BORDETELLA

Objectives
• Introduction
• Epidemiology
• Virulence factors
• Pathogenesis
• Clinical features
• Laboratory diagnosis
• Treatment and prevention
Introduction
• Small Gram negative coccobacilli
• Non fermenters
• Strictly aerobic
• Catalase positive
• It comprises of the species:
 B. pertussis – causes whooping cough
 B. parapertussis – causes milder form of whooping cough
 B. bronchiseptica - pathogen of domestic animals
B. pertussis
• GN coccobacilli
• Strict aerobes
• Capsulated, piliated
• Non motile, non spore forming
• Causes violent proxysmal productive cough called whooping cough
• Strictly human pathogen
Epidemiology
• Whooping cough is a disease of infants and pre-school children
• Catarrhal stage is the main source of infection
• Highest incidence found below age of 5
• Outbreaks occur periodically every 3-4 years
• Marked decline has occurred in incidence and mortality rates during
last four decades in communities with active immunisation
programme, good nutrition and good medical care
Virulence factors
Adhesins – play role in bacteria attachment
• They include; pili, filamentous hemagglutinin, pertactic
Toxins
a) Tracheal cytotoxin- causes damage to cilia of epithelial cells by
producing interluikin 1 intercellularly. Leades to whooping cough.
b) Pertussis toxin- present only in B. pertussis. Active subunit activates
adenylate cyclase leading to increased cAMP. Icreased cAMP
increases respiratory secretions and mucus production also
induction of leukocytosis.
• Dermonecrotic toxin- contributes to respiratory mucusal damage.
• Endotoxin
Pathogenesis
• Transmitted via inhalation of infectious droplets, rarely through direct
contact.
• Inhalled bacteria attaches to the cillia of epithelia using pili and
hemagglutinin, pertactin.
• Bacteria produces toxins;
Treachealcytotoxin – damages the cilia leading to whooping cough
Pertussis toxin – increases respiratory secretions and mucus,
suprsession of host immune, lymphocytosis
Clinical features
• The clinical course passes through three stages followimg incubation
of 7-10 days
Catarrhal phase
• Lasts 1-2 weeks
• Characterized by common cold like symptoms such as mild cough, low
grade fever, malaise, headeache, nasal congestion, loss of taste
• Most infectious stage
• Highest number of bacteria produced
Paroxysmal phase
• Characterized by specific symptoms like whooping cough and post-
tussive vomiting.
• Each paroxysm consists of 5 -20 rapid coughs with the patient unable
to breathe between the coughs.
• Episodes worsen at night.
• During the violent coughs there’s bulging of the eyes, tounge
protrusion and fluid streaming of eyes and nose.
• Weight loss may also be seen.
• Young infants- gasping, apnea, seizures.
• May continue for 1-6 weeks .
• Convalescent phase
• The frequency and severity of coughing gradually decreases,
• Antibody may appear in serum.
Complications;
• Pressure effects- subconjunctival heamorrhage, hernias, rib fructure.
• Bronchopneumonia
• Neurological complications- convulsions, encephalopathy.
Laboratory diagnosis.
• Specimen:per – nasal swabs, cough plate ,post – nasal
secretions ,post – nasal swabs .
• Gram stain – Gram negative cocobacilli arranged in thumb print
appearance.
• Culture smear- fastidious organism requires special complex media for
primary isolation;
a) Regan and lowe medium- charcoal agar supplemented with 10%
horse blood and cephalaxin.
b) Bordet Gengou- glycerine, potato, blood agar, pinicillin to inhibit
growth of other organism.
• Organisms cultured and incubated for 2-6 days in most aerobic
conditions reveals greyish white convex, opaque with shiny surface
appearance ( mercury drops)
• Biochemical tests: oxidase positive, urease negative, nitrate test
negative.
• Detection of serum antibody- using enzyme immunoassays
• PCR- detection of PT promoter region genes.
Treatment
• Macrolides are drugs of choice- erythromycin 7-14 days
• Removal of respiratory secretions ,oxygen therapy for patients with severe symptoms
• Cotrimoxazole is recommended as alternative in macrolide resistance.
Prevention
• Chemoprophylaxis- for household contacts of pertussis cases.
• Isolation.
• Vaccination- two types available ;
Whole-cell pertussis vaccine – prepared by heating followed by chemical inactivation
and purification of whole B. pertussis bacilli.
DPT vaccine- WC pertussis vaccine given under national imunization programme
along with Diptheria and Tetanus toxoids. Three dosses are given 6,10,14 weeks
• Followed by boosters at 1 and 5 years.
Acellular pertussis vaccine
• Composed of pertussis toxoid and 2 or more components such as
FHA, pertactin or fimbriae.