Paroxysmal Cough Research Articles

Clinical repercussions in pertussis infants post-Tdpa vaccination of pregnant woman: An immunization success?

IntroductionIn 2014, there was an epidemic of pertussis in Brazil that caused the death of 129 infants. To control the disease amongst infants under 6 months of age, and especially those under 2 months, the Brazilian Ministry of Health introduced Tdap immunization for all pregnant women. MethodsThis study aimed to describe the morbidity and mortality variables of pertussis cases in 969 infants aged under 6 months, comparing the periods before and after the introduction of Tdap vaccine in pregnant women. Data was extracted from the Information System on Notifiable Diseases (SINAN) including every case of pertussis that occurred in the metropolitan region of Recife-Brazil in infants under 6 months from January 2009 to October 2018. In order to analyze the variables, patients were divided into two groups Pre-Tdap(2009–2014), and Post-Tdap (2016–2018). ResultsThere were no significant differences between the age groups and gender distribution in the period compared. In the Post- Tdap group compared with the Pre-Tdap group, the clinical presentation of pertussis in infants differed with more paroxysmal cough, and more vomiting, less apnea, and cyanosis. During this period, there were fewer complications and no deaths occurred. ConclusionsMaternal immunization with Tdap decreased disease severity, complication rates, and no deaths occurred in infants under 6 months of age diagnosed with pertussis.

Determinants of Pertussis among Young Children in Selangor, Malaysia

The resurgence of pertussis infection worldwide, including Malaysia, is alarming. Young children have the highest reported pertussis incidence and death rates. However, little is known of the risk factors of pertussis in Malaysia. In this study, we aimed to determine the risk factors of pertussis infection among children. We conducted a case-control study involving 143 children aged ≤2 years from Selangor, Malaysia. The children were identified from eNotifikasi, a web-based notification site, from 1 January to 31 December, 2018. Information on clinical presentation and risk factors were collected during investigation of the case by the district health office. Multivariate analysis showed that the odds for pertussis were higher among children aged <3 months (adjusted odds ratio (aOR) 5.54; 95% confidence interval (CI); 1.835, 16.710) and among children who had not received their vaccination according to age (aOR 5.641; 95% CI; 1.845, 17.245). The mean duration of cough among the cases was 10.22 days (SD 8.964); that of the controls was 6.47 days (SD 7.098). Paroxysmal cough (93.6%) was the predominant symptom among the cases. A total of 42.6% of cases were aged <2 months, whilst most of the controls were aged >5 months (40.4%). Up to 42.6% of cases and 68.7% of controls were immunised according to their age. Therefore, it is important to ensure that children are vaccinated once they have attained the appropriate age.

Effectiveness of montelukast in childhood asthma: a prospective observational study

Background: Asthma is characterized by hyperresponsiveness of airways to various stimuli, manifested by widespread narrowing of airways causing paroxysmal dyspnoea, wheezing or cough. Most asthma medications are inhalational and compliance is difficult. So, development of an orally active and once daily drug with additional bronchodilator properties would lead to a major advance for managing young patients with asthma.Methods: Children between 6-18 years with not well controlled asthma on daily controller therapy were enrolled. Their personal data and history regarding the duration of asthma symptoms, frequency and severity of exacerbations was noted. Diagnosis and grading of severity of asthma was confirmed by spirometry. Then subjects were started on montelukast as add on to their daily controller therapy and were reassessed at 4, 8 and 12 weeks by clinical symptoms and PEFR. The change in frequency of symptoms and PEFR at the end of 12 weeks gave the outcome of efficacy of montelukast. Side effects of montelukast were also assessed.Results: Among total 64 subjects, at 4 weeks, 52 improved to well-controlled asthma. The remaining 12 did not improve, so required an increase in dose of their daily controller medication. Out of those 12 subjects, 10 subjects improved to well-controlled asthma at 8 weeks and 2 subjects still did not improve, so, their inhaled corticosteroids (ICS) dose was further increased. All 64 subjects showed improvement at 12 weeks. No serious side effects were observed.Conclusions: 81.25% subjects showed improvement at the 1st follow up itself and no serious complications were observed. So, it can be suggested that montelukast is a safe drug.

Análise do perfil epidemiológico dos casos de coqueluche no estado do Piauí no período de 2013 a 2018

A coqueluche é uma doença aguda, transmissível, de distribuição universal. Compromete especificamente o aparelho respiratório (traqueia e brônquios) e se caracteriza por paroxismo de tosse seca. Esse estudo tem como objetivo descrever os aspectos epidemiológicos da coqueluche no estado do Piauí, Nordeste do Brasil, de 2013 a 2018. Os dados foram retirados dos relatórios clínicos do Sistema de Informação de Agravos de Notificação (SINAN). Realizou-se análises descritivas dos números de casos notificados de coqueluche, segundo a faixa etária, o sexo e município mais afetados, bem como a evolução clínica. De 2013 a 2018 foram notificados 688 casos confirmados de coqueluche no Piauí. A capital do estado foi que apresentou maior número de notificação com 617 casos. Segundo a faixa etária, o maior número de notificações é de crianças menores de 1 ano de idade com 328 casos, seguido por crianças de 1 aos 4 anos com 103 casos. Em relação ao sexo na maioria das notificações as mulheres são as mais afetadas. A coqueluche é uma doença que ocorre sob as formas endêmicas e epidêmicas, tem seu indicio aumentada durante os anos, mas que possuem vacinação no calendário do SUS em crianças para sua prevenção.

Almonertinib-induced interstitial lung disease: A case report.

Rationale:Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have elicited favorable anti-tumor activity in non-small cell lung cancer especially the lung adenocarcinoma. Interstitial lung disease (ILD) is 1 of the fatal side effects of EGFR-TKIs. However, such type of side effect has not been observed in the follow-up during the treatment of the third-generation EGFR-TKI Almonertinib (also called HS-10296). Here, we first report an Almonertinib-induced ILD in an elderly female patient.Patient concerns:A 70-year-old female diagnosed with “ lung adenocarcinoma with intracranial metastasis” harboring a mutation of EGFR 19DEL was administrated with Almonertinib 110 mg orally as the first-line treatment. However, she presented with chest tightness, and shortness of breath, accompanying with paroxysmal dry cough 3 months after the initiation of Almonertinib.Diagnoses:Extensive relevant examinations did not provide conclusive results and the chest computed tomography showed a diffuse ILD in bilateral pulmonary.Interventions:The patient was diagnosed with Almonertinib-induced ILD in the absence of no other potential causes. She discontinued Almonertinib and was treated with oxygen uptaken and methylprednisolone.Outcomes:The whole symptoms were eliminated and the chest computed tomography showed ILD got remission after the prescription of methylprednisolone.Lessons:Almonertinib has potential to cause the rare but severe interstitial lung disease. Clinicians should keep cautious of this when prescribing Almonertinib.

Think ultrasound; could point of care ultrasound really change the management of critically ill patient?

Myxomas are the most common primary cardiac neoplasms. The prevalence of cardiac tumors at autopsy ranges from 0.001% to 0.3%. More than 50% of benign cardiac tumors are myxomas. Approximately 7% of these have genetic origin and arise as a component of a heritable disorder with some clinical manifestations. Over 72% of primary cardiac tumors are benign. In adults, the majority of benign lesions are myxomas. Its clinical manifestations are variable and nonspecific. Commonly observed symptoms and signs are dyspnea, orthopnea, paroxysmal nocturnal dyspnea, pulmonary edema, cough, hemoptysis, edema, and fatigue.
 Key words: POCUS; ARDS; Atrial myxoma; Pulmonary edema
 Abbreviations: ARDS: acute respiratory distress syndrome; CRP: C reactive protein; ABG: arterial blood gases; PEEP: positive end expiratory pressure; HFNC: high frequency nasal cannula; TTE: transthoracic echocardiography; P/F: ratio of partial pressure of oxygen to inspired oxygen fraction; CT: computed tomography; POCUS: point of care ultrasound
 Citation: Aisa T, Lal S, Thomas J, Singh V, Narayanan N. Think ultrasound; could point of care ultrasound really change the management of critically ill patient? Anaesth. pain intensive care 2021;25(1):105–108;
 DOI: 10.35975/apic.v25i1.1438
 Received: 16 June 2020; Reviewed: 4 June 2020; Accepted: 21 June 2020

Protective effect of exclusive breastfeeding and effectiveness of maternal vaccination in reducing pertussis-like illness

ObjectiveTo assess the protective effect of exclusive breastfeeding and the effectiveness of maternal vaccination in reducing pertussis-like illness. MethodThis was a case-control study conducted in sentinel hospitals for pertussis in Recife between July 2016 and July 2018. Cases included children aged under six months with symptoms compatible with pertussis (pertussis-like illness). Controls included children aged under six months, living in the metropolitan region of Recife with no diagnosis of pertussis-like illness and matched by the same hospital and birth date. ResultsSeventy-three cases and 194 controls were included. The diagnosis of pertussis-like illness was predominantly clinical (97,2%). Amongst the main symptoms, paroxysmal cough was observed in 95.89% of cases and vomiting in 53.4%. There were 29 hospitalized cases and no deaths. Out of the 73 cases, 47 were born to mothers vaccinated against pertussis during pregnancy, and the mothers of 144 of the 194 controls had been vaccinated. The protective effect of breastfeeding was of 74% (95% CI;38%, 89%). Children younger than six months, who were exclusively breastfed and with mothers vaccinated against pertussis during pregnancy were 5 times less likely to develop pertussis-like illness, corresponding to a protection of 79% (95% CI;31%, 94%). The effectiveness of maternal vaccination against pertussis-like illness in children under six months was low (27%) and not statistically significant (CI 95%; −34% a 60%). ConclusionsExclusive breastfeeding protects children under six months from pertussis-like illness and may be enhanced when associated with maternal vaccination. These strategies should be encouraged because they also protect against pertussis-like illnesses.

Bronchoo structive syndrome in children: prevalence and difficulties of differential diagnostics

Broncho-obstructive syndrome in children is clinically manifested by paroxysmal cough, expiratory dyspnea, asthma attacks and is associated with impaired bronchial patency, develops acutely, but can be persistent. The first symptoms: shortness of breath and wheezing syndrome often appear in children at an early age. Differential diagnosis of biofeedback in young children is difficult due to the impossibility of using methods for assessing the function of external respiration, difficulties in obtaining sputum for cytological and bacteriological studies in order to verify the diagnosis. Early diagnosis, which determines the tactics of treatment, largely determines the prognosis of the disease and the choice of preventive measures.

1422. Burden of Pertussis in South Korea: Implications for adults

BackgroundThere are a limited number of published studies on pertussis disease burden and epidemiology in South Korea, particularly those evaluating the impact in adults.MethodsWe conducted a systematic literature review on pertussis epidemiology and burden of disease in South Korea. The objective was to highlight evidence gaps which could help improve awareness about pertussis disease in adults in South Korea.ResultsOf 940 articles published between January 2000 to December 2019, 19 articles provided data for pertussis epidemiology and 9 provided data in adults. Laboratory confirmation rates in adults varied according to methodology, likely influenced by study/sampling variations. Three studies reported serological evidence of infection in adolescents and adults (33-57%). Among cases, the average cough duration was 16.5 days (range 7-30 days) and over 85% of cases presented with paroxysmal cough, while only 25% of cases or less presented with a characteristic whoop or post-tussive vomiting. Importantly, in 4 studies reporting vaccination status, almost all adult cases had no history of pertussis vaccination since childhood.ConclusionPrimary childhood vaccination rates in South Korea are among the highest globally, while adult pertussis vaccine uptake appears to be quite low. Our literature review suggests that pertussis is underreported in adults, as evidenced by serology data demonstrating that tetanus antibody levels are low while pertussis toxin antibody levels are relatively high, suggesting continued circulation of community pertussis. These findings highlight the need for strategies such as maternal immunization and decennial revaccination of adults to address the changing epidemiology and waning immunity. Active pertussis testing/reporting and better utilization of adult vaccine registries is required to help provide robust data for vaccine decision-making at the national level. In the current COVID-19 environment, strategies that can reduce clinic or hospital visits will have substantial benefits to authorities managing rapid increases in health care resource utilization, and vaccine preventable diseases provide an easy and immediate target for achieving that goal.DisclosuresBruce Mungall, PhD, the GSK group of companies (Employee, Shareholder) Hyungwoo Kim, MD, MPH, the GSK group of companies (Employee) Kyu-Bin Oh, MD, the GSK group of companies (Employee, Shareholder)

Bordetella pertussis is a common pathogen in infants hospitalized for acute lower respiratory tract infection during the winter season

IntroductionThere is some evidence that Bordetella pertussis (B. pertussis) can co-infect with viral respiratory infections in young infants. MethodsB. pertussis infection was studied by culture, polymerase chain reaction (PCR), and loop-mediated isothermal amplification (LAMP) from nasopharyngeal swabs (NPSs) in 49 infants < 12 months of age, who were admitted for lower respiratory tract infections during the winter season. Seven other possible viral pathogens were documented by antigen detection or PCR in NPSs. The clinical feature of infants with mixed infection of B. pertussis and respiratory viruses were examined. ResultsOverall, B. pertussis infection was found in 10 (20.4%) cases, nine were less than 6 months of age and seven were unvaccinated. Viral etiology was found in 41 (84%) cases and pertussis-viral co-infection was present in eight patients, five of whom had mixed infection with respiratory syncytial virus. Only the presence of staccato coughing, cyanosis, and lymphocytosis were significantly different in B. pertussis-positive cases compared with B. pertussis-negative cases. Of the 10 pertussis cases, only the culture-positive cases showed the typical symptoms and laboratory findings of pertussis in addition to virus-associated respiratory symptoms with severe hospital course, whereas cases identified as DNA-positive lacked the characteristics of pertussis and their clinical severities were the same as B. pertussis-negative cases. ConclusionIn the absence of typical paroxysmal cough and lymphocytosis, we should carefully consider diagnosis of pertussis in young children hospitalized for presumed viral respiratory illness according to local epidemiological surveillance.

Features of antitussive therapy in whooping cough in pediatric practice

Whooping cough is an acute highly contagious infectious disease, the main manifestation of which is a prolonged paroxysmal cough. Despite the availability of the vaccine, over the past 10 years there has been an increase in the incidence of pertussis in both Russia and the world, which is associated both with the refusal of the parents to vaccinate and with the use of the acellular vaccine that induces a time-limited immune response. In the phase of spasmodic cough, the severity of the condition is determined by the frequency and intensity of cough paroxysms. Against the background of coughing, young children may develop apnea and hypoxic encephalopathy, and older children and adolescents may develop neurosis-like reactions, sleep disturbance, enuresis. Virulence factors for bacteria of the genus Bordetella are known, but the pathogenesis of coughing with whooping cough has not been adequately studied. Antibacterial therapy accelerates the eradication of the pathogen, but practically does not affect the duration of symptoms. Due to the severe course of whooping cough, children in the first year of life often require hospitalization in the intensive care unit. Many common methods of treating cough (inhalation therapy, the use of acetylcysteine, carbocysteine, codeine-containing drugs) worsen the course of disease. In this regard, the main place in therapy is the correct treatment of cough. The article provides an overview of the main pathogenetic concepts of coughing and approaches to therapy: during the period of an obsessive spasmodic cough, to reduce the frequency and intensity of coughing, it is recommended to use an antitussive drug with a central effect of butamirate, oxygen therapy, refuse to perform invasive ventilation methods when child has apnea, and rapid rehabilitation of the children.

Clinical and epidemiological features of pertussis in Salvador, Brazil, 2011-2016.

Pertussis, a severe respiratory infection caused by Bordetella pertussis, is distributed globally. Vaccination has been crucial to annual reductions in the number of cases. However, disease reemergence has occurred over the last decade in several countries, including Brazil. Here we describe the clinical and epidemiological aspects of suspected pertussis cases in Salvador, Brazil, and evaluate factors associated with case confirmation. This descriptive and retrospective study was conducted in the five hospitals in Salvador that reported the highest number of pertussis cases between 2011–2016. Demographic and clinical data were recorded for each patient. Bivariate analysis was performed to evaluate differences between groups (confirmed vs. unconfirmed cases) using Pearson’s Chi-square test or Fisher’s exact test. Results: Of 529 suspected pertussis cases, 29.7% (157/529) were confirmed by clinical, clinical-epidemiological or laboratory criteria, with clinical criteria most frequently applied (63.7%; 100/157). Unvaccinated individuals (43.3%; 68/157) were the most affected, followed by age groups 2–3 months (37.6%; 59/157) and <2 months (31.2%; 49/157). Overall, ≤50% of the confirmed cases presented a complete vaccination schedule. All investigated cases presented cough in association with one or more symptoms, especially paroxysmal cough (66.9%; 105/529) (p = 0.001) or cyanosis (66.2%; 104/529) (p<0.001). Our results indicate that pertussis occurred mainly in infants and unvaccinated individuals in Salvador, Brazil. The predominance of clinical criteria used to confirm suspected cases highlights the need for improvement in the laboratory tools used to perform rapid diagnosis. Fluctuations in infection prevalence demonstrate the importance of vaccination strategies in improving the control and prevention of pertussis.

Neonatal pertussis: an emerging issue of concern.

Neonatal pertussis is a resurging disease, possibly due to waning immunity in pregnant women. We report seven cases of neonatal pertussis (Bordetella pertussis DNA PCR positive) in this retrospective study conducted at a tertiary care teaching hospital in north India over eight months (March to October 2018). All except one were male infants and presented at the age of 14-30 days with paroxysmal cough in all, four had fever, four had respiratory distress, three had similar illness in the family, and two had leucocytosis. All recovered well with azithromycin. The duration of hospital stay was 5-7 days. A strong suspicion of neonatal pertussis in neonates with paroxysmal cough and similar family history should be maintained as the prognosis is excellent, if treated appropriately.

Neurologic alterations in an HIV adult patient with pertussis: a case report

BackgroundPertussis is a highly contagious disease of public health interest caused by the bacterium Bordetella pertussis. Although its incidence has decreased substantially after the introduction of a vaccination, the burden of the disease remains high. Although the paroxysmal phase is highly disabling, complications are uncommon and more prevalent in children than in adults. The most frequent neurological complication is encephalopathy, but seizures, paresis, paraplegia, ataxias, aphasias, and decerebration postures have also been described. The complication of decerebration postures has not been previously reported in adults.Case presentationWe present a video case of an adult HIV patient with severe coughing paroxysms, post-tussive emesis and syncope, whose workup confirmed the diagnosis of a B. pertussis respiratory infection. During hospitalization, he had fluctuant encephalopathy and post-tussive decerebration postures following paroxysms. He was treated with antibiotic therapy and finally sent home without residual neurological deficits.ConclusionThis case illustrates the biological plausibility of neurologic complications of pertussis in adults, which, albeit rare, can cause important morbidities. Future research should explore whether there are differences in the clinical presentation, risk factors and pathophysiology of the disease among adults or interventions aimed at preventing or treating pertussis encephalopathy.

Effectiveness of rapid multiplex polymerase chain reaction for early diagnosis and treatment of pertussis.

BackgroundPertussis, is an infectious respiratory disease caused by Bordetella pertussis. The incidence of pertussis has been increasing in South Korea to due to waning vaccine-induced immunity. Culture has a low sensitivity and a long turnaround time (TAT). Recently, a rapid multi-polymerase chain reaction (mPCR) test with a TAT of about 1 h was developed for the detection of respiratory pathogens (17 viruses and three bacteria), including B. pertussis. This study aimed to investigate the effectiveness of mPCR for early diagnosis and treatment of pertussis.MethodsWe performed a retrospective study of patients with pertussis diagnosed from May 2017 to June 2019 at a university hospital in South Korea. Nasopharyngeal swab specimens were tested using mPCR. Data were extracted from medical records.ResultsA total of 27 patients with a median age of 48.9 years (range: 3.3–82.2 years) were diagnosed with pertussis, of whom 9 (33.3%) were male. Eleven (40.7%) had fever, 12 (44.4%) had dyspnea, three (11.1%) had paroxysmal cough, and nine (33.3%) had inspiratory whooping. The median interval from symptom onset to diagnosis was 9.0 days (range: 1–31 days). Twenty-four patients (81.5%) were diagnosed within 2 weeks from symptom onset. All but one patient was prescribed macrolide antibiotics. Twenty-two patients (81.5%) required hospitalization, including three (11.1%) who required intensive care unit care for ventilation.ConclusionTesting patients with respiratory symptoms using mPCR can improve early diagnosis of pertussis, ensure proper treatment, and may help with outbreak control.

Neonatal Deficiencies in NK cell-Activating Cytokines in the Context of Bordetella pertussis Infection

Abstract Whooping cough, caused by Bordetella pertussis, has seen a resurgence in recent years, in part due to the switch from the whole cell to acellular vaccine. Although both adults and infants can suffer from severe paroxysmal cough, infants can experience a fatal health decline. Disease progression in infant and adult mouse models show some parallels to human disease. Adult mice exhibit severe lung pathology, but overcome infection, while infant mice experience mild lung pathology, develop leukocytosis, bacterial dissemination, and succumb to infection. We hypothesize that this discrepancy in response to infection is due to a deficiency in neonatal Interferon gamma (IFN-y) production by Natural Killer (NK) cells, which can activate protective T-helper 1 (Th1) cells. We further hypothesize that this deficiency is in part due to the inability of neonatal antigen presenting cells to produce the NK cell-activating cytokines Interleukin (IL) 12 and IL18 when exposed to B. pertussis. To test this hypothesis, we isolated splenocytes from infected and uninfected infant and adult mice, incubated with heat killed B. pertussis, and analyzed for mRNA expression of cytokines via qRT-PCR. While adult splenocytes responded robustly with upregulated expression of IL12 and TNF-α, infant splenocytes failed to upregulate expression of these cytokines in response to bacterial stimulation. Moreover, analysis of lung tissue from infected mice revealed robust upregulation of IL12, IL18 and TNF-α in adult mice but not in infant mice. These results indicate that infant mouse cells fail to upregulate expression of NK cell-activating cytokines in response to B. pertussis infection, leading to a lack of protective IFN-y responses.

Teaching Video NeuroImages: Vagus nerve schwannoma

A 40-year-old man presented with an insidious slowly enlarging nontender, firm, and movable mass on the right side of the neck for 3 years (figure 1). He had a 2-month history of paroxysmal cough and the cough could be elicited when the mass was palpated (video). MRI (figure 2) demonstrated that the mass involved the vagus nerve and displaced sternocleidomastoid muscle and the internal jugular vein laterally. The cough reflex is caused by stimulation of vagal nerve afferents.1,2 Microscopic dissection showed the tumor was in the carotid sheath and arose from a single fascicle of the vagus nerve. The pathologic diagnosis was schwannoma. After the surgery, the patient had a normal voice, with no evidence of paroxysmal cough or recurrence.

Clinical Profile of Critical Pertussis in Children at a Pediatric Intensive Care Unit in Northern India

ObjectiveTo delineate the clinical profile, complications, intensive care needs, and predictors of mortality in children with critical pertussis.MethodsRetrospective analysis of case records of children in the pediatric intensive care unit of a tertiary-care hospital, with a diagnosis of critical pertussis over 3 years. Diagnostic criteria included CDC case definition and confirmation by polymerase chain reaction (PCR), when available. Survivors and nonsurvivors were compared to identify predictors of mortality.Results36 records were analysed, most cases were infants (31, 86.1%). 10 (27.7%) were (below 6 weeks of age). In the rest, 16 (61.5%) were partially immunized or unimmunized against pertussis. Rapid breathing (88.9%), paroxysmal cough (86.1%) and apnea (41.7%) were common presenting complaints. Hypoxemia (97.2%), hyperleukocytosis (61.1%) and encephalopathy (52.8%) were common complications. Intensive care needs were mechanical ventilation in 11 (30.6%), vasoactive support in 7 (19.4%) and exchange transfusion in 3 (8.3%). Female gender, apnea, hyperleukocytosis, encephalopathy, need for vasoactive support, and mechanical ventilation predicted mortality.ConclusionPertussis demands attention due to its varied presentation, increased complications and higher mortality.

Pertussis: Resurgence of a forgotten entity

Pertussis is a serious and life-threatening infection of infancy. Recurrent apnea with a paroxysm of cough is the early clue for its diagnosis. The rate of pertussis increased worldwide with the occurrence of regular outbreaks globally, including India. The resurgence of pertussis is multifactorial, and it includes antigenic shifts in bacteria, decreasing vaccine immunity, reduced duration of protection by acellular pertussis vaccine, and improved method of surveillance and diagnosis. Family members, especially mothers and siblings, are an important source of pertussis transmission to vulnerable infants. Maternal vaccination for pertussis during pregnancy should be done as many cases of infantile pertussis was found before primary immunization. A 45 days infants admitted to the pediatric intensive care unit with recurrent apnea and bradycardia, require prolonged mechanical ventilation with intense cardiorespiratory monitoring. Real-time polymerase chain reaction of the nasopharyngeal swab for pertussis was positive. Successfully discharged after a long course of hospitalization.

P1242 Giant right atrium aneurysm presenting as right heart failure

Abstract Introduction Idiopathic aneurysmal dilatations of the right atrium are rare anomalies. It can be diagnosed at any time between foetal and adult life. This exceptional condition can be confused with other conditions that involve enlargement of right atrium. We report a clinical case of a symptomatic adult who was diagnosed with giant right atrium aneurysm. Case report An 83-year-old female presented with complaints of fatigue, paroxysmal nocturnal dyspnoea, exertional dyspnoea, orthopnoea and cough since last week. There were no history of syncope, convulsions or evidence of thromboembolism. There were a medical history of diverticulosis and atrial fibrillation (warfarin therapy). The principal findings on physical examination included holosystolic murmur at the left middle sternal border, pulmonary rales, jugular venous distension, enlarged liver and peripheral oedema. An electrocardiogram showed an atrial fibrillation with a controlled heart rate response, right axis deviation, right bundle-branch block. A chest radiography posteroanterior view showed a markedly enlarged cardiac silhouette, increased pulmonary vascular congestion, and bilateral pleural effusions. Computed tomography (CT) scan showed aneurysmal dilated right atrium communicating with right ventricle. Right ventricle (RV) and RV outflow tract were dilated with normal pulmonary arteries. Two-dimensional transthoracic echocardiography revealed aneurysmal dilated right atrium measuring 398mL/m2. The tricuspid valve was no displaced. There was severe tricuspid regurgitation and no stenosis. The right atrium was kinetic without any intracavitary thrombus. The intertrial and interventricular septa were intact. The right ventricle and outflow tract were mildly dilated with preserved systolic function. The left atrium and left ventricle were normal. The patient was admitted to the cardiology department with the diagnosis of right heart failure. Conclusion Aneurysm of right atrium is an uncommon condition. It is diagnosed as a disproportionately enlarged right atrium compared to the other cardiac chambers in the absence of other cardiac or hemodynamic abnormalities and must be distinguished from other anomalies causing structural pathology of the right atrium. Approximately, one-half of the patients have no symptoms. Others presented with arrhythmia, palpitations, chest pain, shortness of breath, and fatigue. The major rhythm abnormality is atrial fibrillation or atrial flutter. Our patient presented with symptoms of right heart failure and atrial fibrillation. The right enlargement is usually associated with tricuspid annular dilatation responsible for functional regurgitation, which can be severe in some cases. The diagnosis of right atrium malformation can be established by echocardiography, CT or magnetic resonance imaging. Literature reports various ways to manage these patients. Treatment ranges from conservative to surgical resection specially in the presence of arrhythmias. Abstract P1242 Figure. Aneurysm of right atrium