The prevention of severe pertussis and pertussis deaths in young infants
The prevention of severe pertussis and pertussis deaths in young infants
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DOI：
10.1080/14760584.2019.1581065
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发表时间：
2019-03-04
影响因子：
6.2
通讯作者：
Cherry, James D.
中科院分区：
文献类型：
--
作者：
Cherry, James D.
导言：今天，在发达国家，几乎所有由百日咳波尔德氏菌引起的死亡都发生在婴儿身上。覆盖范围：婴幼儿百日咳的特点是无热性咳嗽，伴有鳞屑、呼吸暂停、癫痫发作、发紫和呕吐。严重疾病与白细胞和淋巴细胞计数高、呼吸和心率快以及肺炎有关。许多常规的重症监护治疗程序是有害的：包括类固醇和一氧化氮。预防措施包括：对怀孕27至36周的TDAP母亲进行检疫、预防性抗菌剂和免疫接种。专家观点：婴儿死亡是由于肺内小血管中的白细胞聚集引起的不可逆性肺动脉高压。白细胞增多伴淋巴细胞增多是由百日咳毒素引起的。它可以通过换血治疗。然而，为了成功，它需要在休克或器官衰竭发生之前启动。为了预防婴幼儿百日咳，需要注意青少年和成人百日咳的诊断和治疗。同样重要的是在婴儿中进行抗菌素预防，并在所有怀孕期间为母亲接种Tdap疫苗。
Introduction: Today, in the developed world, virtually all deaths due to Bordetella pertussis illnesses occur in young infants. Areas Covered: Pertussis in young infants is characterized by an afebrile cough illness with coryza, apnea, seizures, cyanosis, and emesis. Severe illness is associated with high leukocyte and lymphocyte counts, rapid respiratory and cardiac rates and pneumonia. Many routine intensive care treatment procedures are detrimental: these include steroids and nitric oxide. Preventative measures include: quarantine, prophylactic antimicrobial agents and immunizations of the mother to be with Tdap between 27 and 36 weeks gestation. Expert Opinion: Infants deaths are due to the irreversible pulmonary hypertension which is caused by aggregates of leukocytes in the small vessels in the lung. The leukocytosis with lymphocytosis is due to pertussis toxin. It can be treated by exchange blood transfusions. However for this to be successful it needs to be started before shock or organ failure has occurred. To prevent pertussis in young infants, attention needs to be directed to the diagnosis and treatment of pertussis in adolescents and adults. Also important are antimicrobial prophylaxis in the infant and the immunization of mothers to be with Tdap vaccine during all pregnancies.