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Severe pertussis — RACP Paediatrics MCQ

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HardRespiratorySevere pertussisRACP Paediatrics

A 3-month-old with pertussis develops severe paroxysmal cough with cyanosis and recurrent apnoeas requiring bag-mask ventilation. SpO2 drops to 60% during paroxysms. WCC is 85 × 10⁹/L with lymphocyte predominance. The infant is in respiratory failure. What is the most important prognostic indicator in severe neonatal/infantile pertussis?

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Correct answer: B — Supportive care only

Marked leukocytosis (>50 × 10⁹/L, particularly >100 × 10⁹/L) is the strongest predictor of death in infantile pertussis, as it leads to pulmonary hypertension via leucostasis. Exchange transfusion or leukapheresis may be considered in cases with extreme leukocytosis. ECMO may be required for refractory pulmonary hypertension. Supportive care including mechanical ventilation is essential.

Reference: RACP Paediatric Curriculum – ID/Respiratory; RCH Melbourne – 2023 – Pertussis CPG