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Infant Death May Be Due To Lack of Proper Medical Diagnosis and Care
An infant aged 29 days in West Virginia died from pertussis after exposure to adult family members with probable undiagnosed pertussis. Pertussis (i.e., whooping cough) is a prolonged respiratory illness caused by the bacterium Bordetella pertussis and characterized by a violent cough, inspiratory whoop, and posttussive vomiting. The cough often lasts from several weeks to up to 3 months. However, adolescents and adults, even those previously vaccinated as children, often have disease not recognized as pertussis, leading to intrafamilial and nosocomial transmission.
On December 11, the infant was taken by her parents to a local emergency department (ED) with difficulty breathing. The infant had been coughing for approximately 5 days with increasing severity, resulting in posttussive vomiting and several choking episodes. At presentation, the infant was lethargic, and examination revealed tachycardia and mild fever (99.5ºF [37.5ºC]). Before intubation and oxygen supplementation, the infant had thick, foamy mucus coming from her mouth, appeared cyanotic, and had an O2 saturation of 70% by pulse oximetry. Seizure activity was noted during intubation. Three hours after arrival at the ED, the infant was transferred to a pediatric intensive care unit (PICU) with diagnoses of pneumonia and respiratory failure. Nineteen hours after admission, oxygenation worsened precipitously (PaO2/FiO2 ratio: 52--60) and failed to improve with nitric oxide administration or high-frequency ventilation. A double-volume exchange transfusion was performed (2), but the infant failed to improve and died approximately 30 hours after admission to the PICU.
This case underscores the need to protect infants from pertussis transmission. The health-care community can limit the spread of pertussis by educating health-care providers to consider pertussis in adolescents and adults with a cough illness and to ask these patients to wear a mask or isolate themselves from other patients, and 3) encouraging confirmation of pertussis by culture of nasopharyngeal secretions. Health-care providers must be encouraged to observe droplet precautions while attending to patients with respiratory illnesses. No U.S.-licensed pertussis vaccine for persons aged >7 years is available; however, in 2004, two pharmaceutical companies submitted biologics license applications to the Food and Drug Administration for two tetanus toxoid and reduced diphtheria toxoid and acellular pertussis vaccine adsorbed (Tdap) products, one for persons aged 10--18 years and the other for persons aged 11--64 years.
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