A serologic study of organisms possibly associated with pertussis-like coughing.
OBJECTIVE
To assess the frequency of serologic evidence for an infection with microorganisms other than Bordetella pertussis in children with pertussis-like coughs.


METHODS
The study was performed within a protective efficacy trial of an acellular pertussis vaccine. Children who coughed for >7 days and had no laboratory evidence of recent infection with B. pertussis were eligible for the present study. Antibodies to Mycoplasma, Chlamydia, respiratory syncytial virus and influenza viruses A and B were measured by complement fixation, and antibodies to adenovirus and parainfluenza viruses 1, 2 and 3 were measured by enzyme-linked immunosorbent assay (ELISA) in acute and convalescent serum samples. Significant titer rises (4-fold titer rise in complement fixation, 100% increase of units in ELISA) and concentrations of antibodies beyond age-specific reference values were regarded as indicative of recent infection. In some children IgM antibodies to Epstein-Barr virus and to cytomegalovirus were also measured by ELISA.


RESULTS
A total of 149 of 1179 (12.6%) children had no laboratory evidence of B. pertussis infection. Serologic evidence for other infections were found in 56% (83 of 149). Adenovirus (33), parainfluenza viruses 1, 2 and 3 (18), Mycoplasma pneumoniae (15) and respiratory syncytial virus (14) were most common. Of this group 48% had been vaccinated against pertussis.


CONCLUSIONS
We present data that a proportion of pertussis-like coughs in children may be caused by adenovirus, parainfluenza viruses, respiratory syncytial virus and Mycoplasma. The differential diagnosis of pertussis-like coughs by laboratory methods should include these infections, especially in vaccinated children.
Wirsing von König
C H
CH
Institute for Hygiene and Laboratory Medicine, Klinikum Krefeld, Germany. WvKoenig@t-online.de
Rott
H
H
Bogaerts
H
H
Schmitt
H J
HJ
D000257:Adenoviridae Infections / Q000175:diagnosis; D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000097:blood / Q000382:microbiology* / Q000821:virology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009175:Mycoplasma Infections / Q000175:diagnosis; D018184:Paramyxoviridae Infections / Q000175:diagnosis; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis; D012698:Serologic Tests; D014917:Whooping Cough / Q000175:diagnosis
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral