Performance of the new clinical case definitions of pertussis in pertussis suspected infection and other diagnoses similar to pertussis.

Mioljub Ristić,Vladimir Petrović,Biljana Radosavljević,Vesna D Stojanović,Milan Đilas,Oliver Schildgen

doi:10.1371/journal.pone.0204103

Mioljub Ristić, Vladimir Petrović + Show 4 more

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https://doi.org/10.1371/journal.pone.0204103

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Abstract

BackgroundIn an effort to improve the pertussis diagnosis, the Global Pertussis Initiative (GPI) proposed an algorithm of the signs/symptoms of pertussis for three age groups: 0–3 months, 4 months to 9 years, and ≥10 years of age.MethodsWe evaluated the accuracy of the clinical case definitions for pertussis proposed by the GPI using laboratory-confirmed pertussis as a reference standard for four groups: clinically suspected pertussis without comorbidity; asthma exacerbation; allergic constitution, and other diagnoses (bronchitis, bronchiolitis, laryngitis, and tracheitis). We included only patients who fulfilled one or more criteria of clinical case definitions for the age groups (0–3 months, 4 months–9 years, and ≥10 years of age).The data for this prospective epidemiological study were collected between 1st January 2013–31st December 2016 at the outpatients and inpatients health care settings in the South Bačka District of Autonomous Province of Vojvodina, Serbia. We evaluated accuracy of the certain sign and symptom combinations of GPI case definitions based on their sensitivity, specificity, and likelihood ratios.ResultsA total of 1043 participants were included, with 306 (29.3%) laboratory-confirmed pertussis cases. In patients aged 0–3 months, whoop and apnoea associated with laboratory confirmation of pertussis. In patients aged 4 months-9 years with a pertussis suspicion infection or with one of the other diagnoses, the highest accuracy was found for whoop combined with apnoea or post-tussive emesis. In patients aged 10 years and older, several different sign and symptom combinations were associated with an increased risk of pertussis among all enrolment diagnoses. There were fewer hospitalizations among the fully vaccinated children than in partly or unvaccinated children aged 4 months to 6 years (20.7% vs. 60.0%, p = 0.017).ConclusionsThe numerous sign and symptom combinations in the observed case definitions were good predictors for laboratory-confirmed pertussis among all enrolment diagnoses, therefore suggesting the necessity for increased awareness of possibility for pertussis in patients with certain pertussis-like medical conditions.

Highlights

Pertussis is a highly contagious respiratory illness and a major cause of infant morbidity and mortality worldwide [1, 2]
We evaluated the accuracy of the clinical case definitions for pertussis proposed by the Global Pertussis Initiative (GPI) using laboratory-confirmed pertussis as a reference standard for four groups: clinically suspected pertussis without comorbidity; asthma exacerbation; allergic constitution, and other diagnoses
We evaluated accuracy of the certain sign and symptom combinations of GPI case definitions based on their sensitivity, specificity, and likelihood ratios

Summary

Introduction

Pertussis is a highly contagious respiratory illness and a major cause of infant morbidity and mortality worldwide [1, 2]. Due to many different existing case definitions throughout the world, heterogeneity of clinical manifestations, the change of clinical features induced by immunization, and mixed infections, pertussis still represent an under-estimated disease worldwide [3,4,5]. Many medical conditions (non-infectious diseases or various infections) can resemble pertussis. Among the common causes of prolonged cough are asthma, gastroesophageal reflux disease, and the allergies (atopic constitution). The paroxysmal cough in the laboratory-confirmed pertussis can appear more severe than expected in a patient with one of the above mentioned medical conditions. Subacute cough is a common sign/symptom of upper and lower respiratory tract infection [6]. In an effort to improve the pertussis diagnosis, the Global Pertussis Initiative (GPI) proposed an algorithm of the signs/symptoms of pertussis for three age groups: 0–3 months, 4 months to 9 years, and !10 years of age

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