Bordetella pertussis in an adult intensive care population: a case series
Angus J Neal, Matthew R Hooper, Michael A Corkeron
Intensive Care Unit, Townsville Hospital, Townsville, QLD
Introduction
Bordetella pertussis is a recognised pathogen in infants and children. A number of recent scientific works have investigated the incidence and consequences of pertussis infections in adolescent and adult populations.1-3 While significant morbidity and mortality in adults has been documented,3-6 a case series of critically ill adult patients with proven or suspected pertussis infections has not previously been reported.
Objectives
The aim of this study was to describe a series of adult patients admitted to an intensive care unit who tested positive to B. pertussis in serological assays.
Methods
The retrospective analysis was conducted in a single-centre ICU in regional Australia and examined patients aged 18 years or older at the time of ICU admission. Assays were requested at the discretion of treating intensivists for patients who were admitted with respiratory failure with a suspected infectious cause. Positive IgA assays from March 2004 to September 2006 were cross-referenced with the Australasian Outcomes Research Tool for Intensive Care(AORTIC)database.
Results
A total of 110 assays were requested in the period, representing 96 separate ICU admissions. Twenty-five patients had positive pertussis assays. They had mean age 54.6 (SD, 14.3)years, and mean APACHE II and III scores of 20.0 (SD, 6.54) and 56.20 (SD, 22.92), respectively. Mortality rate was 12% (3/25).
Conclusion
B. pertussis is increasingly acknowledged as a significant pathogen in the adult population. This case series demonstrated that a percentage of adults admitted to the ICU with respiratory failure with a suspected infectious cause had a positive result on pertussis assay. This implies that B. pertussis may have a significantly greater role in adult critical illness than previously considered, and warrants further investigation in a larger, prospective study.
References
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