Pertussis-like syndrome often not associated with Bordetella pertussis: 5-year study in a large children’s hospital

Abstract

Background: Recently, a resurgence of pertussis has been observed worldwide despite broad vaccination coverage. The purpose of this study was to identify the clinical characteristics and the aetiological agent of pertussis-like syndrome (PLS) in Eastern China.

Methods: 1168 patients who were diagnosed with a suspected Bordetella pertussis in Shanghai Children’s Hospital from 2013 to 2017 were included in the study. Clinical features and aetiologies were analysed. Aetiological analyses in sub-cohorts of age, seasons and years were also investigated.

Results: 96.0% (1121) of the patients were less than 12 months old. 59.0% (689) of the patients were male. The Top 5 pathogens were respiratory syncytial virus (RSV; n = 125; 10.7%), Streptococcus pneumonia (SP; n = 109; 9.3%), Haemophilus influenzae type b (HIB; n = 86; 7.4%), Bordetella pertussis (B. pertussis; n = 84; 7.2%), and Mycoplasma pneumonia (MP; n = 80; 6.9%), respectively. The percentage of SP in the age group of 0–3 months was significantly lower than that in other age groups. The percentage of B. pertussis in the age group of 3–6 months was significantly lower than that in the group of 6-12 months. The percentage of MP in 0-3 months’ group was significantly lower than that in >12 months group. RSV peaked in winter (n = 52), while HIB peaked in spring (n = 38).

Conclusion: PLS occurred most often in infants. RSV, SP, HIB, B. pertussis, and MP were the most prevalent pathogens. Since patients with B. pertussis and other pathogens have similar clinical manifestations, diagnosis of pertussis should be based on both clinical symptoms and laboratory confirmation.

Keywords:

• Pertussis, 
• pertussis-like syndrome, 
• etiology, 
• children

Declarations

Ethics approval and consent to participate

This study was approved by the Bioethics Review Committee of the Shanghai Children’s Hospital.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Disclosure statement

The authors declare that they have no competing interests.

Author contributions

YH and GZ designed the study. LS, TC, and JL collected the clinical and lab test data of the participants. QX performed statistical analyses. QX, SH, and YH interpreted the results. YH and SH drafted the manuscript.