Cerebrospinal fluid findings in infants with pertussis or parapertussis1) : Clinical Chemistry and Laboratory Medicine

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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

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Cerebrospinal fluid findings in infants with pertussis or parapertussis1)

Tina T. Chu1 / Jesse Groh1 / 1

1Department of Pediatrics, Baylor College of Medicine, Houtson, TX, USA

Corresponding author: Andrea T. Cruz, MD, MPH, 6621 Fannin Street, Suite A210, MC 1-1481, Houston, Texas 77030, USA Phone: +1 (832) 824-5582, Fax: +1 (832) 825-1182

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 49, Issue 8, Pages 1341–1344, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2011.623, June 2011

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Background: Pertussis has been increasing in frequency and can cause protean manifestation in infants, often resulting in extensive laboratory evaluation.

Methods: We examined the prevalence of cerebrospinal fluid (CSF) anomalies in infants with pertussis and parapertussis over a 5-year period.

Results: In total, 239 of 1489 children (16.1%) had a positive PCR for pertussis or parapertussis. Eighty-three percent were infants; the mean age of the 39 years who received a lumbar puncture (LP) was 43 days. Reasons for performing LP included apnea (62%), toxic appearance (38%), fever (26%), and altered mentation (10%); several had >1 indication for LP. Twenty-four (62%) children had elevated CSF protein. No child had hypoglycorrhachia, bacterial meningitis, bacteremia, or intracranial hemorrhage; one child had a urinary tract infection and five had pneumonia. Seven children had brain imaging performed; one had a subarachnoid hemorrhage and six had normal studies. Elevated age-normalized CSF protein was a common finding in infants with pertussis, potentially due to transfer across a damaged or immature blood-brain barrier. This finding was seen in the absence of concomitant bacterial infections or detectable intracranial anomalies.

Conclusions: While the diagnostic evaluation and clinical management of a toxic-appearing infant should not be limited by a positive pertussis or parapertussis PCR, it is useful for physicians to be cognizant that elevated CSF protein can be seen in association with these infections.

Keywords: cerebrospinal fluid protein; children; pertussis

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