ABSTRACT 598

Abstract

Background and aims: Critical pertussis (CP) is defined as pertussis disease that results in pediatric intensive care unit (PICU) admission or death. Early blood exchange is thought to be effective in critical pertrussis with leukostasis. Aims: To describe evolution of patients with CP treated by blood exchange. Methods: From January to October 2013, 27 patients were admitted in our PICU with pertussis confirmed by RT-PCR. Seventeen patients required mechanical ventilation. Five patients (18%) received blood exchange. We analyzed retrospectively their demographic and clinical data, White blood count (WBC) before and after blood exchange and their outcome. Results: In the study period, seven patients had hyperleukocytosis more than 50 x109/L. Five patients received blood exchange. The median age was 87 days (IQR 25–184). Two patients were unimmunized and three patients had received one dose of pertussis vaccine. The delay of cough was > 14 days in 3 cases. Clinical presentation on admission showed cyanotic cough in all cases, respiratory failure in 2 cases, shock and seizures in 3cases. Median WBC was 105 x109/L (IQR 71-125). The WBC deceased to a half in all patients after blood exchange (median WBC=46 x109/L (IQR 45–60). All patients required mechanical ventilation. Inotropic support was used in three patients and inhaled nitric oxide in two cases. Three patients died from refractory shock in 2 cases and from encephalopathy in the last case. Survivors were discharged from PICU respectively after 11and 14 days. Conclusions: Blood exchange reduced the mass of circulating leukocytes in all patients. However, mortality remains high.