This document provides information about Bordetella pertussis and whooping cough. It discusses how B. pertussis was identified in 1900 by Jules Bordet and Gengou as the bacteria that causes whooping cough. It describes the symptoms and stages of whooping cough including the catarrhal, paroxysmal, and convalescent stages. It also discusses how whooping cough can be diagnosed through culture, PCR, or serological testing and treated through vaccination with the DTaP vaccine.

1. 1
SACHIN MANJUNATH
BORDETELLA PERTUSSIS
WHOOPING COUGH

2. A TRIBUTE TO BORDET -
GENGOU
DR.T.V.RAO MD 2

3. WHAT IS WHOOPING
COUGH
3
• 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.

4. HOW THE NAME WHOOPING
DERIVED
4
• 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.

5. IDENTIFICATION
BODETELLA
5
• Jules Bordet and Gengou contributed for
discovery 1900
• Identified as small bacilli in children with
Whooping cough.
• Bodetella pertussis ( Intense cough )
• Other related Bacteria
B.parapertussis
B.brochoseptica
B.avium

6. BORDETELLA PERTUSSIS ( B G
BACILLUS )
• Gram negative
organism
• Small,
ovoid,cocobacillus.
• Length is 0.5
microns
• Have bipolar
metachromatic
granules when
stained with
Toluidine blue 6

7. BODETELLA PERTUSSIS ( B G
BACILLUS)
• Small ovoid
coccobacillus 0.5
microns
• On repeated cultures
becomes become larger
thread like bacilli.
• Non motile, Non sporing
• Capsulated – loose on
repeated culturing
7

8. OTHER
CHARACTERS
• Do not swell in the
presence of antigen.
• Loose clumps of
bacilli appear as
thumb print
appearance with
clear space between
the organisms.
• Freshly isolated
strains have fimbria.
8

9. CULTURE
CHARACTERS
• Aerobic
• Grows optimally at 350 to
370 c
• Preferred medium –
Bordet Gengou glycerin
potato blood agar
• Blood for neutralizing
inhibitory substances
formed during bacterial
growth.
• Charcoal also serves the
same purpose.
9

10. MERCURY DROP COLONIES ON
BORDET-GENGOU MEDIUM
• Growth takes
longer up to 48 –
72 hours
• On blood agar
appear as small
dome shaped
opaque viscid
grayish white
retractile
• Resembles
bisected pearly or 10

11. ALUMINUM PAINT
APPEARANCE
• Colonies
surrounded by
hazy zone of
hemolysis
• Confluent
growth
presents as
aluminum 11

12. BIOCHEMICAL REACTIONS
• In active – do not
ferment sugars
• Indole test +
• Reduce Nitrates
• Utilize citrates
• Splits urea
• Catalase +ve
• Oxidase +ve
12

13. RESISTANCE
13
• Killed by heat at 550c for 30 mt
• Drying and disinfectants kill the
organism
• Survive outside for 5 days
• 3 days on cloths
• Few hours on paper

14. ANTIGENIC CHARACTERS
AND VIRULENCE
14
• Agglutinogens - Species specific surface
agglutinogens with capsule K antigens or
fimbria
• 14 agglutinin factors are identified
• Factors 7 is common in all species
• Factor 1- 6 in only B pertussis
• Factor 12 in B.brochoseptica
• Factor 14 in B Para pertussis

15. VIRULENCE FACTORS`
15
• These virulence factors include
adhesions such as filamentous
hem agglutinin, agglutinogens,
peractin, and fimbriae
• as well as a number of toxins
including pertussis toxin, acetylate
cyclase toxin, trachael cytotoxins,
Dermonecrtoic toxin and heat-
labile toxin (CDC, 2005).

16. PATHOGENESIS OF
B.PERTUSSIS
• Like most Gram
negative
pathogens, B.
pertussis also
contains a
Lipopolysaccharid
e coat that acts as
an Endotoxin and
can aid
colonization by 16

17. VIRULENT
MOLECULES
DR.T.V.RAO MD 17

18. TOXIN – CELLULAR
ACTION.
DR.T.V.RAO MD 18

19. MECHANISM OF INFECTION
• 1,2,3 are common
infective strains
vaccines contain
all the three
Agglutinogens
promoting
virulence by
helping bacteria to
attach to
respiratory 19

20. • Pertussis toxin – MW
1,17,000
• Hexamer protein
composed of 6
subunits with A – B
structure
• A has enzymatic
activity it can be
toxoided
• Pertussis toxin is the
major component of
Acellular Pertussis
vaccine.
PERTUSSIS TOXIN
20

21. NATURE OF TOXIN
21
• 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.

22. PERTUSSIS TOXIN
22
• Causes pathogenesis
• Present only in B.pertussis
• Pertussis toxin is expressed on the surface,
secreted into the surrounding medium
• Posses Biochemical and Biological activity of
producing lymphocytosis producing factor
causes Lymphocytosis
• Acts as Histamine sensitizing factor
• Islet activating function – causes excessive
Insulin secretion.

23. FILAMENTOUS
HEMAGGLUTININ
23
• One of the Hemagglutinins
produced by B.pertussis
• Filamentous Haemagglutinnins
adheres to cilia of the respiratory
epithelium and to erythrocytes
• Helps in binding to respiratory
epithelium

24. OTHER TOXINS
24
ADENYLATE CYCLASE
• Enters the target cells and acts as
toxin
• It acts by catalyzing the production of
cAmp by various types of cells.
HEAT LABILE TOXIN
• Cytoplasmic protein present in
Bordetella

25. TRACHEAL TOXIN
25
• L M W – peptidoglycan
• Causes ciliary damage, produced by all
Bodetella
• It induces ciliary damage in hamster
tracheal ring
• Lipolysacchardie acts as in Gram –ve
bacilli
• Pertactin – OMP produces immunity in
mice.

26. • B pertussis
may alter from
smooth to
rough variation
• Phase I to
Phase II Phase
III Phase IV(
rough stage )
which is rough
VARIATION SMOOTH TO
ROUGH
26

27. PATHOGENICITY
• An obligate
parasite
• Intranasal
inoculation in mice
induces a
characteristic
patches and
intensive
pneumonia like In
humans 27

28. • 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.
INCUBATION IN WHOOPING
COUGH
28

29. STAGES OF INFECTION
29
• 1 Catarrhal
• 2 Paroxysmal
• 3 Convalescent
Each stage lasts 2 weeks
Catarrhal stage is Maximal
infective
Antibiotics are useful.

30. PAROXYSMAL STAGE
30
• Cough increases – distinctive bouts
• Violent spasms of continuous coughing
• With violent act of cough, air enters into
empty lung with characteristic whoop
Enters into next stage
• Leads to convalescence
• And severity of cough decreases
• Total disease lasts for 6- 8 weeks.

31. VIOLENT PAROXYSMS OF
COUGH
31

32. COMPLICATIONS
CAN YOU GUESS ??
32
a.
b.

33. COMPLICATIONS
33
• The violent bouts of cough leads to
Subconjuctival hemorrhage
Subcutaneous emphysema
Bronchopneumonia
Lung collapse
Neurological complications
Epilepsy, paralysis, mental
retardation, blindness, deafness.

34. EPIDEMIOLOGY
34
• Predominately a pediatric disease
• Highest in the 1st year of life
• Maternal antibodies are not protective.
• Females suffers more than males.
• World wide in distribution
• Epidemics occurs periodically.
• In early stage of infection droplets and
fomites contaminated by oropharengeal
secretion are infective.
• Non immune rarely escape infection

35. EPIDEMIOLOGY
35
• House hold contacts at risk
• Chronic carriers are not known
• B.pertussis - 95 %
• B.parapertussis – 5%
• B.brochoseptica occasionally occur
• Some times Adenovirus, Mycoplasma
pneumonia may mimics whooping cough.

36. • 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
HOW WHOOPING COUGH
DIAGNOSED
36

37. • Isolation by
culture
• PCR
• Direct
fluorescent
antibody
• Serological
testing
DIAGNOSIS
37http://medinfo.ufl.edu/year2/mmid/bms5300/images/d7053.jpg

38. • Microscopy
• Culture.
• Microscopy –
Demonstration of
Bacilli in respiratory
secretions.
• Florescent Antibody
methods
LABORATORY
DIAGNOSIS
38

39. DR.T.V.RAO MD 39

40. • Culture plate held
at 10-15 cm infront
of the mouth when
the patient is
coughing
spontaneously or
induced cough
• Droplets of
respiratory exhaled
impinge on the
media.
• Helpful as bed side
COUGH PLATE METHOD
40

41. COUGH PLATE
METHOD
DR.T.V.RAO MD 41

42. NASOPHARYNGEAL
SWAB
• Secretion from the
posterior
pharyngeal wall
are collected with
cotton swab on a
bent wire passed
from the oral cavity
• A West’s post
nasal swab is used
for collection of 42

43. PER NASAL SWAB
• Swab on a flexible
wire is passed
along the floor of
the nasal cavity
and material
collected from
Pharyngeal wall
• Dacron or Calcium
alginate swabs are
better 43

44. TRANSPORT
MEDIUM
• Transferred into
Casamio acid
solution at pH 7.2
in modified Stuarts
medium Glycerin
potato blood agar
of Bordet Gengou
• Adding Pencillin
becomes more
selective 44

45. IDENTIFICATION OF
BACTERIA
• The culture plates
are incubated at
360c
• The bacteria are
identified by
Microscopy and
slide agglutination
• Immunofluorescen
ce methods
45

46. • Paired serum
sample for
detection of
antibodies
• Gel precipitation
testing
• Complement
fixation test
• Detection of Ig A
by ELISA from
nasopharyngeal
SEROLOGY
46

47. EARLY IMMUNIZATION IS BEST
SOLUTION TO PREVENT THE
PERTUSSIS
47

48. HOW WHOOPING
PREVENTED
• 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.
48

49. PROPHYLAXIS
49
• Alum absorbed vaccine is better
• Administered in combination with Diphtheria,
and tetanus toxoid
• B pertussis acts as an adjuvant
• Early immunization, is essential in prevention
of infection.
• Later doses are given at the interval of 4 – 6
weeks intervals, before 6 moths 3 doses are
completed.

50. BOOSTER DOSES
50
• A booster at the end of the 1st year
• Another dose at 4th year
• Chemoprophylaxis with Erythromycin when
exposed to contacts in the vicinity
• Complications with vaccination
Post vaccinial encephalopathy
5 – 10 million doses
Neurotic complications
Stop further vaccination
Do not vaccinate after 7 years

51. ADVANTAGES OF ACELLULAR
VACCINE
51
• 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 Bodetella pertussis
bacterium, rather than the whole
organism. This "acellular" vaccine works
well but has fewer side effects than the

52. • Contain the
Pertussis bacilli
• Contain PT FHA
Agglutinogens 1, 2,
3
• Produces immunity
in 90 % of
individuals
• Immunity in only 50
% by 12th year
ACELLULAR VACCINES
52

53. • Penicillin is not
useful
• 10 days of
Erythromycin is
useful in early
infection
• Chloramphenicol
and
Cotromoxazole
are effective.
TREATMENT
53

54. • A six month old child was brought from a periphral
centre in a remote rural area with complaints of severe
cough , for the past 10 days and apnea during the
bouts, followed by vomiting , in between the child
slept comfortably. Blood counts were raised and
showed lymphocytosis. There was no h/o any
injection given since birth. A nasopharengeal swab
collected and subjected to culture on a selective
medium was positive for B.pertussis. A diagnosis of
whooping cough was made . In the hospital , the child
responded to antibiotics and supportive care.
A CLASSICAL CASE HISTORY
54

55. THANK YOU... !!! 55

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