Infecção por Bordetella pertussis com hipertensão pulmonar grave num recém -nascido com boa evolução clínica – Caso clínico

 

 Sérgia Soares ¹

Gustavo Rocha ¹*

Susana Pissarra ¹*

Ana Carriço ²

Inês Azevedo ³*

Joana Sobrinho Simões ⁴

Hercília Guimarães ¹*

 

 

Resumo

Apesar da ampla cobertura vacinal, a infecção por Bordetella pertussis está longe de estar controlada. Os recém -nascidos e lactentes ainda sem imunização completa e filhos de mães com baixos títulos de anticorpos para a Bordetella pertussis são altamente susceptíveis à infecção e têm maior risco de doença grave e morte. A infecção por Bordetella pertussis associada a hipertensão pulmonar no recém -nascido é frequentemente fatal.

Os autores descrevem um caso clínico de doença grave num recém -nascido com insuficiência respiratória aguda e hipertensão pulmonar grave, tratado com sucesso com sildenafil e óxido nítrico inalado.

Palavras -chave: Recém -nascido, oxido nítrico, pertussis, hipertensão pulmonar, sildenafil. 

 

 

Pertussis with severe pulmonary hypertension in a newborn with good outcome – case report

Abstract

In spite of the availability and widespread use of vaccines, pertussis is far from controlled. Newborns and infants too young to be fully vaccinated, born from mothers with low antibody titers to Bordetella pertussis, are highly susceptible to infection and at risk of severe disease and death. Pertussis associated with pulmonary hypertension in the newborn is often fatal.

The authors report a clinical case of severe pertussis-induced respiratory failure associated to severe pulmonary hypertension in a neonate successfully treated with sildenafil and inhaled nitric oxide.

Key-words: Neonate, nitric oxide, pertussis, pulmonary hypertension, sildenafil.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

Bibliography

1. Barnett ED, Klein JO. Bacterial infections of the respiratory tract. In: Remington JS, Klein JO, Wilson CB, Baker CJ, eds. Infectious Diseases of the Fetus and Newborn Infant 6th Edition. Elsevier Sanders. Philadelphia 2006; 7:297-317.        [ Links ]

2. Sreenan CD, Osiovich H. Neonatal pertussis requiring extracorporeal membrane oxygenation. Pediatr Surg Int 2001; 17:201-3.

3. Tan T, Trindade E, Skowronski D. Epidemiology of pertussis. Pediatr Infect Dis J 2005; 24:10-8.

4. De Berry BB, Lynch JE, Chung DH, Zwischeenberger JB. Pertussis with severe pulmonary hypertension and leukocytosis treated with extracorporeal membrane oxygenation. Pediatr Surg Int 2005; 21:692-4.

5. Bisgard K. Guidelines for the control of pertussis outbreaks. National Immunization Program – Centers for Disease Control and Prevention U.S. Department of Health and Human Services 2000. [http://www.cdc. gov/vaccines/pubs/pertussis-guide/downloads/chapter1. pdf ].

6. Tuyen JM, Bisgard K. Guidelines for the control of pertussis outbreaks. National Immunization Program – Centers for Disease Control and Prevention U.S. Department of Health and Human Services 2000 [http:// www.cdc.gov/vaccines/pubs/pertussis-guide/downloads/chapter10.pdf ].

7. Casano P, Odena MP, Cambra FJ, Martin JM, Palomeque A. Bordetella pertussis infection causing pulmonary hypertension. Arch Dis Child 2002; 86:453-4.

8. Donoso A, León J, Ramírez M, Rojas G, Oberpaur B. Pertussis and fatal pulmonary hypertension: A discouraged entity. Scand J Infect Dis 2005;37: 145 – 8.

9. Cherry JD. The epidemiology of pertussis: a comparison of the epidemiology of the disease pertussis with the epidemiology of Bordetella pertussis infection. Pediatrics 2005; 115: 1422-6.

10. Committee on Infectious Diseases, American Academy of Pediatrics. Red Book 2000, 25th edition. Elk Grove Village; 2000: 556-69.

11. Raymond J, Armengaud JB, Cosnes-Lambe C, Chalumeau M, Bosdure E, Reglier-Poupet H, El Hajje MJ, Iniguez JL, Moulin F, Poyart C, Grendel D. Pertussis in young infants: apnoea and intra-familial infection. Clin Microbiol Infect 2007; 13:172-5.

12. Wendelboe AM, Njamkepo E, Bourillon A, Floret DD, Gaudelus J, Gerber M, Grimprel E, Greenberg D, Halperin S, Liese J, Muños-Rivas F, Teyssou R, Guiso N, Van Rie A; Infant Pertussis Study Group. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J 2007; 26:293-9.

13. Bamberger E, Lahat N, Gershtein V, Gershtein R, Benilevi D, Shapiro S, Kassis I, Rubin L, Srugo I. Diag- nosing pertussis: the role of polymerase chain reaction. Isr Med Assoc J 2005; 7:351-4.

14. Wendelboe AM, Van Rie A. Diagnosis of pertussis: a historical review and recent developments. Expert Rev Mol Diagn 2006; 6:857-64.

15. Koidl C, Bozic M, Burmeiter A, Hess M, Marth E, Kessler H. Detection and differentiation of Bordetella spp by real-time PCR. J Clin Microbiol 2007; 45: 347-50.

16. Vincart B, De Mendonça R, Rottiers S, Vermeulen F, Struelens MJ, Denis O. A specific real-time PCR assay for the detection of Bordetella pertussis. J Med Microbiol 2007; 56: 918-20.

17. Fry NK, Tzivra O, Li YT, McNiff A, Doshi N, Maple PA, Crowcroft NS, Miller E, George RC, Harrison TG. Laboratory diagnosis of pertussis infections: the role of PCR and serology. J Med Microbiol 2004; 53: 519-25. 18. Ménard A, Lehours P, Sarlanngue J, Bébéar C, Mégraud F, de Barbeyrac B. Development of a real-time PCR for the identification of Bordetella pertussis and Bordetella parapertussis. Clin Microbiol Infect 2007; 13:419-23.

19. Palmer CM, McCall B, Jarvinen K, Nissen MD. Bordetella pertussis PCR positivity, following onset of illness in children under 5 years of age. Commun Dis Intell 2007; 31:202-5.

20. Margotto PR. Uso do sildenafil (Viagra®) na hipertensão pulmonar persistente do recém-nascido. Comum Ciênc Saúde 2006; 17:141-54.

 

 

1 Division of Neonatology, Department of Pediatrics

2 Division of Pediatric Cardiology, Department of Pediatrics

3 Unit of Pediatric Pulmonology, Department of Pediatrics

4 Molecular Biopathology Laboratory, Department of Clinical Pathology

* Faculty of Medicine of Porto University, Porto, Portugal

Correspondence:

Gustavo Rocha

Serviço de Neonatologia / Departamento de Pediatria Hospital de São João – Piso 2 Alameda Prof. Hernâni Monteiro

4202 – 451 Porto Portugal

Tel: +351 225095816

Fax: +351225512273

E -mail: gusrocha@oninet.pt

 

Recebido para publicação/received for publication: 08.02.22

Aceite para publicação/accepted for publication: 08.05.27