PCR Diagnosis of Pertussis

Abstract

Medical Students, Residents & Fellowship Trainees| December 01 2009 PCR Diagnosis of Pertussis AAP Grand Rounds (2009) 22 (6): 62. https://doi.org/10.1542/gr.22-6-62 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation PCR Diagnosis of Pertussis. AAP Grand Rounds December 2009; 22 (6): 62. https://doi.org/10.1542/gr.22-6-62 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: pertussis, polymerase chain reaction Source: Waters V, Jamieson F, Richardson SE, et al. Outbreak of atypical pertussis detected by polymerase chain reaction in immunized preschool-aged children. Pediatr Infect Dis J. 2009;28(7):582–587; doi:10.1097/INF.0b013e318197fac1 Investigators from the Hospital for Sick Children in Toronto and the Ontario Agency for Health Protection and Promotion conducted a retrospective case-control study to assess the role of polymerase chain reaction (PCR) in diagnosing Bordetella pertussis infection and to define risk factors for being PCR-positive. Cases were children <18 years old who tested positive for B pertussis by PCR at the Ontario Central Public Health Laboratory (CPHL) during an outbreak of pertussis in 2005–2006. Matched controls were similarly-aged persons from the same region who tested negative for pertussis by PCR. Clinical information on study participants was retrospectively collected by telephone interview of parents and medical record review. Of 282 eligible cases identified, 189 (67%) were enrolled, 107 were matched to 2 controls, and 82 to 1 control. Of the 189 cases only 5 had positive cultures for B pertussis and 62 were positive by PCR for other respiratory pathogens. Most cases were children 1 to 4 years old. A greater percentage of cases (42%) met the clinical case definition of pertussis (≥14 days of cough and either paroxysmal cough, whoop, or post-tussive emesis) than did controls (25%; P=.0001). Although only 44% of household contacts of cases received adequate antibiotic prophylaxis, just two cases and one control had a household member who tested positive for B pertussis. The secondary attack rate in houses where no prophylaxis was used was only 8%. Ninety-three percent of cases and 91% of controls were age-appropriately immunized against pertussis. Cases were more likely than controls to attend school (Odds ratio [OR]=4; 95% confidence interval [CI], 1.1–14.1), attend daycare (OR=2; 95% CI, 1.2–3.1), have visited a physician in the previous month (OR=1.5; 95% CI, 1.0–2.3), or have a household member with an antecedent pertussis-like cough (OR=2.2; 95% CI, 1.3–3.9). The authors conclude that children who attend school are significantly more likely to have a positive PCR test result for pertussis and that transmission to daycare and school contacts occurs. A positive PCR in the absence of typical symptoms for B pertussis could represent either atypical pertussis or transient colonization. Dr Batlivala has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. According to the WHO and CDC, detection of pertussis by PCR alone is sufficient to confirm a clinical diagnosis of pertussis.1 This study, conducted on possibly the largest pertussis outbreak among immunized children ever recorded, raises questions about the appropriateness of that single criterion for laboratory confirmation of a pertussis case irrespective of the patient’s clinical presentation. The PCR-positive results were validated by a second independent laboratory, making a “pseudo-outbreak” very unlikely, as opposed to findings in other studies.2 Cases and controls were matched according to multiple factors to ensure validity of comparison.... You do not currently have access to this content.