学龄期儿童和成人急性持续性咳嗽何时是百日咳？一项前瞻性病例系列研究。
When is acute persistent cough in school-age children and adults whooping cough? A prospective case series study.
机构信息
Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand.
出版信息
Br J Gen Pract. 2013 Aug;63(613):e573-9. doi: 10.3399/bjgp13X670705.
BACKGROUND
Pertussis is a vaccine modified disease in most age groups and hence subtle in its presentation. Current diagnostic approaches require relatively invasive sampling.
AIM
To determine the incidence of B. pertussis infection among people aged 5-49 years identified in primary care with acute persistent cough using an oral fluid based diagnostic test.
DESIGN AND SETTING
Active surveillance of acute persistent cough of 2 weeks duration or greater was established in Auckland, New Zealand from May to October 2011. The 15 participating primary care practices provided care for a socioeconomically diverse population.
METHOD
Recent B. pertussis infection was determined by measurement of IgG antibodies to pertussis toxin (PT) in an oral fluid sample. An IgG antibody titre to PT of ≥70 arbitrary units defined recent infection. Participants reported symptoms at presentation and kept a cough diary.
RESULTS
A total of 226 participants were enrolled: 70 (31%) were children (5-16 years) and 156 (69%) were adults (17-49 years). Oral fluid samples were obtained from 225 participants. Ten per cent (23/225) had recent B. pertussis infection including a larger proportion of children than adults (17% versus 7%, P = 0.003). Neither cough duration nor any individual symptom discriminated between those with and without recent B. pertussis infection.
CONCLUSION
Pertussis is a frequent cause of acute persistent cough presenting to primary care. Clinical differentiation of pertussis from other causes of acute persistent cough is difficult. An oral fluid based diagnostic test, which is less invasive than other diagnostic approaches, has high acceptability in primary care.
背景
在大多数年龄段，百日咳是一种疫苗改性疾病，因此其表现较为微妙。目前的诊断方法需要相对侵入性的采样。
目的
使用基于口腔液的诊断测试确定在初级保健中患有急性持续性咳嗽的 5-49 岁人群中百日咳博德特氏菌感染的发生率。
设计和设置
2011 年 5 月至 10 月，在新西兰奥克兰建立了急性持续性咳嗽（持续时间为 2 周或更长时间）的主动监测。15 家参与的初级保健诊所为社会经济多样化的人群提供护理。
方法
通过测量口腔液样本中百日咳毒素（PT）的 IgG 抗体来确定近期的博德特氏菌感染。PT 的 IgG 抗体滴度≥70 个任意单位定义为近期感染。参与者在就诊时报告症状并保留咳嗽日记。
结果
共纳入 226 名参与者：70 名（31%）为儿童（5-16 岁），156 名（69%）为成年人（17-49 岁）。从 225 名参与者中获得了口腔液样本。10%（23/225）最近感染了博德特氏菌，儿童的比例高于成年人（17%对 7%，P=0.003）。咳嗽持续时间或任何单个症状都不能区分有和没有最近博德特氏菌感染的患者。
结论
百日咳是急性持续性咳嗽在初级保健中常见的原因。从其他急性持续性咳嗽的原因中区分百日咳是困难的。一种基于口腔液的诊断测试，比其他诊断方法具有更小的侵入性，在初级保健中具有较高的可接受性。
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