Pertussis and pertussis-like syndrome in young children

The most common infectious diseases with a risk of severe, non-smooth course and unfavorable outcome in young children, including the first year of life, are pertussis and respiratory syncytial viral infection (RSV infection), often occurring with pertussis-like syndrome.

Objective: to establish clinical and laboratory differential diagnostic criteria for pertussis and RSV infection in children of the first year of life.

Materials and methods: A retrospective comparative study was conducted, which included patients of the first year of life (from 1 month to 11 months and 29 days), regardless of the duration of hospitalization and duration of the disease: 48 patients with pertussis and 26 with acute RSV infection.

Results: The compared groups of patients were comparable in age, the number of severe forms (4.6 ± 0.5 months, 17% for pertussis and 4.0 ± 0.2 months, 16% for RS infection). The disease in both cases began subacute, however, with RSV infection 92% of children were hospitalized in the first 5 days from the onset of the disease, with pertussis — in the first week of the period of convulsive cough — 47.9%, in the second week — 41.7%, in the third week — 10.4%. 52% of patients with RSV infection had no fever or (in 32%) did not exceed 1—3 days. In 41.3% of patients it was subfebrile (37—38 °C), in 21.1% it was febrile (38—39 °C). In patients with pertussis the onset of the disease took place against the background of normal body temperature. In patients with RSV infection, bronchiolitis was recorded in 24% of cases, obstructive bronchitis — in 60%. Patients with pertussis, 89.6% of whom were not vaccinated and 10.4% did not complete the initial course of vaccination, had a typical paroxysmal cough with reprises. Complications in the form of respiratory rhythm disturbances were recorded in 14.6% of cases, pneumonia — in 6.3%. Comparison of hematological parameters revealed highly significant differences in the levels of leukocytosis and relative lymphocytosis (p < 0.001), as well as thrombocytosis (p < 0.01), with the predominance of all indicators in patients with pertussis.

Conclusion. Differential diagnostic criteria for the similarity of the clinical picture may be established hematological differences: pronounced leukocytosis due to lymphocytosis, increasing in dynamics, and thrombocytosis in pertussis and normocytosis with moderate lymphocytosis, a possible tendency to thrombocytosis in severe RSV infection.

1. Pramono R.X., S.A. Imtiaz, E. Rodriguez-Villegas. A cough-based algorithm for automatic diagnosis of pertussis. PLoS One. 2016; 11 (9): e0162128.

2. Cohen S., A. Black, A. Ross [et al.] Updated treatment and prevention guidelines for pertussis. JAAPA. 2014; 27(1): P. 19—25.

3. Guillot S., G. Descours, Y. Gillet [et al.] Macrolide-resistant Bordetella pertussis infection in newborn girl, France. Emerg. Infect. Dis. 2012; 18 (6): 966—968.

4. Basov A.A., O.V. Tsvirkun, A.G. Gerasimova, A.H. Zekoreeva. Problema koklyusha v nekotoryih regionah mira [The problem of pertussis in some regions of the world]. Infektsiya i Immunitet. 2019; 9(2):354—362. (In Russ.) https://doi.org/10.15789/2220-7619-2019-2-354-362

5. O sostoyanii sanitarno-epidemiologicheskogo blagopoluchiya naseleniya v Rossiyskoy Federatsii v 2019 godu: Gosudarstvennyiy doklad. [On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2019: State Report]. M.: Federalnaya sluzhba po nadzoru v sfere zaschityi prav potrebiteley i blagopoluchiya cheloveka, 2020:299. (In Russ). https://www.rospotrebnadzor.ru/upload/iblock/8e4/gosdoklad-za-2019_seb_29_05.pdf

6. O sostoyanii sanitarno-epidemiologicheskogo blagopoluchiya naseleniya v Rossiyskoy Federatsii v 2020 godu: Gosudarstvennyiy doklad. [On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2020: State Report]. M.: Federalnaya sluzhba po nadzoru v sfere zaschityi prav potrebiteley i blagopoluchiya cheloveka, 2021:256. (In Russ). https://www.rospotrebnadzor.ru/upload/iblock/8e4/gosdoklad-za-2020_seb_27.05.pdf

7. Babachenko I.V., O.V. Samodova, V.A. Anohin [i dr.] Clinical and epidemiological characteristics of respiratory syncytial virus infection in children the first year of life. Zhurnal Infektologii. 2018; 10(3):70—76. (In Russ). https://doi.org/10.22625/2072-6732-2018-10-3-70-76

8. Perk Y., Özdil M. Respiratory syncytial virüs infections in neonates and infants. Turk Pediatri Ars. 2018; 53(2): 63—70.

9. Shi T., McAllister D.A., O'Brien K.L., et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017; 390: 946—58.

10. Caballero M.T., Polack M.T. Respiratory syncytial virus is an «opportunistic» killer (review). Pediatric Pulmonology. 2018 Jan; 53(5): 664—7.

11. Bogdanova A.V., O.V. Samodova, N.L. Rogushina I.V. Schepina Etiologiya respiratornyih virusnyih infektsiy nizhnih dyihatelnyih putey u detey: sovremennoe sostoyanie problemyi. Zhurnal infektologii. 2016; 8(2): 5—9. (In Russ).

12. Rovnyiy V.B., Yu.V. Lobzin, I.V. Babachenko, [i dr.] Kliniko-epidemiologicheskie osobennosti respiratorno-sintsitialnoy infektsii u detey raznogo vozrasta. Zhurnal infektologii. 2013; 5(2): 76—81. (In Russ). https://doi.org/10.22625/2072-6732-2013-5-2-76-81

13. Babachenko I.V., Nesterova Yu.V., Skripchenko N.V. Kliniko-laboratornyie osobennosti koklyusha u detey raznyih vozrastnyih grupp. Pediatriya. 2020; 99(6): 98—104. (In Russ). https://doi.org/10.24110/0031-403X-2020-99-6-98-104

14. Babachenko I.V., Yu.V. Nesterova, Yu.Yu. Chernyishova [i dr.] Kliniko-epidemiologicheskie aspektyi koklyusha u detey v usloviyah massovoy vaktsinoprofilaktiki. Zhurnal infektologii. 2019; 11(2): 88—96. (In Russ). https://doi.org/10.22625/2072-6732-2019-11-2-88-96

15. Nesterova Yu.V. Kliniko-laboratornyie osobennosti koklyusha u detey v sovremennyih usloviyah [Clinical and laboratory features of whooping cough in children in modern conditions]: abstr. PhD med. SPb, 2021:22. (In Russ).

16. Zheng S.Y., Q.Y. Xiao, X.H. Xie [et al.] Association between secondary thrombocytosis and viral respiratory tract infections in children. Sc. Rep., 2016 March: 6:22964. DOI: 10.1038/srep22964