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Whooping cough is a preventable communicable infectious disease
The awareness and practice of Immunization has drastically reduced the epidemics.

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  • Bordetella

    1. 1. Whooping Cough Bordetella Pertussis Infection Dr.T.V.Rao MD
    2. 2. A Tribute to Bordet - Gengou
    3. 3. What is Whooping cough <ul><li>Whooping Cough (Pertussis) is a bacterial infection of the lungs which is caused by a bacterium Bordetella pertussis. It is a very contagious disease which causes coughing with little or no fever. The coughing may be so severe that it leads to vomiting and aspiration. </li></ul>
    4. 4. How the name Whooping derived <ul><li>Whooping cough is an infectious bacterial disease that causes uncontrollable coughing. The name comes from the noise you make when you take a breath after you cough. You may have choking spells or may cough so hard that you vomit. </li></ul>
    5. 5. Identification of Bordetella <ul><li>Jules Bordet and Gengou contributed for discovery 1900 </li></ul><ul><li>Identified as samll bacilli in children with Whooping cough. </li></ul><ul><li>Bordetella pertussis ( Intense cough ) </li></ul><ul><li>Other related Bacteria </li></ul><ul><li>B.parapertussis </li></ul><ul><li>B.brochoseptica </li></ul><ul><li>B.avium </li></ul>
    6. 6. Bordetella pertussis ( B G bacillus ) <ul><li>Gram negative organism </li></ul><ul><li>Small, ovoid,cocobacillus. </li></ul><ul><li>Lengh is 0.5 microns </li></ul><ul><li>Have bipolar metachromatic granules when stained with Toludine blue </li></ul>
    7. 7. Bordetella pertussis ( B G bacillus) <ul><li>Small ovoid coccobacillus 0.5 microns </li></ul><ul><li>On repeated cultures becomes become larger thread like bacilli. </li></ul><ul><li>Non motile, Non sporing </li></ul><ul><li>Capsulated – loose on repeated culturing </li></ul>
    8. 8. Other characters <ul><li>Donot swell in the presence of antigen. </li></ul><ul><li>Loose clumps of bacilli appear as thumb print appereance with clear space between the organisms. </li></ul><ul><li>Freshly isolated strains have fimbria. </li></ul>
    9. 9. Culture Characters <ul><li>Aerobic Not anaerobic </li></ul><ul><li>Grows optimally at 35 0 to 37 0 c </li></ul><ul><li>Preferred medium – Bordet Gengou glycerin potato blood agar </li></ul><ul><li>Blood for neutralizing inhibitory substances formed during bacterial grwoth. </li></ul><ul><li>Charcoal also serves the same purpose. </li></ul>
    10. 10. Mercury Drop colonies on Bordet-Gengou Medium <ul><li>Grwoth takes longer upto 48 – 72 hours </li></ul><ul><li>On blood agar appear as small dome shaped opaque viscid grayish white retractile glishninttg </li></ul><ul><li>Resembles bisected pearly or mercury drops </li></ul>
    11. 11. Aluminum paint appearance <ul><li>Colonies surrounded by hazy zone of hemolysis </li></ul><ul><li>Confluent grwoth presents as aluminum paint. </li></ul>
    12. 12. Biochemical Reactions <ul><li>In active – donot ferment sugars </li></ul><ul><li>Indole test + </li></ul><ul><li>Reduce Nitrates </li></ul><ul><li>Utilize citrates </li></ul><ul><li>Splits urea </li></ul><ul><li>Catalase + </li></ul><ul><li>Oxidase + </li></ul>
    13. 13. Resistance <ul><li>Killed by heat at 55 0 c for 30 mt </li></ul><ul><li>Drying and disinfectants kill the organism </li></ul><ul><li>Survive outside for 5 days </li></ul><ul><li>3 days on cloths </li></ul><ul><li>Few hours on paper </li></ul>
    14. 14. Antigenic characters and Virulence <ul><li>Agglutinogens - Species specific surface agglutinogens with capsule K antigens or fimbria </li></ul><ul><li>14 agglutinin factors are identified </li></ul><ul><li>Factors 7 is common in all species </li></ul><ul><li>Factor 1- 6 in only B pertussis </li></ul><ul><li>Factor 12 in B.brochoseptica </li></ul><ul><li>Factor 14 in B parapertussis </li></ul>
    15. 15. Virulence factors <ul><li>These virulence factors include adhesions such as filamentous hem agglutinin, agglutinogens, peractin, and fimbriae as well as a number of toxins including pertussis toxin, adenylate cyclase toxin, trachael cytotoxin, Dermonecrtoic toxin and heat-labile toxin (CDC, 2005). </li></ul>
    16. 16. Pathogenesis of B.pertussis <ul><li>Like most Gram negative pathogens, B. pertussis also contains a Lipopolysaccharide coat that acts as an Endotoxin and can aid colonization by agglutinating human cells (Steele, 2004). </li></ul>
    17. 17. Virulent Molecules
    18. 18. Toxin – cellular action.
    19. 19. Mechanism of Infection <ul><li>1,2,3 are common infective strains vaccines contain all the three Agglutinogens promoting virulence by helping bacteria to attach to respiratory epithelial cells </li></ul>
    20. 20. Pertussis Toxin <ul><li>Pertussis toxin – MW 1,17,000 </li></ul><ul><li>Hexamer protein composed of 6 subunits with A – B structure </li></ul><ul><li>A has enzymatic activity it can be toxoided </li></ul><ul><li>Pertussis toxin is the major component of Acellular Pertussis vaccine. </li></ul>
    21. 21. Nature of Toxin <ul><li>It produces a highly lethal toxin (formerly called Dermonecrtoic toxin) which causes inflammation and local necrosis adjacent to sites where B. pertussis is located. The lethal toxin is a 102 kDa protein composed of four subunits, two with a mw of 24kDa and two with mw of 30 kDa. </li></ul>
    22. 22. Pertussis Toxin <ul><li>Causes pathogenesis </li></ul><ul><li>Present only in B.pertussis </li></ul><ul><li>Pertussis toxin is expressed on the surface, secreted into the surrounding medium </li></ul><ul><li>Posses Biochemical and Biological activity of producing lymphocytosis producing factor causes Lymphocytosis </li></ul><ul><li>Acts as Histamine sensitizing factor </li></ul><ul><li>Islet activating function – causes excessive Insulin secretion. </li></ul>
    23. 23. Filamentous Hemagglutinin <ul><li>One of the Hemagglutinins produced by B.pertussis </li></ul><ul><li>Filamentous Hemagglutinins adheres to cilia of the respiratory epithelium and to erythrocytes </li></ul><ul><li>Helps in binding to respiratory epithelium </li></ul>
    24. 24. Other Toxins <ul><li>Adenylate cyclase </li></ul><ul><li>Enters the target cells and acts as toxin </li></ul><ul><li>It acts by catalyzing the production of cAmp by various types of cells. </li></ul><ul><li>Heat labile Toxin </li></ul><ul><li>Cytoplasmic protein present in Bordetella </li></ul><ul><li>Dermonecrtoic and lethal in Mice </li></ul>
    25. 25. Tracheal Toxin <ul><li>L M W – peptidoglycan </li></ul><ul><li>Causes ciliary damage, produced by all Bordetella </li></ul><ul><li>It induces ciliary damage in hamster tracheal ring </li></ul><ul><li>Lipolysacchardie acts as in Gram –ve bacilli </li></ul><ul><li>Pertactin – OMP produces immunity in mice. </li></ul>
    26. 26. Variation Smooth to Rough <ul><li>B pertussis may alter from smooth to rough variation </li></ul><ul><li>Phase I to Phase II Phase III Phase IV( rough stage ) which is rough and avirulent form </li></ul>
    27. 27. Pathogenicty <ul><li>An obligate parasite </li></ul><ul><li>Intranasal inoculation in mice induces a characteristic patches and intensive pneumonia like In humans </li></ul><ul><li>Incubation is 1 to 2 weeks </li></ul>
    28. 28. Incubation in Whooping cough <ul><li>The incubation period (the time between infection and the onset of symptoms) for whooping cough is usually 7 to 10 days, but can be as long as 21 days. </li></ul>
    29. 29. Stages of Infection <ul><li>1 Catarrhal </li></ul><ul><li>2 Paroxysmal </li></ul><ul><li>3 Convalescent </li></ul><ul><li>Each stage lasts 2 weeks </li></ul><ul><li>Catarrhal stage is Maximal infective </li></ul><ul><li>Antibiotics are useful. </li></ul>
    30. 30. Paroxysmal Stage <ul><li>Cough increases – distinctive bouts </li></ul><ul><li>Violent spasms of continuous coughing </li></ul><ul><li>With violent act of cough, air enters into empty lung with characteristic whoop </li></ul><ul><li>Enters into next stage </li></ul><ul><li>Leads to convalescence </li></ul><ul><li>And severity of cough decreases </li></ul><ul><li>Total disease lasts for 6- 8 weeks. </li></ul>
    31. 31. Violent Paroxysms of cough
    32. 32. Complications <ul><li>The violent bouts of cough leads to </li></ul><ul><li>Subconjuctival hemorrhage </li></ul><ul><li>Subcutaneous emphysema </li></ul><ul><li>Bronchopneumonia </li></ul><ul><li>Lung collapse </li></ul><ul><li>Neurological complications </li></ul><ul><li>Epilepsy, paralysis, mental retardation, blindness, deafness. </li></ul>
    33. 33. Epidemiology <ul><li>Predominately a pediatric disease </li></ul><ul><li>Highest in the 1 st year of life </li></ul><ul><li>Maternal antibodies are not protective. </li></ul><ul><li>Females suffers more than males. </li></ul><ul><li>World wide in distribution </li></ul><ul><li>Epidemics occurs periodically. </li></ul><ul><li>In early stage of infection droplets and fomites contaminated by oropharengeal secrection are infective. </li></ul><ul><li>Non immune rarely escape infection </li></ul>
    34. 34. Epidemiology <ul><li>House hold contacts at risk </li></ul><ul><li>Chronic carriers are not known </li></ul><ul><li>B.pertussis - 95 % </li></ul><ul><li>B.parapertussis – 5% </li></ul><ul><li>B.brochoseptica occasionally occur </li></ul><ul><li>Some times Adenovirus, Mycoplasma pneumonia may mimics whooping cough. </li></ul>
    35. 35. Diagnosis <ul><li>Isolation by culture </li></ul><ul><li>PCR </li></ul><ul><li>Direct fluorescent antibody </li></ul><ul><li>Serological testing </li></ul>
    36. 36. How Whooping cough Diagnosed <ul><li>Since the early symptoms are so non-specific, pertussis is usually not diagnosed until the appearance of the characteristic cough.  Pertussis can be confirmed by taking cultures of respiratory fluids for examination in the laboratory. This involves taking a sample of secretions from the nose or throat and identifying the pertussis bacteria in the secretion </li></ul>
    37. 37. Laboratory Diagnosis <ul><li>Microscopy </li></ul><ul><li>Culture. </li></ul><ul><li>Microscopy – Demonostration of Bacilli in respiratory secretions. </li></ul><ul><li>Florescent Antibody methods </li></ul>
    38. 38. Cough Plate Method <ul><li>Culture plate held at 10-15 cm infront of the mouth when the patient is coughing spontaneously or induced cough </li></ul><ul><li>Droplets of respiratory exhaled impinge on the media. </li></ul><ul><li>Helpful as bed side investigation </li></ul>
    39. 39. Cough Plate Method
    40. 40. Nasopharyngeal Swab <ul><li>Secretion from the posterior pharyngeal wall are collected with cotton swab on a bent wire passed from the oral cavity </li></ul><ul><li>A West’s post nasal swab is used for collection of specimen. </li></ul>
    41. 41. Per nasal Swab <ul><li>Swab on a flexible wire is passed along the floor of the nasal cavity and material collected from Pharyngeal wall </li></ul><ul><li>Dacron or Calcium alginate swabs are better </li></ul>
    42. 42. Transport Medium <ul><li>Transferred in o Casamio acid solution at pH 7.2 in modified Stuarts medium Glycerin potato blood agar of Bordet Gengou </li></ul><ul><li>Adding Pencillin becomes more selective </li></ul>
    43. 43. Identification of bacteria <ul><li>The culture plates are incubated at 36 0 c </li></ul><ul><li>The bacteria are identified by Microscopy and slide agglutination </li></ul><ul><li>Immunofluorescence methods </li></ul>
    44. 44. Serology <ul><li>Paired serum sample for detection of antibodies </li></ul><ul><li>Gel precipitation testing </li></ul><ul><li>Complement fixation test </li></ul><ul><li>Detection of Ig A by ELISA from nasopharyngeal secretions. </li></ul>
    45. 45. Early Immunization is best solution to prevent the Pertussis
    46. 46. How Whooping Prevented <ul><li>Pertussis can be prevented by the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, a cellular pertussis) vaccine. These important immunizations are routinely given in five doses before a child's sixth birthday. </li></ul>
    47. 47. Prophylaxis <ul><li>Alum absorbed vaccine is better </li></ul><ul><li>Administered in combination with Diptheria, and tetanus toxoid </li></ul><ul><li>B pertussis acts as an adjuvant </li></ul><ul><li>Early immunization, is essential in prevention of infection. </li></ul><ul><li>Later doses are given at the interval of 4 – 6 weeks intervals, before 6 moths 3 doses are completed. </li></ul>
    48. 48. Booster doses <ul><li>A booster at the end of the 1 st year </li></ul><ul><li>Another dose at 4 th year </li></ul><ul><li>Chemoprophylaxis with Erythromycin when exposed to contacts in the vicinity </li></ul><ul><li>Complications with vaccination </li></ul><ul><li>Post vaccinial encephalopathy </li></ul><ul><li>5 – 10 million doses </li></ul><ul><li>Neurotic complications </li></ul><ul><li>Stop further vaccination </li></ul><ul><li>Do not vaccinate after 7 years </li></ul>
    49. 49. Advantages of Acellular Vaccine <ul><li>An acellular vaccine containing whole antigen has been developed and found to elicit good antibody response with fewer side effects. It has replaced the classical vaccine in Japan since 1981 with success, with fewer out breaks and less side effects. whooping cough vaccine can be made from various components of the Bordetella pertussis bacterium, rather than the whole organism. This &quot;acellular&quot; vaccine works well but has fewer side effects than the traditional &quot;whole cell&quot; version. </li></ul>
    50. 50. Acellular Vaccines <ul><li>Contain the Pertussis bacilli </li></ul><ul><li>Contain PT FHA Agglutinogens 1, 2, 3 </li></ul><ul><li>Produces immunity in 90 % of individuals </li></ul><ul><li>Immunity in only 50 % by 12 th year </li></ul>
    51. 51. Treatment <ul><li>Pencillin is not useful </li></ul><ul><li>10 days of Erythromycin is useful in early infection </li></ul><ul><li>Chloramphenicol and Cotrimoxazole are effective. </li></ul>
    52. 52. B.parapertussis <ul><li>Less common </li></ul><ul><li>B.pertussis Vaccine not useful </li></ul><ul><li>Infrequent cause of whooping cough </li></ul>
    53. 53. B.brochiseptica <ul><li>A motile pathogen </li></ul><ul><li>Small proportion of cases 0.1% occur with cough. </li></ul><ul><li>It is antigenically related to B.pertussis, and Brucella. </li></ul>
    54. 54. Created for Benefit of Medical and Paramedical Students in Developing World. Dr.T.V.Rao MD Email [email_address]