Case Reports in Clinical Practice 2017. 2(2):42-45.

Exchange Transfusion in Management of Fulminant Pertussis: A Case Report
Masoud Mohammadpour, Meysam Sharifzadeh, Bahare Yaghmaie, Behdad Gharib, Amir Hossein Noohi


Pertussis incidence is increasing worldwide especially in infants < 2 months old with high mortality rate. Fulminant pertussis is characterized by refractory hypoxemia, cardiogenic shock, pneumonia, and intense leukocytosis that certainly needs intensive care and can lead to 75% mortality rate. Leukoreduction measures especially exchange transfusion (ET) have been used with some successful outcomes. We report ET as a treatment in a case of malignant pertussis with multi-organ failure syndrome. A 57-day-old infant who was admitted in pediatric intensive care unit with severe paroxysmal cough and extreme leukocytosis that despite appropriate treatment and full supportive care progressed to seizure, renal failure, pulmonary hypertension, and shock state, but his condition improved after ET. The patient was discharged from our hospital in good condition. ET even in the presence of multi-organ failure may be lifesaving and should be considered.


Bordetella pertussis; Pediatric intensive care unit; Leukocytosis; Exchange; Transfusion

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Long SS. Pertussis (Bordetella pertussis and B. parapertussis). In: Kliegman RM, Stanton BMD, St.Geme J, Schor NF, editors. Nelson textbook of pediatrics. 20th ed. 2016. p. 1378.

Bisgard KM, Pascual FB, Ehresmann KR, Miller CA, Cianfrini C, Jennings CE, et al. Infant pertussis: who was the source? Pediatr Infect Dis J 2004; 23(11): 985-9.

Martinez M, Rochat I, Corbelli R, Tissieres P, Rimensberger PC, Barazzone-Argiroffo C. Early blood exchange transfusion in malignant pertussis: A case report. Pediatr Crit Care Med 2011; 12(2): e107-e109.

Kuperman A, Hoffmann Y, Glikman D, Dabbah H, Zonis Z. Severe pertussis and hyperleukocytosis: is it time to change for exchange Transfusion 2014; 54(6): 1630-3.

Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: A systematic analysis. Lancet 2010; 375(9730): 1969-87.

Cortese MM, Baughman AL, Zhang R, Srivastava PU, Wallace GS. Pertussis hospitalizations among infants in the United States, 1993 to 2004. Pediatrics 2008; 121(3): 484-92.

Cherry JD, Heininger U. Pertussis and other Bordetella infections. In: Cherry JD, DemmlerHarrison GJ, Kaplan SL, Steinbach WJ, Hotez P, editors. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Saunders; 2014. p. 1627.

Le SN, Barrowman NJ, Moore DL, Whiting S, Scheifele D, Halperin S. Decrease in hospital admissions for febrile seizures and reports of hypotonic-hyporesponsive episodes presenting to hospital emergency departments since switching to acellular pertussis vaccine in Canada: a report from IMPACT. Pediatrics 2003; 112(5): e348.

Vitek CR, Pascual FB, Baughman AL, Murphy TV. Increase in deaths from pertussis among young infants in the United States in the 1990s. Pediatr Infect Dis J 2003; 22(7): 628-34.

Murray EL, Nieves D, Bradley JS, Gargas J, Mason WH, Lehman D, et al. Characteristics of severe Bordetella pertussis infection among infants =90 days of age admitted to pediatric intensive care units - Southern California, September 2009-June 2011. J Pediatric Infect Dis Soc 2013; 2(1): 1-6.

Sugimoto M, Nakanishi Y, Otokawa M, Uchida N, Yasuda T, Sato H, et al. Effect of Bordetella pertussis leukocytosis (lymphocytosis)-promoting factor (LPF) on the physical lymphoepithelial-cell association studied with the use of an in vitro model of mouse thymus. J Immunol 1983; 130(6): 2767-74.

Winter K, Zipprich J, Harriman K, Murray EL, Gornbein J, Hammer SJ, et al. Risk Factors Associated With Infant Deaths From Pertussis: A Case-Control Study. Clin Infect Dis 2015; 61(7): 1099-106.

Romano MJ, Weber MD, Weisse ME, Siu BL. Pertussis pneumonia, hypoxemia, hyperleukocytosis, and pulmonary hypertension: improvement in oxygenation after a double volume exchange transfusion. Pediatrics 2004; 114(2): e264-e266.

Olsen B, Henderson FW, Muhlebach MS, Willis TS. Novel therapeutic strategies for an infant with life-threatening pertussis.: 596. Crit Care Med 2006; 34(12).

Nieves D, Bradley JS, Gargas J, Mason WH, Lehman D, Lehman SM, et al. Exchange blood transfusion in the management of severe pertussis in young infants. Pediatr Infect Dis J 2013; 32(6): 698-9.


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