SEVERE PERTUSSIS IN CHILDHOOD: UPDATE AND CONTROVERSY - SYSTEMATIC REVIEW
SEVERE PERTUSSIS IN CHILDHOOD: UPDATE AND CONTROVERSY - SYSTEMATIC REVIEW
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DOI：
10.1590/1984-0462/;2019;37;3;00006
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发表时间：
2019-09-01
影响因子：
1.7
通讯作者：
Passos, Saulo Duarte
中科院分区：
文献类型：
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作者：
Machado, Márcia Borges;Passos, Saulo Duarte
目的：通过系统综述，本文旨在修订重症百日咳的概念，更新流行病学、病理生理学、临床表现、抗生素治疗以及针对症状和并发症的辅助治疗选择。数据来源：本综述考虑了美国国家医学图书馆 (PubMed)、在线科学电子图书馆 (SciELO)、Literatura Latino-americana e do Caribe em Ciencias da Saude 数据库中过去 30 年的出版物(LILACS)、Cochrane、Google Scholar，以及卫生部的方案和疾病控制与预防中心的建议，与儿童百日咳有关，重点是其严重形式。这项研究基于源自葡萄牙语和英语术语“百日咳”、“阿奇霉素”、“镇咳药”、“白细胞减少”的关键词。排除重复研究和无法获取全文的研究。数据综合：在找到的556条记录中，选择54条进行分析。百日咳作为一种重新出现的疾病，影响了所有年龄段，证明了感染和疫苗接种所赋予的短暂免疫力。重症病例发生在新生儿和婴儿中，伴有继发性病毒和细菌并发症以及恶性百日咳、长侧白细胞增多、呼吸衰竭和休克。大环内酯类药物仍然是首选抗生素，而止咳药仍然无效。重症监护病房的及时治疗改善了严重病例的预后，而输血在白细胞减少手术中是有希望的。结论：儿童期严重百日咳的诊断和治疗仍然是一个挑战，因为现有的治疗方案仍然不能令人满意。预防策略有望减少重症病例的发生，而新的研究应证实辅助疗法的作用。
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 30 years in the databases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciencias da Saude (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.