Encephalopathy: A Rare Complication of an Infection by Bordetella pertussis
Date of submission: 08-11-2017 | Date of acceptance: 03-07-2018 | Published: 29-01-2019
Newborn, 25-day-old admitted for paroxysmal cough, moaning, bilateral crackling with apnoea and acute respiratory failure. Chest X-ray showed an infiltrate in the left hemithorax. Blood tests showed 38,000/μL leukocytes, 19,000/μL lymphocytes and C-reactive protein of 27.4 mg/L. The patient was started on cefuroxime and gentamicin and needed mechanical ventilation. Polymerase chain reaction for Bordetella pertussis was positive and azithromycin was associated. He did not undergo exchange transfusion. On the third day, the newborn initiated clonic movements of the limbs. The electroencephalogram showed epileptiform activity in the posterior temporal regions. The cerebrospinal fluid had 40 cells/μL and 254 mg/dL proteins, and the magnetic resonance showed hyperintensity of the frontoparietal white matter and thalamus. Evolution was favourable under phenobarbital and phenytoin. Within the family, which was a supporter of the antivaccine movements, no family member was vaccinated. Pertussis encephalopathy is a rare but feared complication of Bordetella pertussis infection. An exchange transfusion may improve the prognosis. Universal vaccination, particularly in pregnant women, is an important public health measure for the protection of vulnerable groups.