OBJECTIVE :
Immunization coverage in Indonesia has reached 91,12%,but the number of drop out of DPT/Hb1 immunization reaching 4,1% in 2017.In the last 2 years,there was increased number of diphteria in Saiful Anwar Hospital.Following diphteria incidence,there is tendency to raise the number of pertussis in children.Pertussis is an acute respiratory tract infection,caused by Bordetella pertussis and can be prevented by immunization.Pertussis is prolonged disease divided into catarhal (1-2wk),paroxysmal (2-6wk) and convalescent (>2wk).Catarhal phase begins incidiously with symptoms of congestion and rhinorrhea.Paroxysmal phase signed by dry cough,intermittent and evolves into the inexorable paroxysm as the hallmark of pertussis.Convalescent stage (>2wk),the number,severity and duration of episodes is resolved.Infant <3m.o do not manifest as the classic stage,such as minimal cough,but apnea and cyanosis are prominent.Leucocytosis,thrombocytosis and lymphocytosis are laboratory manifestation of pertussis.Chest radiographic show perihilar infiltrat,atelectasis,pneumothorax and pneumomediastinum.Pertussis in infant <2m.o is not display a classically stage.
CASE :
All patient who diagnosed as severe respiratory distress and then suspected as pertussis,three of them were showed positive nasopharyngeal swab of Bordetella pertussis.All of the patients were <2m.o,didn’t received immunization of Diphteriae,Pertussis and Tetanus (DPT) yet,good nutritional status,atterm baby with symptoms of cough,low grade fever and respiratory failure.Two patients with paroxysm cough followed by apnea and cyanosis.Two patients have cough contact in their family.The laboratory finding were thrombocytosis and leucocytosis.Chest X-ray showed two patients with atelectasis and another one with severe pneumonia as complication of pertussis.Two patients showed symptoms of seizure.All of the patients are placed in isolated room of the PICU and got mechanical ventilator for >1month.Azithromycin was given for 5 days.Supportive therapy are aimed to control seizure and reactive thrombocystosis.All of the patients discharged  with improvement of the condition.
CONCLUSION:
Pertussis in infant with severe complication have a poor outcome.Quick diagnosis,correct management and strict observation will give a good outcome.