This document provides information on whooping cough (pertussis) caused by the Bordetella pertussis bacterium. It discusses the identification of B. pertussis by Jules Bordet and Gengou in 1900. The document describes the stages and symptoms of whooping cough infection, including the characteristic paroxysmal stage involving violent coughing fits. It also covers the laboratory diagnosis and treatment of pertussis as well as methods for prevention through vaccination programs.

1. DR.T.V.RAO MD 1
Dr.T.V.Rao MD
BORDETELLA PERTUSSIS
WHOOPING COUGH

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

3. WHAT IS WHOOPING COUGH
DR.T.V.RAO MD 3
• Whooping Cough (Pertussis) is a bacterial
infection of the lungs which is caused by a
bacterium Bodetella 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
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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.
DR.T.V.RAO MD 8

9. CULTURE CHARACTERS
• Aerobic Not anaerobic
• 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.
DR.T.V.RAO MD 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 mercury
drops
DR.T.V.RAO MD 10

11. ALUMINUM PAINT APPEARANCE
• Colonies
surrounded by
hazy zone of
hemolysis
• Confluent growth
presents as
aluminum paint.
DR.T.V.RAO MD 11

12. BIOCHEMICAL REACTIONS
• In active – do not ferment
sugars
• Indole test +
• Reduce Nitrates
• Utilize citrates
• Splits urea
• Catalase +
• Oxidase +
DR.T.V.RAO MD 12

13. RESISTANCE
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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 Lipopolysaccharide
coat that acts as an
Endotoxin and can aid
colonization by
agglutinating human
cells (Steele, 2004).
DR.T.V.RAO MD 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
epithelial cells
DR.T.V.RAO MD 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
DR.T.V.RAO MD 20

21. NATURE OF TOXIN
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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
DR.T.V.RAO MD 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
• Dermonecrtoic and lethal in Mice

25. TRACHEAL TOXIN
DR.T.V.RAO MD 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 and
avirulent form
VARIATION SMOOTH TO ROUGH
DR.T.V.RAO MD 26

27. PATHOGENICITY
• An obligate parasite
• Intranasal inoculation
in mice induces a
characteristic patches
and intensive
pneumonia like In
humans
• Incubation is 1 to 2
weeks
DR.T.V.RAO MD 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
DR.T.V.RAO MD 28

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

30. PAROXYSMAL STAGE
DR.T.V.RAO MD 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
DR.T.V.RAO MD 31

32. COMPLICATIONS
DR.T.V.RAO MD 32
• The violent bouts of cough leads to
Subconjuctival hemorrhage
Subcutaneous emphysema
Bronchopneumonia
Lung collapse
Neurological complications
Epilepsy, paralysis, mental retardation,
blindness, deafness.

33. EPIDEMIOLOGY
DR.T.V.RAO MD 33
• 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

34. EPIDEMIOLOGY
DR.T.V.RAO MD 34
• 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.

35. • 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
DR.T.V.RAO MD 35

36. • Isolation by culture
• PCR
• Direct fluorescent
antibody
• Serological testing
DIAGNOSIS
DR.T.V.RAO MD 36
http://medinfo.ufl.edu/year2/mmid/bms5300/images/d7053.jpg

37. • Microscopy
• Culture.
• Microscopy –
Demonstration of Bacilli
in respiratory
secretions.
• Florescent Antibody
methods
LABORATORY DIAGNOSIS
DR.T.V.RAO MD 37

38. DR.T.V.RAO MD 38

39. • 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
investigation
COUGH PLATE METHOD
DR.T.V.RAO MD 39

40. COUGH PLATE METHOD
DR.T.V.RAO MD 40

41. 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 specimen.
DR.T.V.RAO MD 41

42. 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
DR.T.V.RAO MD 42

43. 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
DR.T.V.RAO MD 43

44. IDENTIFICATION OF BACTERIA
• The culture plates are
incubated at 360c
• The bacteria are
identified by
Microscopy and slide
agglutination
• Immunofluorescence
methods
DR.T.V.RAO MD 44

45. • Paired serum sample
for detection of
antibodies
• Gel precipitation testing
• Complement fixation
test
• Detection of Ig A by
ELISA from
nasopharyngeal
secretions.
SEROLOGY
DR.T.V.RAO MD 45

46. EARLY IMMUNIZATION IS BEST SOLUTION TO
PREVENT THE PERTUSSIS
DR.T.V.RAO MD 46

47. 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.
DR.T.V.RAO MD 47

48. PROPHYLAXIS
DR.T.V.RAO MD 48
• 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.

49. BOOSTER DOSES
DR.T.V.RAO MD 49
• 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

50. ADVANTAGES OF ACELLULAR
VACCINE
DR.T.V.RAO MD 50
• 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
traditional "whole cell" version.

51. • 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
DR.T.V.RAO MD 51

52. • Penicillin is not
useful
• 10 days of
Erythromycin is
useful in early
infection
• Chloramphenicol
and Cotromoxazole
are effective.
TREATMENT
DR.T.V.RAO MD 52

53. • Programme Created by Dr.T.V.Rao MD for
Medical and Paramedical Students
• Email
• doctortvrao@gmail.com
DR.T.V.RAO MD 53