Clinical characteristics and molecular detection of Bordetella pertussis in hospitalized children with a clinical diagnosis of whooping cough in Peru
Juana del Valle-MendozaCristina del Valle-VargaRonald Aquino-OrtegaLuís J. del ValleErico Cieza-MoraWilmer Silva-CasoJorge Bazán-MayraVíctor Zavaleta-GavidiaMiguel Ángel Aguilar-LuisHernán Cornejo-PacherresJohanna Martins-LunaAngela Cornejo‐Tapia
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Background and Objectives: Pertussis is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. In Peru, actual public health programs indicate that vaccination against B. pertussis must be mandatory and generalized, besides all detected cases must be reported. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age with a presumptive diagnosis of whopping cough in Cajamarca, a region located in northern Peru. Materials and Methods: The population of this cross-sectional study were children under 5 years old hospitalized as presumptive cases of pertussis during December 2017 to December 2018. The nasopharyngeal samples were analyzed by real-time PCR for the detection of B. pertussis.Keywords:
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The significant and sometimes dramatic rise in the number of circulating white blood cells (leukocytosis) in infants suffering from pertussis (whooping cough) has been recognized for over a century. Although pertussis is a disease that afflicts people of all ages, it can be particularly severe in young infants, and these are the individuals in whom leukocytosis is most pronounced. Very high levels of leukocytosis are associated with poor outcome in infants hospitalized with pertussis and modern treatments are often aimed at reducing the number of leukocytes. Pertussis leukocytosis is caused by pertussis toxin, a soluble protein toxin released by Bordetella pertussis during infection, but the exact mechanisms by which this occurs are still unclear. In this minireview, I discuss the history of clinical and experimental findings on pertussis leukocytosis, possible contributing mechanisms causing this condition and treatments aimed at reducing leukocytosis in hospitalized infants. Since recent studies have detailed significant associations between specific levels of pertussis leukocytosis and fatal outcome, this is a timely review that may stimulate new thinking on how to understand and combat this problem.
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The study was performed with 174 rabbits to determine the effect of leukophoresis and the resulting leukopenia on tumor transplant, growth, and survival time using the V2 carcinoma in the rabbit. Definite inhibition of tumor growth, together with increase in survival time, was found when leukophoresis was performed 7-28 days after transplant as evidenced by an increase in survival time of 314 days in the entire group receiving 2 leukophoreses following transplants and 347 days in subgroups of those receiving 3 leukophoreses following transplants (but on days 7-14-21 or 14-21-28) vs. 73 days for the controls. The tumor growth rate paralleled the survival time and following transplant and leukophoresis, the increase and decrease of leukocytes paralleled the rate of tumor growth and retardation, respectively. There is reason to believe that the granulocyte may be more implicated than lymphocyte in tumor inhibition and survival time although so far experimental evidence has been on the side of the latter. A chance observation that leukophoretic plasma injected into cancerous and noncancerous animals produced marked leukocytosis, indicating a leukocytosis-inducing factor, will serve to investigate any significant effects of leukocytosis on tumor growth and survival time and any possible interrelationship of leukopenia/leukocytosis to tumor inhibition and immunosuppression in Part II of this paper.
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Administration of Bordetella pertussis cell extracts induced in mice hypersensitivity to histamine, as well as pronounced leukocytosis and hypoglycemia. The leukocytosis was mainly caused by an increase in the small lymphocytes in the circulating blood, and it was most pronounced 3 to 4 days after injection of B. pertussis extracts. Rabbit antimouse lymphocyte serum produced a decrease in the lymphocyte count in normal mice, as well as in mice treated with B. pertussis extracts. This depression in lymphocytes was observed whether the antilymphocyte serum was given 1 day or 2 days after the administration of B. pertussis extracts. The increased histamine sensitivity and hypoglycemia of mice treated with B. pertussis extract were not affected by treatment with antilymphocyte serum, although a marked lymphopenia was present. These observations indicate that the three phenomena observed in pertussis-treated mice are independent of each other.
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Experiments with the effects of leukocytosis on tumor growth and animal survival time using the V-2 carcinoma transplant in the rabbit failed to show any effect of the leukocytosis per se. However, the present study exploring the Leukocytosis-Inducing Factor (LIF) isolated in leukophoresed plasma found it to be present in the plasma of cancerous rabbits and present to a greater extent in the leukopenic plasma of normal leukophoresed animals. The target cell of the LIF appears to be neutrophil-forming tissue with production of neutrophilic band cells and metamyelocytes. The optimal injection volume and time interval following leukophoresis-leukopenia for achieving maximum leukocytosis suggest a “time-dose” relationship. There was a marked absolute increase in leukocyte response of the cancerous recipients over noncancerous recipients following the injection of cancerous and noncancerous leukopenic plasma as well as both relative and absolute increase with the injection of the former over the latter into both recipients. The interrelationship of chemotherapy, radiation, and leukophoresis is discussed in reference to their common denominator of leukopenia and consequent tumor suppression, immunosuppression, and LIF production which are probably motivated by the Host Resistance Factor (HRF).
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The diagnosis of acute leukemia is based on a combination of clinical, hematological, morphological, cytogenetic, and immunophenotypic data. The authors report a case of reactive lymphocytosis with extremely elevated lymphocytic and lymphoblastic leukocytosis that mimicked acute lymphoblastic leukemia, not only morphologically, but also in immunophenotypic analysis. They could not determine any underlying disease marker other than infectious symptoms that were present for 20 days prior to presentation to their clinic. Although this case presented with extremely high lymphocytic leukocytosis, the patient had normal blood cell lineage, a moderate level of blastic cells in bone marrow, and normal physical findings. These findings convinced the authors to follow up the patient before beginning treatment.
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By the use of radioautographic techniques it was shown that the lymphocytosis induced by Bordetella pertussis in mice was not caused by an increased production of lymphocytes but was primarily due to the entry into the circulation of mature cells from tissue pools. The accompanying polymorphonuclear leukocytosis was due to both proliferation of myeloid elements and entry of mature cells from tissue reserves, with the former the predominant mechanism.
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>A well-conducted irradiation provokes only occasional leukopenia of any importance. A preparation of alkoxyglycerol esters, similar to those found in insaponifiable lipid extracts of bone marrow, was tested on 15 patients whose leukocytosis, normal at the beginning, fell below 5000/mm/sup 3/ during radiotherapeutic treatment. This medication had the property of rapidly curing radioinduced leukopenia. Four patients could not tolerate the medication, and in seven other cases no effect was noted. In four additional cases leukocytosis was increased, but this increase could be attributed to the medication in only two of these cases. (tr-auth)
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