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Clinical Profile of Pertussis among Pediatric Patients Admitted at the Philippine General Hospital

Journal 2015 Vol.16 No.1
Rosalia Belen F. Bonus, MD, Carmina A. delos Reyes, MD, Cleo Anna Marie E. Dy, MD, Ruth Alma Ramos, MD
Bordetella pertussis, pertussis, DPT vaccination, pertussis pneumonia, whooping cough
Objective: The aim of this research was to describe the epidemiologic, clinical, laboratory and microbiologic characteristics, complications and outcome of pertussis among pediatric patients at the Philippines General Hospital.

Methods: A retrospective chart review was performed which included pediatric patients with final diagnosis of pertussis, both clinical and laboratory confirmed, admitted from December 2012 to August 2013 at the Philippine General Hospital.

. Results: This chart review included 28 pertussis patients highest in those aged 1-3 months (86%), females (57%) and from region 4A (57%). 26 (93%) had exposure to household members with respiratory symptoms and unknown pertussis vaccination status. Of those patients who were eligible for vaccination, only 24% received age- appropriate DPT vaccination. .

Onset of illness varied from 3 56 days; majority <2 weeks (57%). The following symptoms were observed: paroxysmal cough (100%), cyanosis (100%), fast breathing (93%), post-tussive vomiting (32%), fever (25%), and apnea (11%). None of patients presented with classical whoop. All patients had leukocytosis (mean WBC: 56.14x10/L, range 14.7-111.5x10/L), lymphotic predominance (mean lymphocyte 0.47, range: 0.20-0.72) and thrombocytosis (mean platelet count: 567x10/L, range: 269-823x10/L). 28% were culture positive for B. pertussis, while 86% tested positive for PCR. .

The most common complications were pneumonia requiring mechanical ventilation (64%), ARDS (28%), seizures (21%), nosocomial pneumonia(11%) and myocarditis (11%). The average length of hospital stay was 7.4 days with 13 deaths or 46% case fatality rate. Deaths were attributed to respiratory failure due to progressive pneumonia and ARDS. Other contributing causes were arrhythmia, MODS, and septic shock.

Conclusion: Susceptible young infants acquire pertussis from household contacts with respiratory symptoms. Paroxysmal cough and cyanosis are common clinical features, with leukocytosis, lymphocytosis and thrombocytosis. High case fatality rate for pertussis was noted among these patients.
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Cecilia Maramba-Lazarte, MD, MScID

Nancy Bermal, MD
Arlene Dy-Co, MD

Gyneth Bibera, MD
Mary Anne Bunyi, MD
Elizabeth Gallardo, MD
Jonathan Lim, MD
Xenia Cathrine Fabay , MD
Fatima Jimenez , MD
Nanette Cuady-Madrid, MD
Carmina Arriola, MD
Arlene S. Dy-Co, MD
Maria Estrella Balao-Litam, MD, MBA-H
Belle Ranile, MD
Xenia Catherine J. Fabay, MD

Rea Uy-Epistola