Fatal case of macrolide-resistant Bordetella pertussis infection, Japan, 2024

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-05-08 DOI:10.1016/j.jiac.2025.102727

Tomoya Iwasaki , Kentaro Koide , Takahiro Kido , Sho Nakagawa , Masataka Goto , Tsuyoshi Kenri , Hiromichi Suzuki , Nao Otsuka , Hidetoshi Takada

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引用次数: 0

Abstract

Here, we present a fatal case of macrolide-resistant Bordetella pertussis (MRBP) infection in a 1-month-old female infant born prematurely at 34 weeks of gestation. The infant, unvaccinated against pertussis, exhibited respiratory failure, bilateral pneumonia, and hyperleukocytosis (109.8 × 10⁹/L) on day 44 of life. Despite initial treatment with azithromycin and a high-flow nasal cannula, her condition deteriorated rapidly, requiring mechanical ventilation and venoarterial extracorporeal membrane oxygenation. The infant passed away four days after symptom onset. Nasopharyngeal swabs confirmed the presence of B. pertussis carrying an A2047G mutation in the 23S rRNA gene, resulting in significant macrolide resistance. Phylogenetic analysis indicated that the isolate was genetically closer to Chinese MT28-MRBP isolates than to previously identified Japanese isolates. The combination of early infancy and delayed administration of effective antimicrobials likely contributed to the unfavorable outcome in this case. It is imperative to monitor the global dissemination of MRBPs and enhance local diagnostic capabilities.

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日本，2024年耐大环内酯百日咳杆菌感染死亡病例。

在这里，我们提出一个致命的病例大环内酯耐药百日咳博德特拉（MRBP）感染1个月大的女婴早产在妊娠34周。未接种百日咳疫苗的婴儿在出生后第44天出现呼吸衰竭、双侧肺炎和白细胞增多（109.8 × 109/L）。尽管最初使用阿奇霉素和高流量鼻插管治疗，但她的病情迅速恶化，需要机械通气和静脉动脉体外膜氧合。这名婴儿在出现症状四天后死亡。鼻咽拭子证实存在携带23S rRNA基因A2047G突变的百日咳，导致明显的大环内酯类药物耐药性。系统发育分析表明，该分离株在遗传上更接近中国MT28-MRBP分离株，而不是先前鉴定的日本分离株。婴儿期早期和延迟给予有效抗菌剂的结合可能促成了本病例的不利结果。必须监测mrbp的全球传播情况，并加强地方诊断能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.