Dive into a gripping case of a five-week-old baby suffering from acute respiratory failure due to pertussis. The experts dissect the disease's stages, early symptoms, and critical management strategies needed for infants. They discuss the alarming public health implications, emphasizing vaccination to prevent outbreaks. Additionally, the podcast unpacks severe complications associated with pertussis and urges the importance of early recognition and support in pediatric care. Get ready for an insightful exploration of this potentially life-threatening disease!
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Severe Infant Pertussis Case
A five-week-old infant presented with severe respiratory distress and hyperleukocytosis reaching above 110,000 WBC.
He rapidly deteriorated to cardiopulmonary collapse, requiring ECMO and was confirmed to have Bordetella pertussis by PCR.
insights INSIGHT
Pulmonary Hypertension Drives Fatality
Pulmonary hypertension is a key indicator of increased mortality in infants with pertussis.
High WBC count correlates with pulmonary hypertension and poor outcomes.
insights INSIGHT
Pertussis Persistence Explained
Pertussis outbreaks recur every 3-5 years due to waning immunity from the acellular vaccine and bacterial changes.
Despite vaccinations, pertussis remains a significant global health threat affecting all ages.
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Chapter and Rogers texbook of Pediatric intensive care
Zimmerman
Fuhrman
Textbook of Pediatric Critical Care offers comprehensive coverage of the field, providing in-depth information on various aspects of pediatric critical care. It covers a wide range of topics, including respiratory support, cardiovascular management, and neurological emergencies. The book is known for its detailed explanations, clinical cases, and practical guidance for healthcare professionals. It is a valuable resource for pediatric intensivists, fellows, and other healthcare providers involved in the care of critically ill children. The book is regularly updated to reflect the latest advancements in the field.
In this episode, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray dive into a critical case involving a five-week-old baby facing acute respiratory failure due to pertussis. They chat about how this condition shows up, how it's diagnosed, and the best ways to manage it, especially considering the serious complications it can cause in infants, like pulmonary hypertension and the potential need for ECMO. The conversation underscores the importance of catching it early and providing supportive care, while also highlighting how crucial vaccination is in preventing pertussis. Tune in to learn how severe this disease can be and why staying alert in pediatric care is so important.
Show Highlights:
Clinical case of a five-week-old infant with acute respiratory failure and pertussis diagnosis
Epidemiology and public health impact of pertussis, including vaccination rates and outbreak patterns
Pathophysiology of pertussis and its effects on respiratory health, particularly in infants
Clinical presentation of pertussis, including stages of the disease and atypical symptoms in infants
Diagnostic approaches for pertussis, including laboratory findings and PCR testing
Management strategies for severe pertussis, including supportive care and antibiotic therapy
Potential complications associated with pertussis, especially in young infants
Differential diagnosis considerations for pertussis and distinguishing features from other infections
Importance of vaccination in preventing pertussis and reducing morbidity and mortality
ECMO as a treatment option for severe cases and its associated challenges, and outcomes
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References:
Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter and Rogers texbook of Pediatric intensive care -both do not have any Pertussis mentioned in their index.
Rowlands HE, Goldman AP, Harrington K, Karimova A, Brierley J, Cross N, Skellett S, Peters MJ. Impact of rapid leukodepletion on the outcome of severe clinical pertussis in young infants. Pediatrics. 2010 Oct;126(4):e816-27. doi: 10.1542/peds.2009-2860. Epub 2010 Sep 6. PMID: 20819895.
Lauria AM, Zabbo CP. Pertussis. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519008/
Berger JT, Carcillo JA, Shanley TP, Wessel DL, Clark A, Holubkov R, Meert KL, Newth CJ, Berg RA, Heidemann S, Harrison R, Pollack M, Dalton H, Harvill E, Karanikas A, Liu T, Burr JS, Doctor A, Dean JM, Jenkins TL, Nicholson CE; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Critical pertussis illness in children: a multicenter prospective cohort study. Pediatr Crit Care Med. 2013 May;14(4):356-65. doi: 10.1097/PCC.0b013e31828a70fe. PMID: 23548960; PMCID: PMC3885763.
Cousin, V.L., Caula, C., Vignot, J. et al. Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score. Crit Care 29, 71 (2025). https://doi.org/10.1186/s13054-025-05300-2
Domico M, Ridout D, MacLaren G, Barbaro R, Annich G, Schlapbach LJ, Brown KL. Extracorporeal Membrane Oxygenation for Pertussis: Predictors of Outcome Including Pulmonary Hypertension and Leukodepletion. Pediatr Crit Care Med. 2018 Mar;19(3):254-261. doi: 10.1097/PCC.0000000000001454. PMID: 29319632.
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