By Latisha Nasse LPN&

Kristen Dieterle Lab Tech

Whooping cough:Pertussis

(Alder, 2013)

What is it?❖ Highly contagious

acute respiratory disease(Mosby 2006)

❖ Bordetella pertussis(Black,2008)

❖ Affects infants and younger children(CDC, 2014)

➢ Fatal to babies >1yr

❖ Teens & adults are susceptible(CDC, 2014)

➢ Mostly are the carriers

Domain- BacteriaKingdom- EubacteriaPhylum-ProteobacteriaClass- BetaproteobacteriaOrder- BurkholderialesFamily- AlcaligenaceaeGenus- Bordetella (7 sp.)Species- Pertussis(Brenner, Krieg, Garrity, & Staley, 2005)

(Bacterial Pathogens, 2005)

Taxonomy

❖ Bordetella- Named after Jules Bordet -isolated pertussis with Octave Gengou

(Brenner et al., 2005)

❖ Per- very, severe Tussis- coughPertussis = very severe cough

(Brenner et al., 2005)

❖ Chinese call it the “cough of 100 days”(Black, 2008)

(Jules Bordet - Biographical, 1967)

Etymology

History❖ 1578- Earliest description- G. Baillou❖ 1813- First complete clinical description- Robert Watt ❖ 1906- Jules bordet & Octave Gengou isolated organism❖ 1940s- vaccine made of inactivated whole cell

suspension❖ 1997- Acellular vaccine (Alder, 2013)

❖ 2003- Genome sequenced (Parkhill, et al., 2003) ➢ Strain: Tahoma I➢ 4,086,186 base pairs & 3,816 genes

Parasitic and Pathogenic

❖ Require a human host (Bergey & Holt, 1994)

❖ Nicotinamide, organic sulfur (cysteine), and organic nitrogen (amino acids) (Bergey & Holt, 1994)

Growth❖ Fastidious❖ Only found in the respiratory tract of humans (Brenner et al. 2005)

❖ Susceptible to compounds such as unsaturated fatty acids and sulfides (Alder, 2013; Brenner et al., 2005)

❖ Can be grown on:➢ Bordet Gengou medium (potato-glycerol-blood agar)

(Alder, 2013; Brenner et al., 2005)

➢ Charcoal horse blood agar (Brenner et al. 2005)

➢ Stainer-Sholte Broth (Brenner et al. 2005)

➢ Cyclodextrin Solid Medium (Brenner et al. 2005)

Morphology & Physiology❖ Colonies- smooth, convex, pearly, glistening, &

surrounded by a zone of hemolysis without definite periphery (Bergey & Holt, 1994)

❖ Does not form a pellicle (Bergey & Holt, 1994)

❖ Minute .2-.5 x .5- 1 Micrometer (Brenner et al., 2005)

❖ Non-motile (Brenner et al., 2005)

❖ Coccobacillus (Black, 2008)

❖ Gram negative (Alder, 2013)

❖ surrounded by a slime sheath composed of extruded filaments or secreted blebs (Brenner et al., 2005)

Morphology & Physiology Cont’d

❖ Obligate aerobe (Brenner et al., 2005)

❖ Optimal temperature 35-37°C (Brenner et al., 2005)

❖ Reproduce by Lysis, not budding (Bergey & Holt, 1994)

❖ Negative for cysts (Bergey & Holt, 1994)

Morphology & Physiology Cont’d❖ Litmus Milk- Alkaline (Bergey & Holt, 1994)

❖ Chemoorganotrophic (Bergey & Holt, 1994)

❖ Does not produce (Bergey & Holt, 1994)

➢ Nitrate reductase (lab)➢ Urease➢ Indole from tryptophan (Lab)

❖ Does Produce➢ Oxidase (Bergey & Holt, 1994)

➢ Catalase (Brenner et al., 2005)

In The Body…❖ Infected respiratory droplet is inhaled (Black, 2008)

❖ Does not invade tissues or enter the blood (Black, 2008)

❖ Pertussis colonizes on the cilia in respiratory tract➢ Pertactin (Khanacademymedicine, 2014)

➢ filamentous hemagglutinin (Khanacademymedicine, 2014)

❖ dermonecrotic toxin-causes inflammation & local necrosis (Todar, 2012)

(Todar, 2012)

In The Body…Cont’d❖ Tracheal cytotoxin (TCT)

➢ kills cilial cells & neutrophils (Khanacademymedicine, 2014)

➢ stimulates release of cytokine IL-1 (Todar, 2012)

❖ Adenylate cyclase toxin (ACT) & Pertussis toxin (PT)➢ Prevent barrier cells and macrophages from

signaling to other cells➢ Prevent breakdown by macrophages➢ Cause lymphocytosis (PT only) (Khanacademymedicine, 2014)

3 Stages(Black, 2008)

❖ Catarrhal 1-2 weeks➢ Highly contagious

❖ Paroxysmal 4-6 weeks

➢ Most intense stage

❖ Convalescent Months up to 2yrs.

Stage I Catarrhal(Mosby, 2006)

❖ fever❖ runny nose❖ sneezing❖ mild dry cough❖ listlessness

❖ irritability❖ anorexia❖ vomiting❖ apnea (infants)❖ cyanosis

Stage II Paroxysmal(CDC, 2014)

http://youtu.be/JKUSKYdYo9w

❖ moist cough ❖ uncontrollable

rapid coughing fits

❖ whooping sound❖ vomiting❖ dehydration❖ electrolyte

imbalance

❖ facial redness❖ cyanosis❖ exhaustion❖ fractured ribs❖ fainting❖ weight loss❖ loss of bladder

control

Stage III Convolescents(Black, 2008)

❖ mild cough❖ secondary infections

Transmission

❖ inhaling respiratory droplets from an infected person(CDC, 2014)

❖ one person can infect up to 15 other people(CDC, 2014)

http://www.superhomeremedies.com/images/sneezing_spreads_flu_virus_800x535_pd.jpg

Diagnosis

❖ nasopharyngeal swab(Black, 2008)

❖ blood work(CDC, 2014)

http://t1.gstatic.com/images?q=tbn:ANd9GcS27OrKksEALMxOToOJ5HrWvmXb1JqK_tTj1NvFiGtS_WbygzTvAbtQYZW7

Treatment

❖ Antibiotics➢ Erythromycin➢ Tetracycline➢ Chloramphenicol➢ Clarithromycin➢ Azithromycin

(CDC, 2014)

❖ bed rest ❖ oxygen therapy❖ fluid and

nutritional encouragement

(Mosby, 2006)

Prevention

❖ Vaccinations(CDC, 2014) ➢ childhood - DTaP

■ 2, 4, 6 months■ booster @ 15-18 months■ booster @ 4-6yrs■ last 5 years

➢ teens & adults - Tdap■ last 10 years

❖ cover cough❖ wash hands❖ dispose of

soiled articles❖ public

education(Leifer,2007)

Pertussis in the news...❖ 2014 California Epidemic❖ By June 10th California department of public health

showed reports of 3,458 cases❖ 800 reported in 3 week period❖ 24% increase in reports from 2013 throughout the U.S. ❖ 23 fold increase in risk of getting sick if not vaccinated❖ 225 deaths in U.S. from 2000-2012

➢ 221 were babies <3 months➢ cocooning (Crawford, 2014)

References(2014, September 05). Retrieved November 12, 2014, from http://www.cdc.gov/pertussis/

Alder, R.P. (2013). Whooping cough. Magill’s Medical Guide (Online Edition)

Bacterial Pathogens. (2005, January 1). Retrieved from http://www.biomedcentral.com/1471-2180/5/19/figure/F2?highres=y

Black, J. G. (2008). Microbiology: Principles and explorations. Hoboken, NJ: J. Wiley & Sons.

Bergey, D. H., & Holt, J. G. (1994). Bergey's manual of determinative bacteriology. Baltimore: Williams & Wilkins.

Brenner, D. J., Krieg, N. R., Garrity, G. M., & Staley, J. T. (2005). Bergey's manual of systematic bacteriology. Volume Two, The proteobacteria. New York: Springer.

Burton, G. R., & Engelkirk, P. G. (1995). Microbiology for the health sciences. Philadelphia: Lippincott.

Crawford, C. (2014, June 25). Pertussis Is Latest Disease Outbreak Concern in United States. Retrieved November 19, 2014, from http://www.aafp.org/news/health-of-the-public/20140625pertussis.html

References cont...Chin, J. (2000). Control of communicable diseases manual: An official report of the American Public Health Association.

Washington, DC: American Public Health Association.

Khanacademymedicine. (2014, October 22). Pertussis pathophysiology [video file]. Retrieved from http://www.youtube.com/watch?vXLcyqs5vQHQ

Leifer, G. (2007). Introduction to maternity & pediatric nursing. St. Louis, MO: Mosby/Elsevier.

Jules Bordet - Biographical. (1967). Retrieved November 18, 2014, from http://www.nobelprize.org/nobel_prizes/medicine/laureates/1919/bordet-bio.html

Mosby's dictionary of medicine, nursing & health professions. (2006). St. Louis, MO: Mosby Elsevier.

Parkhill, J., Sebaihia, M., Preston, A., Murphy, L. D., Thomson, N., Harris, D. E., ... Maskell, D. J. (2003, 12). Comparative analysis of the genome sequences of Bordetella pertussis, Bordetella parapertussis and Bordetella bronchiseptica. Nature Genetics, 35(1), 32-40. doi: 10.1038/ng1227

Todar, K. (2012). Bordetella pertussis and whooping cough. Retrieved November 19, 2014, from http://textbookofbacteriology.net/pertussis_2.html

Weston, J. (2012, May 9). Pertussis Panic. Retrieved November 19, 2014, from http://www.apenotmonkey.com/2012/05/09/pertussis-panic/

Williams, M. E. (2005). Epidemics. Farmington Hills, MI: Greenhaven Press.

(Weston, 2012)

Questions?