Summary: We illustrate 2 cases of pneumonia associated with Bordetella pertussis infection in 72-year-old and 61-year-old patients with cancer receiving myelosuppressive therapy after hematopoietic stem cell transplantation. Bacterial infections are a significant cause of morbidity and mortality in patients with cancer, and those receiving hematopoietic stem cell transplant, solid organ transplant, or myelosuppressive therapy are at increased risk. The infection was detected and the 2 patients had good outcomes following azithromycin treatment. Pertussis, also known as whooping cough, is a contagious respiratory illness that has become a public health challenge due to decreased immunity of the pertussis vaccine. Therefore, it is critical to recognize pertussis early in the course of the disease.
The lung is one of the most frequently involved organs in a variety of complications in the immunocompromised host.1 Among the pulmonary complications that occur in persons who are immunocompromised, infection is the most common and is associated with high rates of morbidity and mortality.1 The most commonly encountered type of infection is bacterial in origin.2 Before the development of vaccines, Bordetella pertussis infection was a significant threat among immunocompetent hosts.3 Bordetella vaccination has significantly reduced the number of infections, but immunity appears to be short lived.4 In addition, a large portion of the population remains susceptible to infection from B pertussis.5 We present 2 cases of B pertussis infection that led to pneumonia in patients with cancer. The medical staff members at our institution were up to date on their vaccinations, and no secondary cases of pertussis were reported.
A woman aged 72 years with metastatic ovarian cancer who was receiving chemotherapy with intrathecal methotrexate, gemcitabine, and carboplatin presented with a 12-day history of productive cough with yellow sputum and shortness of breath associated with the coughing spells. She had tried a cough suppressant with minimal relief. She denied fever, chills, sweats, hemoptysis, ill contacts, and recent travel.
Her vital signs were within normal limits, and findings on physical examination were significant for crackles heard throughout the lung fields. Her white blood cell count was 4,910/μL with a normal differential. The patient denied receiving pneumocystis prophylaxis in the past and tested negative for Pneumocystis jiroveci.
The result from a nasopharyngeal swab sent for a respiratory viral polymerase chain reaction (PCR) panel was positive for B pertussis. PCR testing was negative for adenovirus, Chlamydia pneumoniae, coronavirus, metapneumovirus, rhinovirus, enterovirus, influenza types A and B, Mycoplasma, parainfluenza virus types 1 to 4, and respiratory syncytial virus. Computed tomography (CT) of the chest showed dependent areas of subpleural consolidation and patchy, ground-glass opacities (Figure 1).
(To view a larger version of Figure 1, click here.)
She was discharged home with a 5-day course of oral azithromycin (250 mg daily). Repeat PCR testing 1 week later was negative for B pertussis. She reported improvement of her symptoms 3 weeks later.