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Diagnostic value of symptoms and laboratory data for pertussis in adolescent and adult patients.

Abstract：

BACKGROUND:Several symptoms are classically thought to be suggestive of pertussis in children, but the diagnostic value of these symptoms in adolescent and adult patients is unclear. We evaluated the accuracy of the clinical findings for the early presumptive diagnosis of pertussis in adolescent and adult patients. Furthermore, we measured fractional exhaled nitric oxide (FeNO) with regard to whether we could distinguish eosinophilic inflammation of the airway and pertussis. FeNO is not expected to be associated with pertussis. METHODS:We compared 183 cases with laboratory-confirmed pertussis using serology and polymerase chain reaction and 1,132 cases without laboratory-confirmed pertussis. RESULTS:Among pertussis patients, paroxysmal cough was common with 90% sensitivity, but the specificity was low (25%). Posttussive vomiting and whoop were less common (sensitivity 25% and 19%, respectively), but both showed greater specificity for pertussis (80% and 86%, respectively). Posttussive gagging was observed with intermediate frequency and provided greater specificity (49% and 77%, respectively). Pertussis cases were most frequent between May and August with a peak in June. The mean FeNO value for the pertussis patients was 18.2 ± 9.2 ppb, which was significantly lower than that in asthma patients (56.9 ± 20.3 ppb, p <0.001). The most useful definition was posttussive vomiting and/or gagging, and a plus normal FeNO value, which had a sensitivity of 72% and a specificity of 70%. CONCLUSIONS:Clinical symptoms and laboratory data are of limited value in making the diagnosis of pertussis, and it was clinically difficult to differentiate adolescent and adult patients with or without pertussis. However, pertussis should be considered if patients have posttussive vomiting and/or gagging and a normal FeNO concentration.

journal_name

BMC Infect Dis

journal_title

BMC infectious diseases

authors

Miyashita N,Akaike H,Teranishi H,Kawai Y,Ouchi K,Kato T,Hayashi T,Okimoto N

doi

10.1186/1471-2334-13-129

subject

Has Abstract

pub_date

2013-03-11 00:00:00

pages

129

issn

1471-2334

pii

1471-2334-13-129

journal_volume

pub_type

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Diagnostic value of symptoms and laboratory data for pertussis in adolescent and adult patients.