Updated: 4/3/2020

Bordetella pertussis

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Snapshot
  • A 2-month-old girl infant presents to the emergency room with a 3-day history of a cough and post-tussive emesis. Her mother reports that while she had the Tdap vaccine during pregnancy, the father did not. For the past 2 weeks, the father has had a persistent dry cough. The infant's temperature is 100.4°F (38°C), pulse is 160/min, and respirations are 60/min. Physical exam reveals an infant with a dry cough on expiration and a whooping sound on inspiration. Fine crackles are heard bilaterally on auscultation. She is admitted and given antibiotics.
Introduction
  • Classification
    • Bordetella pertussis
      • a gram-negative aerobic coccobacilli
    • transmission
      • respiratory droplets
  • Epidemiology
    • demographics
      • infants are especially at risk
        • < 6 months of age
        • too young to be vaccinated
      • unvaccinated children
    • risk factors
      • exposure to infected people
      • incomplete vaccination
      • HIV exposure
  • Pathogenesis
    • bacteria colonizes mucosal surface
    • pertussis toxin binds to and activates adenylate cyclase by inhibiting G
      • impairs phagocytosis, allowing the bacteria to survive
    • tracheal cytotoxin 
      • peptidoglycan fragment that impairs cilia, preventing normal clearance of respiratory secretions
    • low lung volume at the beginning of inspiration causes strong inspiration and inspiratory “whoop”
  • Associated conditions
    • whooping cough
    • 100-day cough
  • Prevention
    • DTaP vaccine
      • vaccine against diphtheria, tetanus, and pertussis
      • acellular pertussis vaccine
      • 5 doses before school-age, completed by 4-6 years of age
    • Tdap vaccine
      • booster vaccine at 11-12 years of age
      • should also be given to pregnant mothers and those around them
  • Prognosis
    • can be fatal in infants
Presentation
  • Symptoms
    • catarrhal stage (first)
      • low-grade fevers
      • coryza
    • paroxysmal stage (second)
      • dry cough and whoop
      • post-tussive vomiting
    • convalescent stage (third)
      • recovery
  • Physical exam
    • whooping cough in children
      • dry cough on expiration
      • “whoop” on inspiration
    • 100-day cough in adults
      • post-tussive vomiting
      • paroxysmal cough
Studies
  • Labs
    • culture in
      • Bordet-Gengou agar
      • Regan Lowe medium
    • polymerase chain reaction
    • serology
    • requires nasopharyngeal secretions on a special swab, as the bacteria will not grow on cotton
  • Making the diagnosis
    • based on clinical presentation and laboratory studies
Differential
  • Mycoplasma pneumonia
    • distinguishing factor
      • also presents with a dry cough, but no whooping cough and no posttussive vomiting
Complications
  • Pneumonia
  • Failure to thrive
  • Death
    • especially in young infants
  • Apnea
    • especially in young infants
 

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