title: Respiratory viral infections in infants with clinically suspected pertussis.
abstract: OBJECTIVE
  to evaluate the frequency of respiratory viral infections in hospitalized infants with clinical suspicion of pertussis, and to analyze their characteristics at hospital admission and clinical outcomes.
  
  
  METHODS
  a historical cohort study was performed in a reference service for pertussis, in which the research of respiratory viruses was also a routine for infants hospitalized with respiratory problems. All infants reported as suspected cases of pertussis were included. Tests for Bordetella pertussis (BP) (polymerase chain reaction/culture) and for respiratory viruses (RVs) (immunofluorescence) were performed. Patients who received macrolides before hospitalization were excluded. Clinical data were obtained from medical records.
  
  
  RESULTS
  Among the 67 patients studied, BP tests were positive in 44%, and 26% were positive for RV. There was no etiological identification in 35%, and RV combined with BP was identified in 5%. All patients had similar demographic characteristics. Cough followed by inspiratory stridor or cyanosis was a strong predictor of pertussis, as well as prominent leukocytosis and lymphocytosis. Rhinorrhea and dyspnea were more frequent in viral infections. Macrolides were discontinued in 40% of patients who tested positive for RV and negative for BP.
  
  
  CONCLUSIONS
  the results suggest that viral infection can be present in hospitalized infants with clinical suspicion of pertussis, and etiological tests may enable a reduction in the use of macrolides in some cases. However, the etiological diagnosis of respiratory virus infection, by itself, does not exclude the possibility of infection with BP.
authors.affiliation: Hospital Universitário da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Angela E
authors.initials: AE
authors.lastname: Ferronato
authors.forename: Alfredo E
authors.initials: AE
authors.lastname: Gilio
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Vieira
mesh_terms: D001886:Bordetella pertussis / Q000235:genetics / Q000302:isolation & purification*; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008218:Lymphocytosis / Q000097:blood; D008297:Male; D016133:Polymerase Chain Reaction; D012135:Respiratory Sounds / Q000209:etiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology; D018571:Sentinel Surveillance; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014917:Whooping Cough / Q000175:diagnosis / Q000453:epidemiology*
keywords: Bordetella pertussis; Coqueluche; Infant; Infecção respiratória; Lactentes; Respiratory tract infections; Vírus respiratórios; Whooping cough