Spasmodic Cough Research Articles

Severe course of whooping cough in a month-old child

Acute respiratory diseases are more and more being registered among the population. According to Rospotrebnadzor, the incidence of acute respiratory infections in the Russian Federation in 2023 amounted to 15911.94 per 100.000 of population. Whooping cough plays a special role in the structure of acute respiratory infections. The largest increase is noted in the last months of 2023. In total, 20.497 cases of whooping cough were registered in the Russian Federation for 9 months of 2023. Whooping cough is an acute anthroponotic infection caused by whooping cough bacteria (Bordetella pertussis), accompanied by catarrhal phenomena in the upper respiratory tract and paroxysmal spasmodic cough. In young children, severe forms of whooping cough are still the most common, leading to a fatal outcome. One of the severe complications in children of the first years of life is encephalopathy, with persistent organic brain damage. In adolescents and adults, whooping cough often occurs in atypical forms and is manifested by a prolonged cough, for which they receive, as a rule, ineffective therapy from a pediatrician, therapist, allergist and otorhinolaryngologist. Whooping cough refers to diseases controlled by specific prevention. However, for children of an earlier age, infection from older children in the family or from adults is typical. This article presents a clinical observation of a severe course of whooping cough in a child aged 1 month, the disease proceeded with a paroxysmal cough, mainly nocturnal, with long reprises and redness of the face, ending with apnea of varying severity and duration. Determination of the severity of the course of pertussis infection is based on a complex of clinical and laboratory data. An early and effective method of etiological verification of whooping cough in children of the first year of life is PCR (polymerase chain reaction) of nasal/oropharyngeal smears.

Clinical characteristics of pertussis in hospitalized children under 3 months

Demographic data and clinical data were collected retrospectively from patients with pertussis at the Children's Hospital Affiliated to the Capital Institute of Pediatrics between March 2011 and February 2023. Among the 270 hospitalized patients, 151 cases were male and 119 were female. The youngest age of admission was 10 days and the eldest age of admission was 11 years. The 270 hospitalized patients were divided into two groups according to onset age: <3 months (n=143) and≥3 months (n=127). For those in the <3-month-old group, the incidence of severe pneumonia and severe pertussis were 21.0% and 38.5%, respectively, both were significantly higher than those in≥3-month-old group (7.9% and 11.0%, both P<0.05). For those in the <3-month-old group, paroxysmal spasmodic cough, post-tussive vomiting, paroxysmal cyanosis, apnea, and decreased heart rate after coughing were 86.7%, 25.2%, 38.5%, 7.0% and 16.8%, respectively, all were significantly higher than those in ≥3-month-old group (76.4%, 10.2%, 15.7%, 1.6% and 1.6%, all P<0.05). For those in the<3-month-old group, the incidence of hypoxemia, respiratory failure, were 36.4%, 16.8%, respectively, and both were significantly higher than those in≥3-month-old group (10.2%, 7.1%, P<0.05). It indicated that among the infants under 3 months, the incidence of vomiting after coughing, paroxysmal cyanosis, apnea, hypoxemia, respiratory failure, decreased heart rate after coughing and severe pneumonia were significantly higher than those above 3 months. Infants under 3 months were prone to severe pertussis.

Epidemiological characteristics and clinical features of pertussis in Shandong Province from 2007 to 2022

Objective: To analyze the epidemiological characteristics and clinical features of pertussis cases reported in Shandong Province of China. Methods: Data on pertussis cases in Shandong Province from 2007 to 2022 were collected from China Information System for Disease Control and Prevention. At the same time, some case information was collected from the database of notifiable pertussis in Shandong Province from 2007 to 2022. The distribution characteristics and clinical features of pertussis were analyzed. A spatial distribution map of pertussis cases in Shandong Province was drawn. Results: A total of 26 122 pertussis cases were reported in Shandong Province during 2007-2022, with an annual incidence rate ranging from 0.11 to 5.77 cases per 100 000 people. Cases occurred throughout the whole year, with a seasonal peak occurring in spring and summer, especially in July and August. In recent years, reported cases were mainly distributed in the central and western regions of Shandong Province, with fewer cases in the eastern region. The hot spots of the disease shifted from Heze and Dezhou City in 2007-2013 to Jinan and Tai'an city in 2014-2022. The age range of onset was from 1 day to 93 years old. The proportion of cases with age≤1 year was the largest (41.81%, 10 922/26 122), and the proportion of cases aged 0-6 months decreased from 32.21% (67/208)-55.67% (157/282) within the period of 2007 to 2013 to 16.78% (883/5 263)-41.97% (444/1 058) within the period of 2014 to 2022, with a statistically significant trend (χ² trend=670.01, P<0.001). There were 13 682 male cases and 12 440 female cases, with a male-female ratio of 1.10∶1. The male-female ratio was 1.45∶1 (806∶556) from 2007 to 2013 and 1.08∶1 (12 876∶11 884) from 2014 to 2022. The proportion of women increased from 42.31% (88/208) in 2007 to 47.84% (2 518/5 263) in 2022, and with a significant trend (χ² trend=22.25, P<0.001). In pertussis cases, the proportions of scattered children, kindergarten children and students were 71.38% (18 645/26 122), 15.13% (3 951/26 122), and 11.60% (3 031/26 122), respectively. The top five clinical symptoms of pertussis cases were paroxysmal spasmodic cough (86.33%, 21 411 cases), flushing (39.61%, 9 824 cases), restless sleep (34.51%, 8 558 cases), fever (30.80%, 7 638 cases), and crowing (27.53%, 6 829 cases). Among 24 802 cases, there were 15 542 cases (62.66%) with a history of immunization against pertussis vaccine. Conclusion: From 2007 to 2022, the incidence rate of pertussis cases in Shandong Province shows an upward trend, with the majority being young children, and the clinical symptoms are relatively typical.

Гидрокортизон в практике лечения тяжелых форм коклюша (от прошлого к настоящему)

Objective. Studying the clinical efficacy of the experimental justification of hydrocortisone use in severe pertussis. Patients and methods. The study was carried out in the State Budgetary Institution of Children's Infectious Disease Clinical Hospital No.1 of the Moscow Health Department. A total of 206 children with pertussis, aged from 0 to 3–4 months, with severe pertussis were under observation. The indication for prescribing the drug was the presence of apnea accompanied by spasmodic cough. Group I (n = 166) consisted of children who received hydrocortisone along with conventional therapy. Group II (comparison, n = 40) consisted of children who were not treated with hydrocortisone. The effect of hydrocortisone on lethal toxicity of Bordetella pertussis extract for mice was experimentally studied. Results. The clinical effect of hydrocortisone was positive. Apnea cupping was observed in 1.8 ± 0.3 days from the start of therapy compared to the control group, in which apnea persisted for 10.6 ± 1.7 days. In the experiments, lethal toxin doses for mice receiving hydrocortisone were significantly higher than for mice to which the hormone was not administered. Conclusion. Long-term clinical and experimental studies have proved the effectiveness of hydrocortisone in the therapy of respiratory rhythm disorders in children aged 0–4 months. The antitoxic effect of the natural glucocorticoid hormone hydrocortisone has been proved on the example of pertussis. Key words: pertussis, hydrocortisone, whooping cough, severity of course, clinical effect

Acute Respiratory Distress Syndrome: A Case Report and Review on Diagnosis and Novel Interventions in Management

Acute respiratory distress syndrome is a type of acute diffuse lung injury, frequently brought on by sepsis, trauma, and severe pulmonary infections and continues to be one of the major causes of morbidity and mortality in critically ill patients, despite the constantly involving advancements. The management strategies have constantly evolved with a wide array of ventilation strategies, conservative fluid management, neuromuscular blockade. As we move into the post pandemic Era, the mortality rate due to ARDS continues to remain high hence improving patient outcomes is the primary goal of the various treatment approaches. The two most effective techniques are still prone ventilation and lung protection ventilation. In this report we aim to present the case of a 30-year old female who has undergone left lobectomy in childhood and presents to the clinic with palpitations, fever, shortness of breath and spasmodic cough with phlegm. The workup included chest Xray, CT scan, arterial blood gas with electrolytes, echocardiography and urinanalysis. Based on clinical and imaging findings, the diagnosis of acute respiratory distress syndrome was made. Against the background of intensive treatment, the patient’s condition improved to some extent, with positive dynamics. Lung protective ventilation, prone ventilation, high frequency oscillatory ventilation among many other novel interventions and futuristic direction of ARDS with mesenchymal stromal cells and Ulinastatin, a urinary glycoprotein and protease inhibitor provides a ray of hope in the management of this acute condition. Keywords: Acute respiratory distress syndrome; hypoplasia; lung ventilation; prone ventilation; mesenchymal stem cells; ulinastatin

SARCOIDOSIS WITH PROLONGED REMISSION – A CLINICAL CASE REPORT

Sarcoidosis is a rare multisystem disease characterized by the development of inflammatory granulomatous formations in tissues without caseous necrosis. It can involve any organ or system where T-lymphocytes and mononuclear phagocytes are concentrated. Sarcoidosis usually occurs in adults of both sexes, although research shows that it is more common in females. Many infectious and non-infectious factors are considered as probable causes of the development of sarcoidosis. This article describes pulmonary sarcoidosis in a 41-year-old woman, whom we have been monitoring since 2015. The patient came to the clinic with complaints: shortness of breath, spasmodic cough, pain in the left ring area. She was initially treated with a diagnosis of pneumonia, without success. Radiography of the lungs showed lymphadenopathy of the roots and mediastinum of the lungs, along with changes in the lung parenchyma. In order to rule out oncological disease, additional studies were appointed: on chest computer tomography - enlarged tracheobronchial lymph nodes; by fibrobronchoscopy: tubular bronchiectasis; By cytology of the washed material: leukocytes and lymphocytes were seen in the mucus, by biopsy: non-caseous granulomatosis. As a result of examination, a diagnosis of pulmonary sarcoidosis was made. Treatment with hormonal drugs was prescribed. For the purpose of continuous monitoring, the patient has been under observation for 3 years and instrumental-laboratory studies are being conducted, steroid treatment is continued according to the appropriate scheme. At this stage, the disease is not progressing and is manageable, remission has been achieved. There are no additional complications.

ЭПИДЕМИОЛОГИЧЕСКИЕ АСПЕКТЫ КОКЛЮША У ДЕТЕЙ

Objective: To analyze the epidemiological aspects of pertussis (whooping cough) in the Astrakhan region among children in the period from 2020 to 2022. Methods: During the observation period, 33 children’s outpatient medical records between 2020 and 2022 from various medical institutions in the Astrakhan region were analyzed. Results: Whooping cough affected children of different ages but was more common in infants (younger than 1 year): 46% (n=15), slightly less common in toddlers and preschoolers (1 to 6 years of age): 42% (n=14), while the rate of school-aged children was the lowest: 12% (n=4). In the Astrakhan region, contrary to the city of Astrakhan, the rate of cases under one year of age was higher: 62% (n=6); followed by children 1 to 6 years of age: 25% (n=2), with rarer cases in the school-aged group: 13% (n=1). Among the examined cases the following symptoms prevailed: spasmodic cough (100%; n=33), weakness (94%; n=31), and nasal congestion (58%; n=19), which are typical for the classic course of whooping cough. An extremely rare symptom among children was tonic-clonic seizures: 6% (n=2). No cases of whooping cough with atypical courses have been recorded in the Astrakhan region. Conclusion: Over the past few years, the epidemiological situation with whooping cough infection among the population of the Astrakhan region tended to improve. Susceptibility to whooping cough was characteristic of all ages, but most often children under one year of age were affected. The clinical course was dominated by classical manifestations of pertussis: spasmodic cough, weakness, and nasal congestion. Important diagnostic criteria were the presence of posttussive vomiting and the absence of fever. The main reason for infection among children was non-vaccination due to various medical circumstances or parental refusal. Keywords: Whooping cough, children, vaccination, vaccination calendar, morbidity.

Chronic Cough in CANVAS

Among patients with RFC1 spectrum disorders represented by the phenotype of cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS), at least 60% are known to manifest chronic, paroxysmal, and spasmodic dry cough. Chronic cough is a key diagnostic feature of RFC1-related diseases. It is often the first symptom and, in some cases, precedes neurological symptoms such as ataxia and sensory disturbance for more than 30 years. Although the pathogenesis of the cough remains unclear, it is possible that impairment of the vagus nerve, which includes an afferent pathway of the cough reflex, or the cerebellum would have contributed to the generation of the cough.

RFC1 CANVAS/Spectrum Disorder: Historical Details and Clinical Diversity

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) refers to a multi-system neurodegenerative disorder, with middle-age onset, which mainly presents with progressive imbalance. Imbalance is attributable to isolated or combined impairment of the cerebellar, proprioceptive, and vestibular systems. Chronic spasmodic cough, which usually precedes neurological symptoms, serves as a useful diagnostic clue to CANVAS. Diagnostic criteria have been proposed for CANVAS in 2016, based on 3 cardinal features. In 2019, a biallelic intronic AAGGG repeat expansion (AAGGG)exp in the replication factor complex subunit 1 gene (RFC1) was identified as a genetic contributor to CANVAS, and (ACGGG)exp in RFC1 was subsequently confirmed as a causative factor for CANVAS. Genetic screening for RFC1 has shown that CANVAS is an overlooked entity in patients with cerebellar ataxia or sensory neuropathy, which highlights more restricted phenotypes that exclusively involve one of the aforementioned systems. The phenotypic spectrum of RFC1-related disorders has been expanding since the discovery of (AAGGG)exp or (ACGGG)exp in the RFC1. Studies have reported atypical features, including parkinsonism, motor neuron involvement, cognitive decline, and sleep disorders. Currently, a wide variety of clinical conditions associated with biallelic intronic pentanucleotide repeat expansion in RFC1 are classified as RFC1 CANVAS/spectrum disorder.

Un asma sine asma: la SIRT

The paper describes the case of a girl with recurrent cough attributable to the so-called Cough Hypersensitivity Syndrome (CHS). The cough was misdiagnosed as drug resistant asthma for long time. CHS should be considered in all cases where recurrent, spasmodic cough, more than wheezing, predominates in the clinical picture.

Movement disorders in 2020: clinical trials, genetic discoveries, and COVID-19

Movement disorders in 2020: clinical trials, genetic discoveries, and COVID-19

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.

Spasmodic cough preceding CANVAS phenotype in a family with biallelic repeat expansions in RFC1.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a late-onset, multisystem ataxia that remained only clinically defined, until recently, when the discovery of biallelic repeat expansion in the RFC1 gene allowed the genetic link. We describe the first Portuguese familial CANVAS harboring the pathogenic RFC1 expansion. Detail clinical features and course of four affected members are provided. Phenotype characterizations are important as the novel RFC1 mutation is expected to be a major cause of idiopathic late-onset ataxia.

Safety and immunogenicity of the live attenuated intranasal pertussis vaccine BPZE1: a phase 1b, double-blind, randomised, placebo-controlled dose-escalation study

Long-term protection and herd immunity induced by existing pertussis vaccines are imperfect, and a need therefore exists to develop new pertussis vaccines. This study aimed to investigate the safety, colonisation, and immunogenicity of the new, live attenuated pertussis vaccine, BPZE1, when given intranasally. This phase 1b, double-blind, randomised, placebo-controlled, dose-escalation study was done at the phase 1 unit, Karolinska Trial Alliance, Karolinska University Hospital, Stockholm, Sweden. Healthy adults (18-32 years) were screened and included sequentially into three groups of increasing BPZE1 dose strength (107 colony-forming units [CFU], 108 CFU, and 109 CFU), and were randomly assigned (3:1 within each group) to receive vaccine or placebo. Vaccine and placebo were administered in phosphate-buffered saline contained 5% saccharose as 0·4 mL in each nostril. The primary outcome was solicited and unsolicited adverse events between day 0 and day 28. The analysis included all randomised participants who received a vaccine dose. Colonisation with BPZE1 was determined by repeatedly culturing nasopharyngeal aspirates at day 4, day 7, day 11, day 14, day 21, and day 28 after vaccination. Immunogenicity, as serum IgG and IgA responses were assessed at day 0, day 7, day 14, day 21, day 28, 6 months, and 12 months after vaccination. This trial is registered at Clinicaltrials.gov, NCT02453048. Between Sept 1, 2015, and Feb 3, 2016, 120 participants were assessed for eligibility, 48 of whom were enrolled and randomly assigned (3:1) to receive vaccine or placebo, with 12 participants each in a low-dose, medium-dose, and high-dose vaccine group. Adverse events between day 0 and day 28 were reported by one (8%, 95% CI 0-39) of 12 participants in both the placebo and low-dose groups, and two (17%; 2-48) of 12 participants in both the medium-dose and high-dose groups, including cough of grade 2 or more, oropharyngeal pain, and rhinorrhoea and nasal congestion. During this time, none of the participants experienced any spasmodic cough, difficulties in breathing, or adverse events following immunisation concerning vital signs. The tested doses of BPZE1 or placebo were well tolerated, with no apparent difference in solicited or unsolicited adverse events following immunisation between groups. Colonisation at least once after vaccination was observed in 29 (81%; 68-93) of 36 vaccinated participants. The tested vaccine doses were immunogenic, with increases in serum IgG and IgA titres against the four B pertussis antigens from baseline to 12 months. The tested vaccine was safe, induced a high colonisation rate in an adult population, and was immunogenic at all doses. These findings justify further clinical development of BPZE1 to ultimately be used as a priming vaccine for neonates or a booster vaccine for adolescents and adults, or both. ILiAD Biotechnologies.

Cerebellar ataxia, neuropathy, vestibular areflexia syndrome due to RFC1 repeat expansion.

Ataxia, causing imbalance, dizziness and falls, is a leading cause of neurological disability. We have recently identified a biallelic intronic AAGGG repeat expansion in replication factor complex subunit 1 (RFC1) as the cause of cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) and a major cause of late onset ataxia. Here we describe the full spectrum of the disease phenotype in our first 100 genetically confirmed carriers of biallelic repeat expansions in RFC1 and identify the sensory neuropathy as a common feature in all cases to date. All patients were Caucasian and half were sporadic. Patients typically reported progressive unsteadiness starting in the sixth decade. A dry spasmodic cough was also frequently associated and often preceded by decades the onset of walking difficulty. Sensory symptoms, oscillopsia, dysautonomia and dysarthria were also variably associated. The disease seems to follow a pattern of spatial progression from the early involvement of sensory neurons, to the later appearance of vestibular and cerebellar dysfunction. Half of the patients needed walking aids after 10 years of disease duration and a quarter were wheelchair dependent after 15 years. Overall, two-thirds of cases had full CANVAS. Sensory neuropathy was the only manifestation in 15 patients. Sixteen patients additionally showed cerebellar involvement, and six showed vestibular involvement. The disease is very likely to be underdiagnosed. Repeat expansion in RFC1 should be considered in all cases of sensory ataxic neuropathy, particularly, but not only, if cerebellar dysfunction, vestibular involvement and cough coexist.

Analyse des paramètres épidémiologiques des symptômes de l’allergie au Bénin : cas de Cotonou

Purpose of the studyThis study aimed to analyze the epidemiological parameters concerning allergy in Benin. Patients and methodThe study was carried out in Benin in Cotonou at the University Hospital Center for Mothers and Children and at the University Hospital Pulmonology-Tuberculosis Department respectively via external pediatric consultations and pulmonology departments. It was conducted using an accountancy sheet to collect the sociodemographic data of patients, the reasons for consultations, the diagnoses made, and the treatments followed. Counting was based on the archived records of patients visiting these hospitals throughout 2016. Only data for subjects diagnosed with allergy symptoms or presenting suspected allergy were selected and then examined. The collected data were analyzed using Excel and STATA software. ResultsIn all, 1098 of the patient files consulted were processed. In total, 58.3 % (640 files) of these cases were from the University Hospital Center for Mother and Child, with the remainder (458 files) coming from the University Hospital Pulmonology-Tuberculosis Department. In children, age affects the type of allergic pathology seen, while in adults, the key factor is sector of activity. The sectors most affected are the tertiary sector (traders, lawyers, administrators) and subjects not in work (retired people, school children, and students). The most commonly diagnosed symptoms of allergies are allergic rhinitis with spasmodic cough (36.0 %), allergic cough (28.1 %), allergic rhinitis (13.8 %) and asthma (12.6 %). The peak period for these events is from November to February. ConclusionAllergy is thus clearly a public health issue in Benin.

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 in 857 patients with pediatric pertussis in Xi′an

Objective To analyze the clinical characteristics in children with pertussis, and to provide a scientific basis for treatment of pertussis. Methods Retrospective analysis of general data, symptoms, signs, auxiliary examinations, treatment and prognosis was performed on the patients with pediatric pertussis in Xi′an from January 2015 to December 2016; the epidemiological data were analyzed by using descriptive approach. Results In a total of 857 patients with pertussis, there were 469 males and 388 females (the gender ratio of 1.211.00), 183 cases (21.3%) from the urban areas and 674 cases (78.7%) from the rural areas.The cases were reported throughout the year, indicating 2 peak times of onset: 355 cases (41.5%) from July to September and 218 cases (25.4%) from February to April.And 473 cases (55.2%) were younger than 6 months; 479 cases (55.9%) were inoculated with diphtheria, tetanus and pertussis combined vaccine(DTP) vaccine; 492 cases (57.4%) were exposed to their family members who coughed at that time.Cough was the main symptom, and the median duration of pertussis from onset to diagnosis was 20 days.Concomitant symptoms included spasmodic cough was relieved in 836 cases (97.5%), facial suffusion in 806 cases (94.0%), peri-oral cyanosis in 308 cases (35.9%), asthma in 269 cases (31.4%), crow-like echo in 248 cases (28.9%), and apnea in 46 cases (5.4%); pulmonary moist rale was found by check-up in 761 cases (88.8%), and fever was observed in 159 cases (18.5%). The increased proportion of the peripheral blood lymphocytes was found in 702 cases (81.9%), the increased total count of leukocytes in 505 cases (58.9%), the increased procalcitonin(PCT) in 36 cases (4.2%) and the elevated level of high sensitivity C reactive protein(hsCRP) in 17 cases (2.0%); pneumonia was suggested by chest radiography in 673 cases (78.5%); in the blood-gas analysis, hypoxemia was suggested in 50 cases (5.8%) and respiratory failure in 9 cases (1.1%). In the 857 patients with pertussis, 59 cases (6.9%) were with severe-type pertussis.At 1 week of the treatment, no spasmodic cough was reported in 515 cases (60.1%) and obviously relieved spasmodic cough in 198 cases (23.1%), and no deaths occurred. Conclusions The cases of pertussis occur throughout the year in Xi′an, predominately from July to September and February to April.A higher incidence is reported in the rural areas, compared with the urban areas, particularly in those younger than 6 months with incomplete DTP vaccination, who usually have severe conditions.In many cases, those with pediatric pertussis are infected by family members; most of them have spasmodic cough with good prognosis, without typical clinical signs. Key words: Pertussis; Epidemiologic characteristics; Clinical characteristics

CLINICAL AND IMMUNOLOGICAL FEATURES OF THE COMBINED COURSE OF PERTUSSIS AND CHLAMIDYAL INFECTION IN CHILDREN

The article presents the analysis of clinical and immunological features of the combined course of pertussis and respiratory chlamydia in children. The study of the prodromal period and spasmodic cough symptoms showed that concomitant chlamydial infection did not significantly affect the severity of pertussis: 63.2% of patients had mild degree and 36.8% — moderate severity of the disease. However, in this case, the disease was delayed. Bronchitis and in some cases obstructive bronchitis was observed mainly in children under 1 year.The study of the lymphocytes subpopulation found that the content of NK cells decreased only in 10.5% of children, T helpers — in 21.1%, the ratio of CD4+ /CD8+ — in 26.3%. The function of cytokine network was characterized by more active production of such proinflammatory cytokines as IFN and TNF than their production during pertussis monoinfection. The levels of production of IL-8 and IL-6 were similar in all the studied groups. The production of IL-4 by lymphocytes in children with whooping cough in combination with chlamydial infection was weaker then in patients with pertussis monoinfection or in healthy children. These features are considered as immunological predictors of long reconvalescence in patients with association of pertussis and respiratory chlamydia.

A case report of pediatric calciphylaxis–a rare and potentially fatal under diagnosed condition

Rationale:Though to be rare, calcific uremic arteriolophathy (CUA) is an ectopic calcification entity causing pain and disabilities in patients with chronic renal insufficiency, thus increasing the morbidity and mortality.Patient concern:We report a case of four years old boy admitted with acute respiratory failure. Physical examination revealed: irritability, purple subcutaneous hard nodules, tachypnea, dry spasmodic cough, respiratory rate 45/min, heart rate 110/min, blood pressure 100/60 mmHg, with normal heart sounds, no murmurs, hepatomegaly with hepato-jugular reflux. He was diagnosed at 2 years old with stage 5 chronic kidney disease due to untreated posterior urethral valve, and subsequently started peritoneal dialysis. He developed severe renal osteodystrophy, refractory to standard phosphate binders.Diagnoses:Pathology examination revealed the presence of diffuse calcifications involving the skin, brain, heart, lung, kidney, stomach and pancreas, consistent with the underlying diagnosis of CUA.Intervention:Apart from standard treatment for end stage renal disease and associated co-morbidities, intensive care procedures have been initiated: oxygen therapy, continuous positive airway pressure, inotropic medication (Dopamine, Dobutamine), anticonvulsants (Diazepam), and antiedematous therapy (Dexamethasone).Outcome:His pulmonary function rapidly deteriorated up to the severe hypoxemia, seizures and cardio-respiratory arrest, despite the initiation of intensive care measures.Lessons:A careful follow up of small children might detect in time an abnormal urinary pattern. The diagnosis of growth failure should also trigger urgent further investigation.