Clinical and Epidemiological Characteristics of Pediatric Pertussis Cases: A Retrospective Study from Southeast Romania

Abstract

Background/Objectives: Pertussis remains a significant cause of respiratory illness in children, particularly in regions with suboptimal vaccination coverage. This retrospective study analyzes the clinical presentations, co-infections, treatment, and outcomes of pediatric patients diagnosed with Bordetella pertussis at the Constanța County Clinical Emergency Hospital "St. Apostle Andrew" between 1 January and 30 September 2024. Methods: Thirty-eight children, predominantly under the age of 3 years (81.58%), were included. Demographic data, clinical features, coinfecting pathogens, antimicrobial regimens, and hospital outcomes were reviewed. Results: Only 7 out of 38 children (18.42%) had received pertussis vaccination, and none benefited from maternal immunization. The highest incidence occurred in infants under 1 year (44.74%). Intensive care was required in 18.42% of cases, and macrolides were the most frequently used antibiotics (68.42%). Co-detection of respiratory pathogens-particularly Streptococcus pneumoniae, enteroviruses, and human rhinoviruses-was common. Severe cases often exhibited hyperleukocytosis, which was associated with complications such as heart failure. Conclusions: These findings underscore the need for timely recognition and management of pertussis and its complications. Although macrolides remain the first-line therapy, adjunctive treatments like leukoreduction may be considered in critical cases. The persistence of pertussis despite vaccination efforts highlights the challenges posed by waning immunity and diagnostic limitations, reinforcing the need for strengthened public health strategies.

Keywords: B. pertussis vaccine; Bordetella pertussis; co-infections; hyperleukocytosis; macrolides; pediatric patients; whooping cough.

Figure 1

The correlations between baseline variable parameters. BPV = Bordetella pertussis vaccine; F—female; M—male; RT-PCR—reverse transcription-polymerase chain reaction; ELISA—serological diagnosis.

Figure 2

The correspondence between radiological findings and illness severity: (A). Total sample; (B). Clinical cure; (C). Death; (D). Transfer. C-X-ray 1—Accentuated interstitial pattern below the hilum bilaterally; C-X-ray 2—Alveolar opacities around and below the right hilum; C-X-ray 3—Bilateral pulmonary infiltrate; C-X-ray 4—Blurring of the right basal pulmonary field: C-X-ray 5—Congestive pulmonary hila, microalveolar, and reticular opacities around and below the hilum bilaterally; C-X-ray 6—Enlarged congestive hila, confluent alveolar opacities around the left hilum and below the hilum bilaterally; C-X-ray 7—Right pulmonary consolidation process; C-X-ray 8—Widespread, homogeneous opacities of medium intensity, with blurred margins, showing air bronchograms, located in the upper third of both lung fields and left retrocardiac area—indicative of pulmonary infiltrates. All data presented were obtained using Descriptive Statistics, available in extensive form in Supplementary Materials.

Figure 2

The correspondence between radiological findings and illness severity: (A). Total sample; (B). Clinical cure; (C). Death; (D). Transfer. C-X-ray 1—Accentuated interstitial pattern below the hilum bilaterally; C-X-ray 2—Alveolar opacities around and below the right hilum; C-X-ray 3—Bilateral pulmonary infiltrate; C-X-ray 4—Blurring of the right basal pulmonary field: C-X-ray 5—Congestive pulmonary hila, microalveolar, and reticular opacities around and below the hilum bilaterally; C-X-ray 6—Enlarged congestive hila, confluent alveolar opacities around the left hilum and below the hilum bilaterally; C-X-ray 7—Right pulmonary consolidation process; C-X-ray 8—Widespread, homogeneous opacities of medium intensity, with blurred margins, showing air bronchograms, located in the upper third of both lung fields and left retrocardiac area—indicative of pulmonary infiltrates. All data presented were obtained using Descriptive Statistics, available in extensive form in Supplementary Materials.

Figure 3

The correlations between clinical laboratory analyses, radiological examination, complications, and hospitalization period. PBS—peripheral blood smear—all PBS abnormalities are detailed in Supplementary Materials. CRP—C-reactive protein: normal: <0.4 mg/mL; moderately increased: 0.4–1.0 mg/mL; high level: 1.1–10 mg/mL; C-complications; WBCs—White blood cells; Lym—Lymphocytes; C-X-ray—Chest radiography; HD—Hospitalization days.

Figure 4

Correlations between therapy and clinical outcomes in pediatric patients. PICU—Pediatric intensive care unit; Dex—Dexamethasone; HHC—Hydrocortisone hemisuccinate; Neb.Adr.—Nebulized adrenaline; HFNCO2—High-flow nasal cannula oxygen therapy; LFNCO2—Low-flow nasal cannula oxygen therapy.

Figure 5

Correlations between baseline data and clinical outcomes in pediatric patients. RSB—Respiratory symptoms before presentation in ECU; HD—Hospitalization days, C–Complications; PICU—Pediatric intensive care unit; BPV—B. pertussis vaccination.