Malignant pertussis and exchange transfusion

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie Vol. 22; no. 1; pp. 84 - 87
• Main Authors: Chantreuil, J, Fakhri, N, Labarthe, F, Saliba, E, Favrais, G
• Format: Journal Article
• Language: French
• Published: France 01-01-2015
• Subjects: Exchange Transfusion, Whole Blood; Female; Humans; Infant; Leukocytosis - etiology; Leukocytosis - therapy; Whooping Cough - complications; Whooping Cough - therapy
• ISSN: 1769-664X
• DOI: 10.1016/j.arcped.2014.10.010

Malignant pertussis is a critical clinical state associated with fatal outcome in 70% of cases. The severity criteria are a lung infection with pulmonary hypertension and hyperleukocytosis usually above 50 G/L. We report the case of a 2.5-month-old girl hospitalized with critical pertussis in a pediatric intensive care unit. She had acute respiratory distress syndrome with pulmonary hypertension complicated by a bacterial secondary infection with Enterobacter cloacae managed by high-frequency oscillatory ventilation associated with pulmonary vasodilatation therapy. In the absence of clinical improvement and before considering extracorporeal life support, exchange transfusion was performed at day 9 to reduce hyperleukocytosis at 70 G/L. Exchange transfusion was successfully performed with a reduction of leukocytes to under 40 G/L followed by steady improvement of pulmonary function. Weaning from mechanical ventilation and discharge took place at day 23 and 38, respectively.
Exchange transfusion should be considered in infants suffering from malignant pertussis with extreme leukocytosis before hemodynamic failure to improve the survival prognosis.