Pneumonia in whooping cough in children

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Introduction. Currently, whooping cough is one of the most common manageable infections. Despite the introduction of routine vaccination, this disease continues to circulate in the population.[1] Whooping cough is characterized by a prolonged paroxysmal cough lasting up to several weeks and even months, and is accompanied by the development of serious complications such as pneumonia, atelectasis, convulsive syndrome, encephalopathy. Pneumonia is crucial in the structure of complications in whooping cough, which are more often associated with the addition of secondary bacterial flora, respiratory mycoplasmosis, and concomitant cytomegalovirus infection.[3] According to Rosstat, in 2023, 27.8 thousand new cases of whooping cough were registered in the Russian Federation, which is 19.1 thousand per 100,000 population.[2] The purpose of the work. To study the course of pneumonia in children with whooping cough, the effect of vaccination status on the course of the disease and the presence of secondary infection. Materials and methods of research. We analyzed 40 medical records of patients with this pathology from 1 month to 16 years old, who received inpatient treatment at the box infectious diseases department of the CSTO No. 2 for the period from 2018 to 2023. In the age structure, children of the first year of life were more common - 40%, children 1-3 years old made up 23%, 3-7 years old - 14%, 7-10 years old - 8%, older than 10 years - 15%. The gender distribution was almost the same, with girls accounting for 52.5%. The diagnosis of whooping cough at the prehospital stage was suspected in 45% of children, 30% of children were admitted to the hospital with a diagnosis of pneumonia, 13% with bronchitis. Upon admission to the emergency department, another 24% of children were suspected of whooping cough complicated by pneumonia. The diagnosis of the remaining children was clarified during an examination in an infectious diseases hospital.

The results of the study. Children with whooping cough complicated by pneumonia were admitted to the hospital on the second or third week of the disease - 18.6±6.6 days of illness. The reason for hospitalization was the deterioration of the condition associated with increased paroxysmal cough, the appearance of fever and intoxication syndrome (56.5%), and the development of respiratory failure (18%). In the observed group of children, 3 children were under the age of 3 months, which is considered as a risk group for severe whooping cough, taking into account the early age and lack of vaccination (routine vaccination is carried out from 3 months).[4] It is worth noting that all three children, in addition to whooping cough, were diagnosed with cytomegalovirus infection according to PCR studies of blood serum, which is an additional aggravating factor for whooping cough in children in the first months of life. In 42.5% of the observed children with complicated whooping cough, the infection occurred on an unfavorable background (anemia, congenital heart defects, atopic dermatitis, perinatal CNS lesion). In such children, the frequency of detection of combined pathology was higher than in the general observation group and amounted to 62.5%. In children under 1 year of age, in 41.1% of cases, whooping cough was combined with acute respiratory viral infections: 5.9% each with boka, rhino, seasonal coronavirus infections and type 3 parainfluenza; 15.9% with the new coronavirus infection COVID-19. In children over 7 years of age, the percentage of co-infection was 2 times higher - 88.8%, of which 11.1% had community-acquired pneumonia: 1 child with pneumococcal and streptococcal pneumonia, 2 patients with respiratory mycoplasmosis and COVID-19. When assessing the vaccination status, it was found that the majority of children under 1 year of age (95%) were not vaccinated against pertussis, while 68% of patients over 7 years of age had indications of vaccination at an early age against pertussis according to the National Preventive Vaccination Calendar. Severe forms of the disease were recorded only in children of the first months of life with concomitant cytomegalovirus infection, and the most severe course was with a combination of CMVI, HCV6, and acute respiratory viral infections.[5] The onset of the disease in most older children was gradual at normal temperature. In the later stages of the disease, with the development of pneumonia, the temperature increased in 56.5% of patients. In 38.5%, pneumonia debuted against a background of normal temperature, including in children with respiratory mycoplasmosis and a new coronavirus infection.[6] The clinical symptoms of whooping cough were typical and manifested by a paroxysmal convulsive cough. In children under one year of age, the frequency of typical cough attacks per day was 18.0±0.8, in patients over 7 years of age – 12.0±0.9 (p<0.001).In the majority (82.4%) of patients under the age of one year, coughing attacks ended in vomiting; in older children, vomiting was recorded in 35% of cases (p<0.001).Such a pathognomonic symptom for whooping cough as reprises was observed in 47.1% of children in the first year of life, while in preschool and school-age children only in 13.04% (p<0.05). The diagnosis of pneumonia was confirmed radiologically: focal, segmental and interstitial pneumonia accounted for 15%, polysegmental - 37.5%, lobular -17.5%. 10% of the children had polysegmental pneumonia on both sides. At the same time, 70.6% of young children and 34.8% of older children had pneumonia with bronchial obstruction. In 1 child of 2 months (2.6%) with severe whooping cough, a non-smooth course of right-sided upper lobular pneumonia with the development of atelectasis in the right lung was noted against the background of activation of cytomegalovirus infection.

Conclusion. Whooping cough in children, especially young children who are unvaccinated and have an unfavorable premorbid background, is often complicated by pneumonia, the development of which may be associated with the accumulation of other respiratory infections, including CMVI, acute respiratory viral infections, bacterial, atypical flora and a new coronavirus infection. The severity of pneumonia varies from mild to severe and may or may not be accompanied by typical symptoms. Bronchoobstructive syndrome is a common cause of respiratory failure in whooping cough with pneumonia. Primary care physicians should be attentive to patients with whooping cough, especially in the presence of an unfavorable background, prolonged cough, auscultation changes in the lungs, and catarrhal symptoms, as this may indicate the development of complications of whooping cough.

About the authors

Alexandra Fedorovna Polygina

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: alexs.pol1802@mail.ru
ORCID iD: 0000-0001-6520-8353

6th year student of the Pediatric Faculty

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Julia Andreyevna Abramova

Voronezh State Medical University named after N. N. Burdenko

Email: flora.yulyaa@mail.ru
ORCID iD: 0000-0003-1734-8401

6th year student of the Pediatric Faculty

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Anastasia Igorevna Maranchak

Voronezh State Medical University named after N. N. Burdenko

Email: niusia838@gmail.com
ORCID iD: 0009-0003-8713-0966

5th year student of the Pediatric Faculty

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Victoria Dmitrievna Poliakova

Voronezh State Medical University named after N. N. Burdenko

Email: lyalinavika1201@gmail.com
ORCID iD: 0009-0001-3465-7735

5th year student of the Pediatric Faculty

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

References

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