Abstract
BackgroundThe clinical diagnosis of pertussis is not easy in early infancy since clinical manifestations can overlap with several different diseases. Many cases are often misclassified and underdiagnosed. We conducted a retrospective study on infants to assess how often physicians suspected pertussis and the actual frequency of Bordetella pertussis infections.MethodsWe analyzed all infants with age ≤90 days hospitalized from March 2011 until September 2013 for acute respiratory symptoms tested with a Real Time Polymerase Chain Reaction able to detect Bordetella pertussis and with a Real Time Polymerase Chain Reaction for a multipanel respiratory virus. Therefore, we compared patients with pertussis positive aspirate, patients with respiratory virus positive aspirate and patients with negative aspirate to identify symptoms or clinical findings predictive of pertussis.ResultsOut of 215 patients analyzed, 53 were positive for pertussis (24.7 %), 119 were positive for respiratory virus (55.3 %) and 43 had a negative aspirate (20 %). Pertussis was suspected in 22 patients at admission and 16 of them were confirmed by laboratory tests, while 37 infants with different admission diagnosis resulted positive for pertussis. The sensitivity of clinical diagnosis was 30.2 % and the specificity 96.3 %. Infants with pertussis had more often paroxysmal cough, absence of fever and a higher absolute lymphocyte count than infants without pertussis.ConclusionsPertussis is a serious disease in infants and it is often unrecognized; some features should help pediatricians to suspect pertussis, but clinical suspicion has a low sensitivity. We suggest a systematic use of Real Time Polymerase Chain Reaction to support the clinical suspicion of pertussis in patients with less than 3 months of age hospitalized with acute respiratory symptoms.
Highlights
The clinical diagnosis of pertussis is not easy in early infancy since clinical manifestations can overlap with several different diseases
Since other countries with high immunization coverage over a long period of time experienced a resurgence of pertussis [3, 5], we hypothesized that the epidemiology of this disease in Italy may be affected by the lack of recognition by clinicians with the consequence of limiting the use of laboratory confirmation [9]
A nasopharyngeal specimen was tested for Bordetella pertussis (BP) and for viruses generally associated to respiratory infections (RV) such as Adenovirus, Influenzae Virus, Parainfluenzae Virus, Respiratory Syncytial Virus (RSV), Metapneumovirus, Coronavirus and Rhinovirus
Summary
The clinical diagnosis of pertussis is not easy in early infancy since clinical manifestations can overlap with several different diseases. In contrast to what is reported in other countries, in Italy after the introduction of acellular vaccine in 1995 incidence has continued to decrease and pertussis has not reemerged yet [9, 10]. Since other countries with high immunization coverage over a long period of time experienced a resurgence of pertussis [3, 5], we hypothesized that the epidemiology of this disease in Italy may be affected by the lack of recognition by clinicians with the consequence of limiting the use of laboratory confirmation [9]. In clinical practice the diagnosis of pertussis is generally reached without microbiological confirmation leading to a Vittucci et al BMC Infectious Diseases (2016) 16:414 possible lack of clinical awareness to start early treatment and prevent complications
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