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Updated: Apr 3 2020

Bordetella pertussis

  • 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 Gi
        • 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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