title: Cerebrospinal fluid findings in infants with pertussis or parapertussis(1)).
abstract: 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.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houtson, TX, USA.
authors.forename: Tina T
authors.initials: TT
authors.lastname: Chu
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houtson, TX, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Groh
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houtson, TX, USA.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
mesh_terms: D001885:Bordetella Infections / Q000134:cerebrospinal fluid* / Q000382:microbiology* / Q000473:pathology; D042483:Bordetella parapertussis / Q000235:genetics / Q000302:isolation & purification; D001886:Bordetella pertussis / Q000235:genetics / Q000302:isolation & purification; D002556:Cerebrospinal Fluid Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D014917:Whooping Cough / Q000134:cerebrospinal fluid* / Q000382:microbiology* / Q000473:pathology
chemical_list: D002556:Cerebrospinal Fluid Proteins