The pertussis hypothesis: Bordetella pertussis colonization in the etiology of asthma and diseases of allergic sensitization.

Decades of peer reviewed evidence demonstrate that: 1)Bordetellapertussisand pertussis toxin are potent adjuvants, inducing asthma and allergic sensitization in animal models of human disease, 2)Bordetella pertussisoften colonizes the human nasopharynx, and is well documented in highly pertussis-vaccinated populations and 3) in children, a history of whooping cough increases the risk of asthma and allergic sensitization disease. We build on these observations with six case studies and offer a pertussis-based explanation for the rapid rise in allergic disease in former East Germany following the fall of the Berlin Wall; the current asthma, peanut allergy, and anaphylaxis epidemics in the United States; the correlation between the risk of asthma and gross national income per capita by country; the lower risk of asthma and allergy in children raised on farms; and the reduced risk of atopy with increased family size and later sibling birth order. To organize the evidence for the pertussis hypothesis, we apply the Bradford Hill criteria to the association between Bordetella pertussisand asthma and allergicsensitization disease. We propose that, contrary to conventional wisdom that nasopharyngealBordetella pertussiscolonizing infections are harmless, subclinicalBordetella pertussiscolonization is an important cause of asthma and diseases of allergic sensitization.

[Update on leukoreduction therapies as alternatives for the treatment of severe pertussis]. / Actualización en terapias de leucorreducción como alternativas para el tratamiento de coqueluche grave.

Pertussis is a contagious disease that in patients under 1 year of age may evolve to a highly lethal course characterized by hypoxemia and refractory pulmonary hypertension, being this responsible for cardiovascular collapse. Pulmonary hypertension occurs by direct action of bacteria and its toxins, responsible for the vascular tone alteration associated with hyperviscosity syndrome and arteriolar thrombosis due to hyperleukocytosis. Since 2004, leucodepletion has been proposed as a treatment option; there are currently 18 publications on leucodepletion in patients with severe Pertussis, with a total of 288 patients, 68 cytoreduction procedures and a mortality rate of 28% in those exposed to the mentioned treatment. Published studies have design limitations, so the evidence for using leukoreduction in patients with severe pertussis remains low.

La coqueluche es una enfermedad infectocontagiosa que, en pacientes menores de 1 año, puede evolucionar hacia un cuadro grave con elevada mortalidad, caracterizado por hipoxemia e hipertensión pulmonar refractaria al tratamiento, responsable del colapso cardiovascular. La hipertensión pulmonar se produce por acción directa de la bacteria y de sus toxinas, responsable de la alteración del tono vascular, asociada a un síndrome de hiperviscosidad y trombosis arteriolar por la hiperleucocitosis. La leucodepleción se plantea como una opción terapéutica desde el año 2004. En la actualidad, existen 18 publicaciones referentes a leucorreducción en pacientes con coqueluche grave, con un total de 288 pacientes y 68 procedimientos de citorreducción y una mortalidad del 28% en los expuestos a dicho tratamiento. Los trabajos publicados presentan limitaciones en el diseño, de modo que es baja la calidad de la evidencia sobre la utilidad de la leucorreducción en pacientes con tos ferina grave

Resolution of migratory pulmonary infiltrates by moxifloxacin in a patient with dual infection of Mycoplasma pneumoniae and Bordetella pertussis.

A 37-year-old Japanese woman, who was not vaccinated against Bordetella pertussis, developed a nocturnal fever with persistent dry cough for more than 2 weeks. A chest radiograph showed poorly-defined nodular opacities in the left lung. Due to the significant rise in serum antibodies for both Mycoplasma pneumoniae and B. pertussis, a diagnosis of dual infection with the organisms was made. Despite the use of susceptible antibiotics, the patient symptoms did not improve and her chest radiograph showed migratory pulmonary infiltrates. However, a quinolone derivative, moxifloxacin, dramatically improved her symptoms and resolved the pulmonary infiltrates shortly after administration. In this case, due to the lymphocyte-stimulatory nature of M. pneumoniae and B. pertussis, an increased immunological response was likely to be involved in the pathogenesis of pneumonia. The immunomodulatory property of moxifloxacin was thought to repress the increased lymphocyte activity, and thus facilitated complete remission of the disease.

Quimioprofilaxis en coqueluche: ¿sacar agua a canastos? / Pertussis chemoprophylaxis: a sterile effort?

La quimioprofilaxis (QP) en coqueluche debe orientarse a proteger personas con riesgo de presentar complicaciones graves o fallecer: neonatos y lactantes bajo un año, senescentes, pacientes con afecciones cardiacas y pulmonares con insuficiencia funcional, y mujeres en tercer trimestre de embarazo (para proteger al neonato). La evidencia disponible permite recomendar una QP selectiva en los contactos ocurridos en el hogar, hasta 21 días de aparecer el caso primario, y antes de presentarse un caso secundario, recomendación que puede hacerse extensible a personas con alto riesgo que co-habitan con un caso índice en el hospital, guarderías infantiles y hogares de ancianos. La transmisibilidad de B. pertussis podría alcanzar una distancia mayor de 1,5 metros desde la cara del paciente, concepto importante para diseñar la QP en el medio hospitalario. Sólo existen argumentos sólidos para emplear macrólidos y azálidas; siete días es un plazo suficiente para erradicar B. pertussis con eritromicina o claritromicina, 5 días para azitromicina.

[Protective effects of baicalin, mannitol and dexamethasone on infective brain edema in rats].

OBJECTIVE: To compare the therapeutic effects of baicalin, mannitol and dexamethasone on infective brain edema(IBE) in rats. METHODS: Forty normal Sprague-Dawley(SD) rats (200 +/- 30) g by weight were divided into 5 groups randomly: (1) normal saline control group(NS, n = 8); (2) infective brain edema group (BE, n = 8); (3) mannitol treatment group(MAN, n = 8); (4) dexamethasone treatment group(DXM, n = 8); and (5) baicalin treatment group(BC, n = 8). Pertussis bacilli(PB, contained bacilli in 10.8 x 10(9), 0.2 ml-1.kg-1) were injected into the left carotid arteries through the left common carotid arteries by puncture to obtain BE models. The contents of brain water, sodium ion, potassium ion and Evans blue in brain tissues were observed too. RESULTS: The contents of brain water, sodium ion, and EB in BE group were higher than those in BE group(P < 0.01), they decreased in MAN, DXM, BC groups and were lower than those in BE group(P < 0.01). In MAN, DXM, BC groups, there were no significant difference in the contents of brain water and sodium ion(P > 0.05). The EB content in BC group was higher than that in MAN and DXM groups(P < 0.01). The content of potassium ion in BE group was higher than that in MAN and DXM groups, the content of potassium ion was similar to that in NS group, but lower than that in BC group. Light microscope inspection in MAN, DXM and BC groups showed lessened brain edema, slight increase of perivascular space, and occasional nerve cell pyknotic nucleus. We found on nerve cell vacuolar degeneration in DXM group. CONCLUSION: Baicalin, mannitol and dexamethasone all have similar protective effects on infective brain edema in rats.

[Therapy of pneumonia in children with mezlocillin (author's transl)]. / Therapie der Pneumonien im Kindesalter mit Mezlocillin.

Pneumonia in children requires immediate antibiotic treatment. The identification of the causative organism is very difficult and, therefore, of little importance for therapy. A number of simple examinations, such as BSR, neutrophil count and unsegmented neutrophil count, allow to differentiate between bacterial and viral infections. This method is particularly suitable for assessing an antibiotic treatment retrospectively. These considerations were borne in mind when instituting treatment in 72 babies and children suffering from pneumonia. The following diagnoses were established: 12 cases of whooping cough associated with pneumonia, 4 cases of congenital defects and pneumonia, 1 case of rare Salmonella-induced septicopyaemia and pneumonia, 6 cases of pneumonia and reduced defence against infections and 49 cases of primary pneumonia. Except for one child presenting an insufficiently developed immunity system, all the children were rapidly cured within 5-7 days. The only side effect observed was rash in two cases.