title: Severe pertussis infection in infants less than 6 months of age: Clinical manifestations and molecular characterization.
abstract: We conducted a study to determine the main traits of pertussis among unimmunized infants less than 6 months of age. From August 2012 to March 2015, 141 nasopharyngeal aspirates (NPAs) were collected from infants with respiratory symptoms attending 2 major hospitals in Rome. Clinical data were recorded and analyzed. Lab-confirmation was performed by culture and realtime PCR. B. pertussis virulence-associated genes (ptxP, ptxA and prn), together with multilocus variable-number tandem repeat analysis (MLVA), were also investigated by the sequence-based analysis on the DNAs extracted from positive samples. Antibiotic susceptibility with Etest was defined on 18 viable B. pertussis isolates. Samples from 73 infants resulted positives for B. pertussis. The median age of the patients was 45 d (range 7-165); 21 infants were treated with macrolides before hospital admission. Cough was reported for a median of 10 d before admission and 18 d after hospital discharge among infected infants, 84% of whom showed paroxysmal cough. No resistance to macrolides was detected. Molecular analysis identified MT27 as the predominant MLVA profile, combined with ptxP3-ptxA1-prn2 associated virulence genes. Although our data may not be generalized to the whole country, they provide evidence of disease severity among infants not vaccinated against pertussis. Moreover, genetically related B. pertussis strains, comprising allelic variants of virulence associated genes, were identified.
authors.affiliation: a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Stefanelli
authors.affiliation: a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Buttinelli
authors.affiliation: a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Vacca
authors.affiliation: b Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS , Rome , Italy.
authors.forename: Alberto E
authors.initials: AE
authors.lastname: Tozzi
authors.affiliation: c Departments of Pediatrics . "Sapienza" University of Rome , Rome , Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Midulla
authors.affiliation: d Immunology Unit, Immunology and Pharmacotherapy Area, Bambino Gesù Children Hospital IRCSS , Rome , Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Carsetti
authors.affiliation: a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fedele
authors.affiliation: e Department of Pediatrics and Infectious Disease , Bambino Gesù Children Hospital IRCSS , Rome , Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Villani
authors.affiliation: f Virology Unit, Bambino Gesù Children Hospital IRCCS , Rome , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Concato
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001886:Bordetella pertussis / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D018942:Macrolides / Q000494:pharmacology; D008297:Male; D058885:Multilocus Sequence Typing; D009305:Nasopharynx / Q000382:microbiology; D010641:Phenotype; D060888:Real-Time Polymerase Chain Reaction; D037521:Virulence Factors / Q000235:genetics; D014917:Whooping Cough / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D018942:Macrolides; D037521:Virulence Factors
keywords: infant; molecular characterization; pertussis; vaccination; virulence gene