Pertussis Syndrome Research Articles

Epidemiological and Clinical Characteristics of Human Parainfluenza Virus Infection in Children of Xianyang Children's Hospital in 2022

The incidence of HPIV infection in children is on the rise, particularly following the emergence of SARS-CoV-2, which presents a potential risk to the health of children.
 Objective: This study aims to investigate the epidemiological and clinical features of human parainfluenza virus (HPIV) in children admitted to Xianyang Children's Hospital (Xianyang Caihong Hospital) from January 2022 to December 2022.
 Methods: Out of the 5873 cases of hospitalised children, the ones which had HPIV as the only pathogen and were non-standard cases were excluded, and the rest were analysed for their clinical characteristics, based on the six nucleic acids kits used to detect HPIV in respiratory tract viruses. Results: Among 5873 cases of Nasopharyngeal swab specimens, there were 795 cases of HPIV antigen positive, of which 794 cases of HPIV3（13.52%, 3 cases of HPIV1（0.05%; There were 472 males (13.92%) and 325 females (13.09%) in them(χ2 =0.381, P=0.362).The infection rates in spring, summer, autumn and winter were 8.03%, 55.71%, 28.48% and 7.78%, respectively, and the difference of pairwise comparison were statistically significant (χ2=539.158, P=0).There were 318 cases (19.51%) in infant group and 164 cases (10.86%) in children group (χ2=45.118, P=0). With HPIV as the sole pathogen including 363 cases of bronchopneumonia, 237 cases of bronchitis, 8 cases of pertussis syndrome, 84 cases of bronchiolitis.
 Conclusion: ⑴. During the period of January to December 2022, Xianyang Children's Hospital has seen a high prevalence of HPIV, a virus causing lower respiratory tract infection, especially HPIV3. ⑵.No statistical evidence showed a difference between men and women in terms of high morbidity during spring and summer, which was more common among infants and young children. ⑶. Among children infected with HPIV, the four most common respiratory illnesses are bronchopneumonia, bronchitis, pertussis syndrome, and bronchiolitis. After undergoing symptomatic treatment, most children showed marked improvement. It is imperative to gain a thorough understanding of HPIV infections in children, enabling timely prevention and symptomatic treatment, identifying critical and serious illnesses, and reducing morbidity and mortality.

Pertussis and pertussis-like syndrome in young children

The most common infectious diseases with a risk of severe, non-smooth course and unfavorable outcome in young children, including the first year of life, are pertussis and respiratory syncytial viral infection (RSV infection), often occurring with pertussis-like syndrome.Objective: to establish clinical and laboratory differential diagnostic criteria for pertussis and RSV infection in children of the first year of life.Materials and methods: A retrospective comparative study was conducted, which included patients of the first year of life (from 1 month to 11 months and 29 days), regardless of the duration of hospitalization and duration of the disease: 48 patients with pertussis and 26 with acute RSV infection.Results: The compared groups of patients were comparable in age, the number of severe forms (4.6 ± 0.5 months, 17% for pertussis and 4.0 ± 0.2 months, 16% for RS infection). The disease in both cases began subacute, however, with RSV infection 92% of children were hospitalized in the first 5 days from the onset of the disease, with pertussis — in the first week of the period of convulsive cough — 47.9%, in the second week — 41.7%, in the third week — 10.4%. 52% of patients with RSV infection had no fever or (in 32%) did not exceed 1—3 days. In 41.3% of patients it was subfebrile (37—38 °C), in 21.1% it was febrile (38—39 °C). In patients with pertussis the onset of the disease took place against the background of normal body temperature. In patients with RSV infection, bronchiolitis was recorded in 24% of cases, obstructive bronchitis — in 60%. Patients with pertussis, 89.6% of whom were not vaccinated and 10.4% did not complete the initial course of vaccination, had a typical paroxysmal cough with reprises. Complications in the form of respiratory rhythm disturbances were recorded in 14.6% of cases, pneumonia — in 6.3%. Comparison of hematological parameters revealed highly significant differences in the levels of leukocytosis and relative lymphocytosis (p < 0.001), as well as thrombocytosis (p < 0.01), with the predominance of all indicators in patients with pertussis.Conclusion. Differential diagnostic criteria for the similarity of the clinical picture may be established hematological differences: pronounced leukocytosis due to lymphocytosis, increasing in dynamics, and thrombocytosis in pertussis and normocytosis with moderate lymphocytosis, a possible tendency to thrombocytosis in severe RSV infection.

Progress in etiology, pathogenesis and clinical characteristics of pertussis syndrome

百日咳综合征是由流行性感冒病毒及副流行性感冒病毒、腺病毒、呼吸道合胞病毒、巨细胞病毒、支原体等病原体感染引起的一组临床症候群。百日咳综合征发病率呈周期性上升趋势。本文就百日咳综合征病原学、发病机制与临床特点研究进展展开综述。.

Therapeutic effect of vitamin K1 combined with meropenem on the treatment of pertussis syndrome.

Clinical efficacy of vitamin K1 combined with meropenem on the treatment of pertussis syndrome was evaluated. Clinical data of 170 children with pertussis syndrome treated in the Second People's Hospital of Liaocheng from March 2015 to March 2017 were collected. Of these, 87 patients who were treated with vitamin K1 combined with meropenem were regarded as the experiment group. A total of 83 patients who were treated with meropenem alone were regarded as the control group. Both groups were treated with anti-infective, respiratory support, antispasmodic, expectorant and other basic treatments. The therapeutic effects, duration of spasmodic cough, length of hospitalization, antipyretic time, duration of voice disappearance and healing time were observed between the two groups. The duration of spasmodic cough and length of hospitalization in the experiment were lower than the control group, and the difference was statistically significant between the groups (P<0.05). The explicit efficiency (51.72%) and total effective efficiency (99.55%) in the experiment group were significantly higher than the explicit efficiency (36.14%) and total effective efficiency (78.31%) in the control group. There was a statistically significant difference between the groups (P<0.05). The voice disappearance time and healing time in the experiment group were significantly shorter than the control group, and there was a statistically significant difference between the groups (P<0.05). The antipyretic time in the experiment group was lower than that of the control group, the difference between the groups was not statistically significant (P>0.05). The treatment with vitamin K1 and meropenem has a significant effect in relieving pediatric pertussis syndrome, it can shorten the duration of spasmodic cough, antipyretic time, duration of voice disappearance and length of hospitalization in children with pertussis syndrome, and improve the efficacy clinically.

Analysis of clinical characteristics and laboratory indexes of pneumonia complicated with pertussis syndrome in Suzhou area from 2012 to 2016

Objective To analyze the clinical characteristics and laboratory indexes of pneumonia complicated with pertussis syndrome in Suzhou area in order to provide the basis for rational treatment. Methods Children who had been hospitalized at Department of Respiratory, Children′s Hospital of Soochow University during January 2012 to October 2016 were enrolled and diagnosed as pneumonia complicated with pertussis syndrome.A total of 236 cases were enrolled.Multiple pathogen detection and clinical information were collected in all patients.The subjects were divided into 28 days -<3 months group, 3-<6 months old group, 6-<12 months old group and≥12 months old group.The clinical data of children in each age group were retrospectively analyzed. Results Pneumonia complicated with pertu-ssis syndrome was easy to occur within 6 months of infants, with the highest incidence in the 3-<6 months group, there was a significant difference among the different age groups(χ2=231.870, P<0.05)[28 d-<3 months group: 5.3%(102/1 910 cases), 3-<6 months group: 5.7%(76/1 341 cases), 6-<12 months group: 2.0%(36/1 762 cases), ≥12 months group: 0.4%(22/5 304 cases)]. The patients could become sick all the year round, with the highest incidence in summer[2.6%(72/2 740 cases)in spring, 3.7%(96/2 611 cases)in summer, 2.1%(56/2 749 cases)in autumn, and 0.48%(12/2 487 cases)in winter], and there were significant differences among the different seasons (χ2=62.380, P<0.001). Clinical symptoms were paroxysmal spasmodic cough, 33.0% (78/236 cases) of the performance with wheezing, mainly in the older than 3 months group.The incidence of fever was positively correlated with age(χ2=12.938, P<0.05). Peripheral white blood cell count and lymphocyte percentage increased, and the 3-<6 months old group increased markedly.White blood cell count as high as (19.01±11.99)×109/L, the highest percentage of lymphocytes was up to 0.80, platelets were significantly increased in more than 80% of children.The incidence of C-reactive protein (CRP) was negatively correlated with age, 28 days-<3 months group more prone to have high CRP.Pulmonary inflammatory pathology showed multiple pulmonary involvement by chest radiography, and it was more likely to occur in 28 d-<3 months group.Viruses, bacteria and mycoplasma pneumoniae (MP) could cause pneumonia associated with pertussis syndrome, and mixed infection occurred in 56 cases.The top three pathogens were rhinovirus, MP and Streptococcus pneumoniae, and mixed infection was more prone to occur in 28 d-<3 months group. Conclusion Pneumonia complicated with pertussis syndrome is easy to occur within 6 months of infants, with the highest incidence in summer.Viruses, bacteria and MP all could cause pneumonia associated with pertussis syndrome, and mixed infection could occur in some cases.The top three pathogens are rhinovirus, MP and Streptococcus pneumoniae. Key words: Pertussis syndrome; Clinical feature; Child

ABSTRACT 822

Background and aims: Pertussis a preventable disease with vaccine protection is still causing outbreaks in several parts of the world. Most of cases admitted to the hospital are young children, which had incomplete vaccine pattern. As there is no specific treatment, the morbidity and mortality risks remain high even being cared by experienced medical staff and technical facilities. Aims: Evaluate the characteristic and outcome of children with Pertussis Syndrome admitted to a referral Brazilian hospital in a period of two consecutive years. Methods: The records of all children admitted to a referral Brazilian Hospital between July 2011 and July 2013 with the diagnosis of Pertussis Syndrome (positive culture or positive PCR) were evaluated regarding: demographic data, length of hospital stay, use and length of MV, complications and outcome. The local Ethical and Research committee approved the study. Results: Between 2011 and 2013, 155 children were admitted to the Hospital with Pertussis Syndrome, being 85 male (55%) with a median age of 3.5 months (range: 0.3 to 90 months) and median weight of 6.1kg. The majority (88%) was admitted at the emergency department and 8.4% directly to the PICU. MV was provided to 13 patients (8.3%) with a mean of 7.2 +6.1 days. Two patients required exsanguinous transfusion to treat hyperleucocitosis. There were 4 deaths (2.5%), being all of them ventilated (30% mortality!). Conclusions: Despite of vaccine coverage, Pertussis remains nowadays as an enormous medical challenge with uncontrolled outbreaks and elevated morbidity even when treated by experience medical staff and technical facilities.

Comparison of clinical characteristics of severe pertussis and pertussis-like syndrome in children

Objective To explore the clinical characteristics and management of children who were critically ill with severe pertussis and those who had severe pertussis-like syndrome. Methods The patients with severe pertussis and severe pertussis-like syndrome admitted to Pediatric Intensive Care Unit from Mar.2005 to Mar.2013 were involved in this study, and their clinical characteristics were collected and the experience of management was summarized. Results Totally 31 patients were involved in the study, 15 cases were male and 16 cases were female, the median age was 2.68 months(age ranged 34 days-7 months). All the 16 cases of severe pertussis were less than 3 months, and none of them had received pertussis vaccine.Of 31 patients, 16(51.61%) cases were characterized by apnea, 12(38.70%) cases showed cyanosis, 10(32.26%) cases exhibited bradycardia, 8(25.80%) cases presented spasmodic cough, leukocytosis[white blood cell count (26.85± 12.43)×109/L]as well as lymphocytosis[blood lymphocyte(70.10±8.82)%] were observed.Complications included respiratory failure(13 cases, 41.94%), pulmonary hypertension(7 cases, 22.58%), circulatory dysfunction(6 cases, 19.35%) and encephalopathy(5 cases, 16.13%). Two cases of severe pertussis patients presenting with cardiac arrest received CPR survival due to prolonged apnea.Severe pertussis infants were more likely to present apnea, cyanosis, bradycardia and be complicated with pulmonary hypertension than those who had severe pertussis-like syndrome infants [75.00%(12/16 cases) vs 26.70%(4/15 cases), χ2=7.008, P=0.008; 62.50%(10/16 cases)vs 13.30%(2/15 cases), χ2=7.634, P=0.006; 50.00%(8/16 cases) vs 13.30%(2/15 cases), χ2=4.610, P=0.032; 37.50%(6/16 cases) vs 6.67%(1/15 cases), χ2=4.074, P=0.044]. In the patients with pulmonary hypertension group, the white blood cell count, the rate of suffering from respiratory failure as well as circulatory dysfunction, the rate of using mechanical ventilation, the rate of using vasoactive drug were significantly higher than those in the normal pulmonary arterial pressure group[(47.96±17.79) ×109/L vs(23.20±5.29)×109/L, t=2.278, P=0.025; 71.42%(5/7 cases) vs 8.33%(2/24 cases), χ2 =11.943, P=0.001; 71.42%(5/7 cases) vs 8.33%(2/24 cases), χ2=11.943, P=0.001; 42.86%(3/7 cases)vs 0 (0 case), χ2=11.020, P=0.001; 42.86% (3/7 cases) vs 0(0 case), χ2=11.020, P=0.001]. Pertussis-mediated pulmonary hypertension were also treated with milrinone, and all cases were cured. Conclusions Severe pertussis and severe per-tussis-like syndrome in infants are characterized by high morbidity of apnea and respiratory failure.Severe pertussis tends to occur in younger unvaccinated infants(<3 months). Severe pertussis is more likely to be combined with pulmonary hypertension.Pulmonary hypertension is the sign of disease get aggravation, and milrinone treatment may be effective. Key words: Pertussis; Pertussis-like syndrome; Apnea; Respiratory failure; Pulmonary hypertension; Child

Despite Good Vaccines, Some Childhood Diseases Present Challenges

Several childhood diseases that supposedly disappeared are resurgent, while others show signs of yielding at long last to analysis and novel interventions, according to several investigators who presented their findings during the 2013 Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Denver, Colo., last September. Diseases and syndromes in question include pertussis, mumps, polio, and toxic shock syndrome (TSS).

The Bordetella pertussis Type III Secretion System Tip Complex Protein Bsp22 Is Not a Protective Antigen and Fails To Elicit Serum Antibody Responses during Infection of Humans and Mice

The type III secretion system (T3SS) of pathogenic bordetellae employs a self-associating tip complex protein Bsp22. This protein is immunogenic during infections by Bordetella bronchiseptica and could be used as a protective antigen to immunize mice against B. bronchiseptica challenge. Since low-passage clinical isolates of the human pathogen Bordetella pertussis produce a highly homologous Bsp22 protein (97% homology), we examined its vaccine and diagnostic potential. No Bsp22-specific antibodies were, however, detected in serum samples from 36 patients with clinically and serologically confirmed whooping cough disease (pertussis syndrome). Moreover, although the induction of Bsp22 secretion by the laboratory-adapted 18323 strain in the course of mice lung infection was observed, the B. pertussis 18323-infected mice did not mount any detectable serum antibody response against Bsp22. Furthermore, immunization with recombinant Bsp22 protein yielded induction of high Bsp22-specific serum antibody titers but did not protect mice against an intranasal challenge with B. pertussis 18323. Unlike for B. bronchiseptica, hence, the Bsp22 protein is nonimmunogenic, and/or the serum antibody response to it is suppressed, during B. pertussis infections of humans and mice.

Insertion sequences shared by Bordetella species and implications for the biological diagnosis of pertussis syndrome

The molecular diagnosis of pertussis and parapertussis syndromes is based on the detection of insertion sequences (IS) 481 and 1001, respectively. However, these IS are also detected in the genomes of various Bordetella species, such that they are not specific for either B. pertussis or B. parapertussis. Therefore, we screened the genome of recently circulating isolates of Bordetella species to compare the prevalence of IS481, IS1001 and, also IS1002 with previously published data and to sequence all IS detected. We also investigated whether the numbers of IS481 and IS1001 copies vary in recently circulating isolates of the different Bordetella species. We used the polymerase chain reaction (PCR) method for screening the genome of circulating isolates and to prepare the fragments for sequencing. We used Southern blotting and quantitative real-time PCR for quantification of the numbers of IS. We found no significant diversity in the sequences of the IS harboured in the genomes of the Bordetella isolates screened, except for a 71-nucleotide deletion from IS1002 in B. bronchiseptica. The IS copy numbers in the genome of recently circulating isolates were similar to those in reference strains. Our results confirm that biological diagnosis targeting the IS481 and IS1001 elements are not specific and detect the species B. pertussis, B. holmesii and B. bronchiseptica (IS481), and B. parapertussis and B. bronchiseptica (IS1001).

Acute cough

Acute cough

Tos ferina confirmada por cultivo en un hospital terciario

To study the characteristics of patients diagnosed with whooping cough at a tertiary center in Barcelona, Spain. We performed a retrospective study of patients aged less than 18 years treated for pertussis-like cough or clinically-suspected whooping cough over a 12-year period (1989-2000). Only patients with isolated Bordetella spp. were included. The variables of age, sex, vaccination status, hospitalization, clinical manifestations, severity, and lethality were analyzed. One hundred sixty-one patients with positive Bordetella spp. culture were identified. Of these, complete information was available in 149 (79 boys and 70 girls) with a median age of 3 months (range: 13 days-17 years); 77.2 % were aged 6 months or less. All the isolated strains corresponded to B. pertussis except three that corresponded to B. parapertussis. Three epidemic cycles (in 1989, 1992 and 2000) were observed during the study period. A total of 72.5 % of cases occurred between May and September. Bordetella spp. was associated with other bacteria in 28.2 % of the patients, viruses in 13.4 % and a bacterium and a virus in 4.7 %. One hundred twenty-one patients required hospitalization, of which 14.9 % were admitted to the intensive care unit. Age was the only factor associated with risk for hospitalization, which was more frequent in younger infants (p < 0.0001). Paroxysmal cough with cyanosis was present in 53.4 % of the patients, leucocytosis with lymphocytosis occurred in 67.5 % and apneas were present in 21.5 %. Chest X-ray revealed atelectasis in 34.1 %. The mean length of hospital stay was 11 days (range: 1-70 days). Three boys aged less than 3 months with malignant pertussis syndrome died (lethality: 2 %). More than half the patients (59.7 %) were not vaccinated (55.4 % for being under the age of 3 months) and only 16 % had received three or more vaccination doses. Whooping cough continues to be a severe disease in infants, with a high admission rate during the first 6 months of life. New preventive strategies are required to protect infants who have not yet developed full immunity to this infection.

Rapid-cycle PCR method to detect Bordetella pertussis that fulfills all consensus recommendations for use of PCR in diagnosis of pertussis.

No standardized PCR method is available for the laboratory diagnosis of the pertussis syndrome. Consensus recommendations for the use of PCR in the diagnosis of Bordetella pertussis infections have been proposed, and the aim of this study was to develop a method that fulfills all of these criteria. A rapid-cycle shared-primer PCR method with a microwell format and probe hybridization detection step (POR) was developed using novel oligonucleotides targeted to the outer membrane porin gene (Bordetella spp.). In specimens positive for Bordetella spp., B. pertussis was differentiated from Bordetella parapertussis and Bordetella bronchiseptica by hybridization with organism-specific oligonucleotide probes. An internal control was developed using overlap extension PCR and mouse beta-actin DNA. The analytical specificity was 100%. The analytical sensitivity was comparable to that of nested IS481 and IS1001 PCR ( approximately 1 organism per reaction). The clinical sensitivity and specificity were ascertained using 705 specimens (from 705 patients). The results were compared to those of a nested-PCR method targeting the insertion sequences IS481 and IS1001. Fifty-one specimens were positive for B. pertussis by POR and IS481 PCR. Two specimens which fulfilled a clinical definition of pertussis were positive by POR and negative by IS481 PCR. A total of 652 specimens were negative by both methods. B. parapertussis was not detected in any specimens. PCR inhibition was detected in 21 out of 705 specimens (2.98%). Thus, a rapid (4 h, including specimen preparation) PCR method which fulfills all of the consensus recommendations was developed and validated for the detection of B. pertussis.

Rapid diagnosis of pertussis in young infants: comparison of culture, PCR, and infant's and mother's serology

The contribution of maternal pertussis serology comparing prepartum serum to serum collected during the infant's disease to the diagnosis of pertussis in infants was evaluated for 28 pairs of young infants with pertussis syndrome and their mothers and was compared to those of culture and PCR. Infants had a nasopharyngeal aspiration tested by PCR, and acute and convalescent sera were collected during their disease. Mothers had a first acute serum collected concomitantly with the infant's acute serum, and both acute sera were compared to a prepartum serum. Sera were analyzed by immunoblotting for the detection of anti-pertussis toxin (PT) antibodies. Serological evidence of pertussis in infants was assessed as either an increase in anti-PT antibody levels between the mother's prepartum and acute sera or the presence of antibodies in the infant's acute serum and their absence in both the mother's acute and prepartum sera. Culture and PCR sensitivity were 43 and 89%, respectively. Most infants (18 of 24) had no pertussis antibody detectable in their acute sera, confirming a delayed immune response at this age. A comparison of infant's and mother's serology, using prepartum serum, rapidly confirmed the diagnosis in 57% of the cases. Although less sensitive than PCR, this serological method should be used for a rapid diagnosis of pertussis in young infants when culture and PCR are either not available or negative.

Autotoxicity of nitric oxide in airway disease.

Though nitric oxide (NO) plays a role in many normal pulmonary functions and is involved in inflammatory and immune responses, it also has cytopathologic potential if not tightly controlled. In Bordetella pertussis infection, NO mediates the respiratory epithelial pathology that is a hallmark of the pertussis syndrome. Tracheal cytotoxin (TCT) released by B. pertussis triggers the production of an inducible NO synthase (iNOS) within tracheal epithelial cells, which produce the NO ultimately responsible for their destruction. The induction of iNOS is most likely due to the cytokine interleukin-1, which is generated intracellularly in response to TCT; this cytokine, like TCT, can reproduce the pathology caused by B. pertussis infection. Similar epithelial destruction is observed in asthma, but the precise mechanism of damage remains incompletely defined. It is possible that NO induced by proinflammatory cytokines in the asthmatic respiratory epithelium plays a central role in the observed epithelial damage in asthma as it does in pertussis.

Recalcitrant Asthma: An Allergist's Approach

Patients with asthma who have incomplete control of their symptoms or require regular systemic steroidal therapy are said to have recalcitrant asthma. A systematic approach may significantly improve quality of life. Factors that should be evaluated include living with an antigen, occupational exposure, use of beta-adrenoreceptor blockers, use of nonsteroidal anti-inflammatory agents, sensitivity to dietary chemicals, endocrinopathies, gastroesophageal reflux, sinusitis, bronchopulmonary aspergillosis, and noncompliance. Other diseases may mimic asthma or exacerbate nonspecific bronchial hyperreactivity. These include congestive heart failure, chronic infectious bronchitis resulting from cystic fibrosis, ciliary dysfunction syndrome, and immunodeficiency syndromes, upper airway obstruction, pertussis syndrome, psychogenic coughs, bronchiolitis obliterans, chronic eosinophilic pneumonia, and vasculitides. A systematic approach to the evaluation of coexisting factors and potential exacerbating diseases is presented.

Pertussis and pertussis-like syndrome: a review of the issues.

Pertussis and pertussis-like syndrome: a review of the issues.

Pertussis and pertussis-like syndrome: A review of the issues

Pertussis and pertussis-like syndrome: A review of the issues

Etiology of Pertussis Syndrome

Keller et al1 reported the interesting finding that 91 of 100 patients with pertussis syndrome were infected with Bordetella pertussis or had been exposed to this agent. Their article, however, did not mention the precise age distribution of the patients who "ranged from six weeks to adulthood." It is possible that the etiologic factors of pertussis syndrome in young infants is somewhat different from the etiology of pertussis syndrome in older children. We believe that the laboratory investigation of pertussis syndrome during the first months of life should include examinations for Chlamydia trachomatis infection in addition to the search for Bordetella, Mycoplasma pneumoniae, and viruses, as demonstrated by the following case: A 4-week-old boy with previous history of conjunctivitis was admitted because of paroxysms of staccato cough followed by occasional vomiting or cyanosis.

Etiology of Pertussis Syndrome

One hundred patients with clinical pertussis were studied to determine the etiology of pertussis syndrome. Forty-two (42%) of the patients had either Bordetella pertussis of Bordetella parapertussis isolated from the nasopharynx. In additional 36 (36%) patients, B pertussis was isolated from the nasopharynx of the associated index case or family contact case. Thus, Bordetella was isolated from 78 (78%) of the patients or from their immediate family group. Of the 22 culture-negative patients residing in culture-negative families, 12 had serologic evidence of Bordetella infection and another was from a family group in which two members were seropositive. Therefore, 91 patients (91%) had bacteriologic or serologic evidence of Bordetella infection themselves or within their families. Viral cultures were obtained on 75 of the patients. Adenoviruses were isolated from 33% of those with positive cultures for B pertussis and from 14% of those with negative cultures. In the group without direct or indirect, bacteriologic or serologic evidence of Bordetella infection, the adenoviral isolation rate (13%) was not significantly different from the adenoviral isolation rate (33%) in patients with a positive bacterial culture. These data do not support a role of adenovirus alone in causing pertussis syndrome.