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1.
Public Health Rep ; 134(6): 587-591, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31568732

RESUMO

Oregon continues to face epidemics of pertussis, and infants younger than 2 months of age have the highest incidence and rates of hospitalization and complications. We describe the medical course and sequelae of an infant's severe pertussis illness through age 5½ years. The child has failed to meet developmental milestones, requires substantial medical care, and bears the burdens of chronic lung disease, stroke, epilepsy, impaired neurodevelopment, and problems with vision. The medical and social burden of pertussis among infants too young to be vaccinated underscores the importance of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination during pregnancy.


Assuntos
Epidemias , Vacinação , Coqueluche/complicações , Coqueluche/epidemiologia , Coqueluche/terapia , Pré-Escolar , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Seguimentos , Hospitalização , Humanos , Incidência , Lactente , Recém-Nascido , Mães , Transtornos do Neurodesenvolvimento , Oregon , Gravidez
2.
BMC Infect Dis ; 19(1): 919, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664950

RESUMO

BACKGROUND: Pertussis causes severe disease in young unvaccinated infants, with preterms potentially at highest risk. We studied pertussis in hospitalized infants as related to gestational age (GA) and vaccination history. METHODS: Medical record data of 0-2y old patients hospitalized for pertussis during 2005-2014 were linked to vaccination data. Multivariable logistic regression was used to study the association between GA and vaccination history on the clinical disease course. We compared vaccine effectiveness (VE) against hospitalization for pertussis between term and preterm infants (i.e., <37w GA) using the screening method as developed by Farrington. RESULTS: Of 1187 records, medical data from 676 were retrieved. Of these, 12% concerned preterms, whereas they are 8% of Dutch birth cohorts. Median age at admission was 3 m for preterms and 2 m for terms (p < 0.001). Preterms more often had received pertussis vaccination (62% vs 44%; p = 0.01) and more often had coinfections (37% vs 21%; p = 0.01). Preterms tended more often to have complications, to require artificial respiration or to need admittance to the intensive care unit (ICU). Preterms had longer ICU stays (15d vs 9d; p = 0.004). Vaccinated preterms and terms had a lower median length of hospital stay and lower crude risks of apneas and the need for artificial respiration, additional oxygen, and ICU admittance than those not vaccinated. After adjustment for presence of coinfections and age at admittance, these differences were not significant, except the lower need of oxygen treatment in vaccinated terms. Effectiveness of the first vaccination against pertussis hospitalizations was 95% (95% CI 93-96%) and 73% (95% CI 20-91%) in terms and preterms, respectively. Effectiveness of the second dose of the primary vaccination series was comparable in both groups (86 and 99%, respectively). CONCLUSIONS: Infants hospitalized for pertussis suffer from severe disease. Preterms were overrepresented, with higher need for intensive treatment and less VE of first vaccination. These findings stress the need for alternative prevention, in particular prenatal vaccination of mothers, to reduce pertussis in both groups.


Assuntos
Criança Hospitalizada , Recém-Nascido Prematuro , Vacina contra Coqueluche/uso terapêutico , Coqueluche/prevenção & controle , Coqueluche/terapia , Apneia/etiologia , Pré-Escolar , Estudos de Coortes , Feminino , Idade Gestacional , Hospitalização , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Modelos Logísticos , Masculino , Mães , Países Baixos , Vacina contra Coqueluche/efeitos adversos , Gravidez , Respiração Artificial , Estudos Retrospectivos , Resultado do Tratamento , Vacinação/efeitos adversos
3.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(3): 351-362, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1041347

RESUMO

ABSTRACT Objective: Through a systematic review, this essay aimed at revising the concepts of severe pertussis, updating the epidemiology, pathophysiology, clinical presentation, antibiotic therapy and auxiliary therapeutic options for symptomatology and complications. Data sources: This review considered publications from the last 30years in the databases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane, Google Scholar, as well as protocols of the Ministry of Health and recommendations of the Centers for Disease Control and Prevention, related to childhood pertussis (whooping cough), with emphasis on its severe form. This research was based on keywords derived from the terms "pertussis", "azithromycin", "antitussives", "leukocyte reduction" in Portuguese and English. Duplicate studies and those with unavailable full-text were excluded. Data synthesis: Among 556 records found, 54 were selected for analysis. Pertussis, as a reemerging disease, has affected all age groups, evidencing the transient immunity conferred by infection and vaccination. Severe cases occur in neonates and infants, with secondary viral and bacterial complications and malignant pertussis, a longside hyperleukocytosis, respiratory failure and shock. Macrolides continue to be the chosen antibiotics, while antitussives for coughing remain without efficacy. The prompt treatment in Intensive Care Units improved the prognostic in severe cases, and transfusion was promising among procedures for leukoreduction. Conclusions: Approaching severe pertussis in childhood remains a challenge for diagnostic and therapy, as the available therapeutic options are still unsatisfactory. Strategies of prevention are expected to reduce the occurrence of severe cases, while new studies should confirm the role of auxiliary therapies.


RESUMO Objetivo: Rever os conceitos de coqueluche grave, atualizar epidemiologia, fisiopatologia e apresentação clínica, verificar as recomendações de antibioticoterapia e conhecer opções terapêuticas auxiliares na sintomatologia e complicações, por meio de revisão sistemática. Fontes de dados: Foram pesquisados trabalhos publicados nos últimos 30 anos nas bases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane e Google Scholar, bem como protocolos do Ministério da Saúde e recomendações do Centers for Disease Control and Prevention, relacionados à coqueluche na infância, com ênfase na forma grave. Apesquisa baseou-se em palavras-chave derivadas dos termos "coqueluche", "azitromicina", "antitussígenos" e "redução de leucócitos", nos idiomas português e inglês. Foramexcluídos estudos em duplicata ou texto integral indisponíveis. Síntese dos dados: Dos 556 registros encontrados, foram selecionados 54 para análise. A coqueluche, como doença reemergente, tem acometido todas as faixas etárias, evidenciando a imunidade transitória conferida pela infecção e pela vacinação. Quadros graves ocorrem em neonatos e lactentes, com complicações virais e bacterianas secundárias e pertussis maligna, com hiperleucocitose, insuficiência respiratória e choque refratário. Os macrolídeos continuam como antibióticos de escolha. Os sintomáticos da tosse não demonstraram eficácia. O suporte precoce em Unidade de Terapia Intensiva melhorou o prognóstico dos casos graves e a exsanguineotransfusão se mostrou a mais promissora entre os procedimentos para leucorredução. Conclusões: A abordagem da coqueluche grave na infância segue como desafio diagnóstico e terapêutico. As opções terapêuticas disponíveis ainda são insatisfatórias. Espera-se que as estratégias de prevenção reduzam a ocorrência de casos graves e que novos estudos confirmem o papel das terapias adjuvantes.


Assuntos
Humanos , Recém-Nascido , Lactente , Índice de Gravidade de Doença , Coqueluche/diagnóstico , Coqueluche/terapia , Coqueluche/epidemiologia , Saúde Global/estatística & dados numéricos , Terapia Combinada , Antibacterianos/uso terapêutico
5.
Paediatr Respir Rev ; 30: 58-64, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30962153

RESUMO

Cough is a forced expulsive manoeuvre, usually against a closed glottis and is associated with a characteristic sound that is easily recognised. It is a protective reflex against aspiration and to clear airway secretions. In children cough is extremely common and when prolonged it is often a cause for concern for parents, resulting in a high proportion of attendances to primary and secondary care. There are many causes of cough which may be divided into productive or non-productive in character. As there are many guidelines for the management of productive or 'wet' cough the focus of this paper will be to discuss some of the main causes, investigations and management options for 'dry' cough. Dry coughing suggests airway irritation and or inflammation (without excessive extra secretion formation) and is predominantly the result of an acute viral respiratory infection that may last up to 3-4 weeks.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Tosse/terapia , Refluxo Gastroesofágico/tratamento farmacológico , Infecções Respiratórias/terapia , Rinite Alérgica/tratamento farmacológico , Viroses/terapia , Coqueluche/terapia , Asma/complicações , Criança , Tosse/etiologia , Progressão da Doença , Refluxo Gastroesofágico/complicações , Humanos , Infecções Respiratórias/complicações , Rinite Alérgica/complicações , Poluição por Fumaça de Tabaco/efeitos adversos , Viroses/complicações , Coqueluche/complicações
7.
J Am Osteopath Assoc ; 119(2): 116-125, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30688349

RESUMO

Background: Cases of pertussis, or whooping cough, have increased in recent years despite widespread vaccination and adequate antibiotic treatments. Osteopathic physicians may want to consider using osteopathic manipulative treatment (OMT) as an adjunctive treatment modality for pertussis; however, suitable OMT techniques are not specified in the research literature. Objective: To search the historical osteopathic literature to identify OMT techniques that were used in the management of pertussis in the pre-antibiotic era. Methods: A structured literature review of electronic databases and historical osteopathic journals and books was conducted. Included were information on OMT techniques used for patients with pertussis. Results: The 24 identified sources included 8 articles and 16 book contributions from the years 1886 to 1958. Most sources were published within the first quarter of the 20th century. Commonly identified OMT techniques included mobilization techniques, lymphatic pump techniques, and other manipulative techniques predominantly in the cervical and thoracic regions. Conclusion: The wealth of OMT techniques for patients with pertussis that were identified suggests that pertussis was commonly treated by early osteopaths. Further research is necessary to identify or establish the evidence base for these techniques so that in case of favorable outcomes, their use by osteopathic physicians is justified as adjunctive modalities when encountering a patient with pertussis.


Assuntos
Manipulação Osteopática/história , Coqueluche/história , Coqueluche/terapia , História do Século XIX , História do Século XX , Humanos
9.
BMC Pediatr ; 18(1): 377, 2018 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-30501615

RESUMO

BACKGROUND: Bordetella pertussis can cause fatal illness with severe acute respiratory distress syndrome (ARDS) and pulmonary hypertension (PHT). CASE PRESENTATION: A 6-month-old non-vaccinated boy with B. pertussis infection who developed ARDS was treated by extracorporeal membrane oxygenation (ECMO). During his ECMO support stage, sudden occurred decreasing of ECMO flow implied increasing intrathoracic pressure. The airway spasm followed caused sudden drop of ventilator tidal volume as well as poor lung compliance. Prone position ventilation and bundle care were conducted as lung protection ventilator strategy. After 297-h of ECMO support, the patient was weaned off ECMO, and extubated one week later. CONCLUSIONS: In this patient with severe ARDS caused by Bordetella pertussis, ECMO was performed for cardiopulmonary support and rescued the infant with severe pertussis. During ECMO support period, prone position ventilation and care bundle nursing strategy contributed to the relief of continuous airway spasm.


Assuntos
Oxigenação por Membrana Extracorpórea , Pacotes de Assistência ao Paciente , Decúbito Ventral , Respiração Artificial/métodos , Síndrome Respiratória Aguda Grave/terapia , Coqueluche/complicações , Coqueluche/terapia , Espasmo Brônquico/etiologia , Espasmo Brônquico/terapia , Humanos , Lactente , Masculino , Síndrome Respiratória Aguda Grave/etiologia
11.
Infect Dis (Lond) ; 50(8): 625-633, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29616584

RESUMO

BACKGROUND: Pertussis has caused several outbreaks and concern worldwide. Despite high vaccination coverage, people of all ages are still affected with significant morbidity and mortality. We aimed to analyse all pertussis hospitalizations in Portugal to help to delineate preventive policies. METHODS: Data were collected from a Portuguese administrative database, which contains all registered hospitalizations in mainland Portugal. Cases were identified using the ICD-9-CM code 033.x (whooping cough) as principal or secondary diagnosis, with hospital discharges between 2000 and 2015. Data were analysed by age groups. RESULTS: Of 2281 hospitalizations, 94% occurred in infants (<1 year). The mean and median ages were 20 and 2 months, respectively. A seasonal pattern was observed, with higher number of hospitalizations during the winter for infants, and during the summer for other age groups. Higher hospitalization rates were registered in the Southern regions. The mean and median lengths of hospital stay were 8 and 6 days, respectively. The main complications were acute respiratory failure and pneumonia. Invasive or non-invasive ventilation, or both, was required in 2.4, 1.8 and 0.6% of hospitalized cases, respectively. The overall inpatient case fatality rate was 0.7%; 0.8, 11.5 and 17.4% for the age groups 0-1 months, 18-64 years and ≥65 years, respectively. Total hospitalization costs were estimated to be 2,698,995€. CONCLUSION: Our study emphasizes the need to adopt new preventive strategies mainly focused on infants, to reduce morbidity and costs of hospitalizations related to pertussis.


Assuntos
Hospitalização/economia , Coqueluche/economia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , História do Século XXI , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Portugal , Estações do Ano , Coqueluche/história , Coqueluche/terapia , Adulto Jovem
12.
J Clin Apher ; 33(4): 529-537, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29488237

RESUMO

Cytapheresis (removal of cellular blood components) has been employed for treatment of infectious diseases since the 1960s. Techniques have included thrombocytapheresis (buffy coat apheresis) for loiasis, erythrocytapheresis for malaria and babesiosis, and leukocytapheresis for pertussis-associated lymphocytosis. Published data on these applications is largely limited to case level data and small observational studies; as such, recommendations for or against the use of cytapheresis in the treatment of infections have been extrapolated from these limited (and at times flawed) data sets. Consequently, utilization of cytapheresis in many instances is not uniform between institutions, and typically occurs at the discretion of treating medical teams. This review revisits the existing literature on the use of cytapheresis in the treatment of four infections (loasis, malaria, babesiosis, and pertussis) and examines the rationale underlying current treatment recommendations concerning its use.


Assuntos
Doenças Transmissíveis/terapia , Citaferese/métodos , Babesiose/terapia , Humanos , Loíase/terapia , Malária/terapia , Coqueluche/terapia
13.
Pediatr Crit Care Med ; 19(3): 254-261, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29319632

RESUMO

OBJECTIVE: The recent increase of pertussis cases worldwide has generated questions regarding the utility of extracorporeal membrane oxygenation for children with pertussis. We aimed to evaluate factors associated with extracorporeal membrane oxygenation outcome. DESIGN: The study was designed in two parts: a retrospective analysis of the Extracorporeal Life Support Organization Registry to identify factors independently linked to outcome, and an expanded dataset from individual institutions to examine the association of WBC count, pulmonary hypertension, and leukodepletion with survival. SETTING: Extracorporeal Life Support Organization Registry database from 2002 though 2015, and contributions from 19 international centers. PATIENTS: Two hundred infants from the Extracorporeal Life Support Organization Registry and expanded data on 73 children. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 200 infants who received extracorporeal membrane oxygenation for pertussis, only 56 survived (28%). In a multivariable logistic regression analysis, the following variables were independently associated with increased chance of survival: older age (odds ratio, 1.43 [1.03-1.98]; p = 0.034), higher PaO2/FIO2 ratio (odds ratio, 1.10 [1.03-1.17]; p = 0.003), and longer intubation time prior to the initiation of extracorporeal membrane oxygenation (odds ratio, 2.10 [1.37-3.22]; p = 0.001). The use of vasoactive medications (odds ratio, 0.33 [0.11-0.99]; p = 0.047), and renal neurologic or infectious complications (odds ratio, 0.21 [0.08-0.56]; p = 0.002) were associated with increased mortality. In the expanded dataset (n =73), leukodepletion was independently associated with increased chance of survival (odds ratio, 3.36 [1.13-11.68]; p = 0.03) while the presence of pulmonary hypertension was adverse (odds ratio, 0.06 [0.01-0.55]; p = 0.01). CONCLUSIONS: The survival rate for infants with pertussis who received extracorporeal membrane oxygenation support remains poor. Younger age, lower PaO2/FIO2 ratio, vasoactive use, pulmonary hypertension, and a rapidly progressive course were associated with increased mortality. Our results suggest that pre-extracorporeal membrane oxygenation leukodepletion may provide a survival advantage.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Hipertensão Pulmonar/complicações , Leucocitose/complicações , Coqueluche/terapia , Criança , Pré-Escolar , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Lactente , Recém-Nascido , Contagem de Leucócitos , Procedimentos de Redução de Leucócitos/estatística & dados numéricos , Leucocitose/terapia , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento , Coqueluche/complicações , Coqueluche/mortalidade
15.
J Pediatric Infect Dis Soc ; 7(4): 310-316, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-29045690

RESUMO

Background: Pertussis is an important cause of hospitalization and death in infants too young to be vaccinated (aged <2 months). Limited data on infant pertussis have been reported from Central America. The aim of this study was to characterize acute respiratory illnesses (ARIs) attributable to Bordetella pertussis among infants enrolled in an ongoing surveillance study in Guatemala. Methods: As part of a population-based surveillance study in Guatemala, infants aged <2 months who presented with ARI and required hospitalization were enrolled, and nasopharyngeal and oropharyngeal swab specimens were obtained. For this study, these specimens were tested for B pertussis using real-time polymerase chain reaction (PCR). Results: Among 301 infants hospitalized with ARI, we found 11 with pertussis confirmed by PCR (pertussis-positive infants). Compared to pertussis-negative infants, pertussis-positive infants had a higher mean admission white blood cell count (20900 vs 12579 cells/µl, respectively; P = .024), absolute lymphocyte count (11517 vs 5591 cells/µl, respectively; P < .001), rate of admission to the intensive care unit (64% vs 35%, respectively; P = .054), and case fatality rate (18% vs 3%, respectively; P = .014). Ten of the 11 pertussis-positive infants had cough at presentation; the majority (80%) of them had a cough duration of <7 days, and only 1 had a cough duration of >14 days. Fever (temperature ≥ 38°C) was documented in nearly half (45%) of the pertussis-positive infants (range, 38.0-38.4°C). Conclusions: In this study of infants <2 months of age hospitalized with ARI in Guatemala, pertussis-positive infants had a high rate of intensive care unit admission and a higher case fatality rate than pertussis-negative infants.


Assuntos
Cuidados Críticos , Hospitalização , Coqueluche/diagnóstico , Coqueluche/terapia , Feminino , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Reação em Cadeia da Polimerase , Vigilância da População , Coqueluche/complicações , Coqueluche/mortalidade
16.
Pediatr Infect Dis J ; 37(3): 202-205, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28737623

RESUMO

BACKGROUND: Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal. METHODS: All pertussis cases ≤120 days of age admitted to a pediatric intensive care unit in California between October 1, 2013, and April 25, 2015, were evaluated. RESULTS: Of 100 pertussis patients ≤120 days of age admitted to pediatric intensive care unit, there were 5 deaths. The white blood cell counts in the fatal cases were significantly higher than in the nonfatal cases. Thirty-four percent of patients were intubated, 18% received inotropic and/or vasoactive support, 22% received steroid, 4% received extracorporal membrane oxygenation, and 3% underwent exchange blood transfusion. The median age at the time of illness onset in the patients who died was 23 days. CONCLUSIONS: These data, as well as data from previous California studies, suggest updated strategies for the management of severe pertussis. These include perform serial white blood cell counts, treat all presumptive cases with azithromycin, evaluate for pulmonary hypertension, intubate and administer oxygen for apneic episodes and administer inotropic/vasoactive agents for cardiogenic shock. Do not administer steroids or nitric oxide. Criteria for exchange blood transfusion therapy for leukocytosis with lymphocytosis are suggested.


Assuntos
Bordetella pertussis , Coqueluche/epidemiologia , Fatores Etários , Terapia Combinada , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Vigilância em Saúde Pública , Índice de Gravidade de Doença , Coqueluche/diagnóstico , Coqueluche/mortalidade , Coqueluche/terapia
17.
Vaccine ; 35(47): 6422-6428, 2017 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-29032896

RESUMO

INTRODUCTION: Pertussis causes the highest complication rates and deaths in the infant group. Our study explored risk factors for ICU/high dependency (HD) admissions and intubation/non-invasive ventilation (NIV). METHODS: A retrospective review of pertussis admissions over 10 years from 2007 to 2016 was done at KK Women's and Children's Hospital, Singapore. To understand risk factors for severe pertussis infection, we compared cases requiring ICU/HD care with controls admitted to the general ward. Risk factors for intubation/NIV were also studied. Vaccine efficacy for protection against ICU/HD admission or intubation/NIV was also calculated. RESULTS: There were 200 pertussis patients with a median age of 2.75 months. Sixty-one % were ≤3 months and 14.5% were <6 weeks old. Majority of patients (77%) had no prior pertussis vaccination. After removing 3 patients with missing vaccination records, 20 cases were compared with 177 controls. On univariate analysis, risk factors for ICU/HD admission comprised: Age ≤3 months, contact history, underlying co-morbidity, prematurity, absent DTaP vaccination, lymphocytosis, hyperleukocytosis (wbc ≥50×109/L), thrombocytosis (platelet ≥500×109/L), and pneumonia. Multivariate analysis revealed that age ≤3 months (OR 40, 95% CI 4.57-1111.11, p=.007), co-morbidity (OR 8.46 (95% CI 1.47-56.89, p=.019), pneumonia (OR 18.08, 95% CI 3.22-132.15, p=.002), white cell count (OR 1.07, 95% CI 1.01-1.14, p=.023) and cyanosis (OR 5.09, 95% CI 1.31-24.71, p=.026) were risk factors for ICU/HD admission. Prior DTaP vaccination had a vaccine effectiveness of 86.5% in preventing ICU/HD admission and 82.1% in preventing intubation/NIV. CONCLUSIONS: As the majority of pertussis patients were infants ≤3 months old who are at high risk for ICU/HD admission and intubation/NIV, prevention is key to reducing pertussis morbidity. Even though not statistically significant, DTaP vaccination had a role in preventing ICU/HD admission and intubation/NIV.


Assuntos
Cuidados Críticos , Hospitalização , Coqueluche/patologia , Coqueluche/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Singapura
18.
Pediatr Emerg Med Pract ; 14(2): 1-24, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28749121

RESUMO

Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.


Assuntos
Antibacterianos/uso terapêutico , Benzodiazepinas/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Desbridamento , Difteria/terapia , Profilaxia Pós-Exposição/métodos , Tétano/terapia , Coqueluche/terapia , Criança , Pré-Escolar , Busca de Comunicante , Difteria/diagnóstico , Difteria/epidemiologia , Difteria/prevenção & controle , Antitoxina Diftérica/uso terapêutico , Vacinas contra Difteria, Tétano e Coqueluche Acelular/uso terapêutico , Notificação de Doenças , Serviço Hospitalar de Emergência , Medicina de Emergência Baseada em Evidências , Humanos , Lactente , Recém-Nascido , Sulfato de Magnésio/uso terapêutico , Isolamento de Pacientes , Tétano/diagnóstico , Tétano/epidemiologia , Tétano/prevenção & controle , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
19.
Pediatr Crit Care Med ; 18(1): e42-e47, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27811532

RESUMO

OBJECTIVE: To identify factors associated with malignant pertussis. DESIGN: A retrospective case notes review from January 2003 to August 2013. Area under the receiver-operator characteristic curve was used to determine how well vital sign and white cell characteristics within 48 hours of hospital presentation identified children with malignant pertussis. SETTING: The national children's hospital in Auckland, New Zealand. PATIENTS: One hundred fifty-two children with pertussis. MEASUREMENTS AND MAIN RESULTS: There were 152 children with confirmed pertussis identified, including 11 children with malignant pertussis. The area under the receiver-operator characteristic curve was 0.88 (95% CI, 0.78-0.97) for maximum heart rate. The optimal cut-point was 180 beats/min, which predicted malignant pertussis with a sensitivity of 73% and a specificity of 91%. The area under the receiver-operator characteristic curve was 0.92 (95% CI, 0.81-1.0) for absolute neutrophil count, 0.85 (95% CI, 0.71-0.99) for total WBC count, 0.80 (95% CI, 0.63-0.96) for neutrophil-to-lymphocyte ratio, and 0.77 (95% CI, 0.58-0.92) for absolute lymphocyte count. All children with malignant pertussis had one or more of heart rate greater than 180 beats/min, total WBC count greater than 25 × 10/L, and neutrophil-to-lymphocyte ratio greater than 1.0 with an area under the receiver-operator characteristic curve of 0.96 (95% CI, 0.91-1.0) for a multivariate model that included these three variables. CONCLUSIONS: Clinical predictors of malignant pertussis are identifiable within 48 hours of hospital presentation. Early recognition of children at risk of malignant pertussis may facilitate early referral to a PICU for advanced life support and selection for trials of investigational therapies.


Assuntos
Índice de Gravidade de Doença , Coqueluche/diagnóstico , Coqueluche/etiologia , Criança , Pré-Escolar , Cuidados Críticos , Progressão da Doença , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Contagem de Leucócitos , Masculino , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Sinais Vitais , Coqueluche/terapia
20.
Artigo em Russo | MEDLINE | ID: mdl-30695490

RESUMO

AIM: Study the possibility of inclusion of complex immunoglobulin preparation (CIP) pos- sessing specific activity against pertussis exotoxins into complex therapy of pertussis infection in young children. MATERIALS AND METHODS: -2 groups of children with.pertussis younger than 3 years were examined. The main group (50 individuals) received CIPper os - 1 dose 1 - 2 times per day for 5 days, comparison group (34 children) received only basic therapy. Evaluation of clinical effectiveness of CIP was carried out, the content of anti-pertussis class G antibodies and total IgE in patients were studied. RESULTS: A good clinical effectiveness of the preparation was shown, as well as immune modulating activity against humoral immune response to pertussis infection. CONCLUSION: The detected positive effect of CIP on pertussis -course in children has indicated a principally novel use of this per oral drug form.


Assuntos
Anticorpos Antibacterianos/administração & dosagem , Imunoglobulina G/administração & dosagem , Coqueluche/terapia , Anticorpos Antibacterianos/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina G/imunologia , Lactente , Recém-Nascido , Masculino , Coqueluche/imunologia
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