition, 417 cases (40.7%) were diagnosed as clinically suspected, and 145 cases (14.1%) exhibited epidemiological correlations. The median duration of symptoms before hospitalization was 15 days. Following PCR testing, 163 individuals tested positive for pertussis, comprising 38 adults (≥18 years old) and 125 infants and children (0~17 years old). Within our study cohort, the pertussis infection rate stood at 15.9%. The infants and children included in our investigation were all suspected pertussis cases, yielding a pertussis infection rate of 45% among this demographic. Among the enrolled adult cases, 139 cases (18.6%) were deemed suspected, resulting in a pertussis infection rate of 5.1% among adults presenting with cough symptoms.?Primary Clinical Manifestations: Among children, all presented with paroxysmal coughing; 94 cases (75.2%) experienced post-cough vomiting, 115 cases (92%) had nocturnal coughing, 57 cases (45.6%) manifested a whooping cough-like sound, 103 cases (82.4%) had a cough duration of ≥2 weeks, 64 cases (51.2%) exhibited inspiratory pause after coughing, 115 cases (92%) had nocturnal coughing, 21 cases (16.8%) had low-grade fever, 7 cases (5.6%) had pneumonia, and 25 cases (20.0%) experienced weight loss. In adults, 33 cases (86.8%) had paroxysmal coughing, 20 patients had a cough duration of ≥2 weeks (52.6%), 25 cases (65.8%) had nocturnal coughing, 1 case (2.6%) experienced post-cough vomiting, 2 cases (5.3%) had a whooping cough-like sound, 1 case (4%) exhibited inspiratory pause after coughing, and additional observations included 1 case (4%) with syncope after coughing, 3 cases (7.9%) with perspiration after coughing, 1 case (2.6%) with low-grade fever, and 3 cases (7.9%) with pneumonia.?Comparative Analysis of Hematological Parameters Across Various Age Groups and Immune States: White blood cell counts exhibit elevation in the non-immune cohort, with a statistically significant difference observed between distinct immune groups (P<0.01); Neutrophil levels progressively rise with advancing age, demonstrating statistical significance across different age brackets (P<0.01); Lymphocytes display a marked elevation in the non-immune group (P?0.01), with a statistically significant variance noted among diverse age groups (P<0.05); Monocytes exhibit elevated values in the non-immune group, showcasing a statistically significant difference across various immune statuses (P<0.01); Platelet counts show heightened values in the non-immune group, with statistically significant disparities apparent between distinct immune statuses and age groups (P<0.01).
Conclusions:Pertussis, identified as a causative agent of persistent coughing, affects both immunized children and adults, presenting with atypical clinical symptoms. Our study suggests a potential overestimation of the diagnostic efficacy of blood routine tests in infants aged 0-3 months. Furthermore, the existing vaccine immunization strategy proves inadequate in preventing pertussis, emphasizing the imperative for the development of novel diagnostic criteria and a comprehensive immunization approach.
