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Pertussis - The Death Of Malignant Pertussis And How To Avoid It

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Pertussis is a life-threatening illness marked by exaggerated respiratory distress, true leukocytosis, and aspiratory hypertension. Pertussis that is threatening is a common clinical symptom that is associated with a 70% mortality rate. A lung infection with aspiratory hypertension and hyperleukocytosis of more than 50 G/L meets the seriousness criteria. Bordetella pertussis causes pertussis (whooping cough), a highly contagious, neutralizer-preventable respiratory infection.

History Of Pertussis And Bordetella Pertussis

A pertussis-like illness was described as "the cough of 100 days" by Chinese medical scholar Yuanfang Chao during the Sui Dynasty in the seventh century. Guillaume De Baillou, a thousand years later in France (1578), described whooping cough in children in Paris for the first time; he called the illness "quinte" because of the 5-hour periodicity of paroxysms seen in acute episodes of disease.

Pertussis epidemics were first documented in Persia (modern-day Iran), according to new research. Pertussis outbreaks were first documented in Europe in the 16th century, but it was not until 300 years later that the causative agent was identified. Carl Burger, a German scientist at the University of Bonn, discovered bacteria rods in a stained sputum sample from a patient with clinical pertussis in 1883. Jules Bordet, a Belgian physician and scientist, discovered small Gram-negative bacilli in the sputum of his 5-month-old daughter who had whooping cough seventeen years later. Bordet, however, was unable to grow these bacilli in the culture media available at the time. Bordet's son contracted pertussis six years later, and by that time, Bordet and Gengou had succeeded for the first time in history in isolating and growing B. pertussis.

Bordet won the Nobel Prize in Physiology or Medicine in 1919 for his work on antimicrobial immunology, which included extensive research on B. pertussis and paved the way for the organism's identification as the cause of whooping cough.

COPYRIGHT_OAPL: Published on https://www.oapublishinglondon.com/pop/pertussis/ by Dr. Cooney Blades on 2022-05-26T05:13:04.300Z

Microbiology Of Bordetella Species

Bordetella species belong to the Alcaligenaceae family and include ten genetically distinct species. Although B. pertussis has long been thought to be the sole cause of whooping cough, other species (such as B. parapertussis and B. holmesii) can cause coughing that is similar to whooping cough (15–28). B. pertussis is a Gram-negative, pleomorphic aerobic coccobacillus that thrives at 35°C to 37°C and can be distinguished from other Bordetella species by its growth and biochemical characteristics. In contrast to B. parapertussis, which is less fastidious, oxidase negative, and urease positive, and produces a brown pigment on heart infusion, Regan-Lowe, or Mueller-Hinton agar, B. pertussis is a fastidious, nonmotile, catalase and oxidase-positive species. On blood-supplemented medium and synthetic medium containing appropriate growth factors, such as nicotinamide, Bordetella species grow slowly.

A woman wearing a purple t-shirt coughing with her head resting on one hand and the other hand closing her mouth
A woman wearing a purple t-shirt coughing with her head resting on one hand and the other hand closing her mouth

Pathogenesis And Histopathological Findings Of Pertussis

Mechanisms Of Pathogenesis

B. pertussis is a human-specific pathogen, whereas B. bronchiseptica, B. parapertussis, and B. holmesii can infect a wide range of mammals, including humans. Toxins such as pertussis toxin (PT), adenylate cyclase toxin (AC), dermonecrotic toxin (DNT), and tracheal cytotoxin (TCT) are among the virulence factors of B. pertussis. Surface structures like filamentous hemagglutinin (FHA), fimbriae (FIM), pertactin (PRN), the type III secretion system, and lipopolysaccharide (LPS), as well as metabolic proteins like BrkA, BapC, and BatB, influence the virulence of B. pertussis. Several virulence factors, including PT, AC, DNT, FHA, TcfA, pertactin, FIM, BrkA, BipA, BcfA, and Vag8, are positively controlled by the bvgAS genes in B. pertussis. The B. pertussis BvgAS two-component signal transduction system is critical for pertussis pathogenicity.

Epidemiology

Global Burden Of Pertussis

Pertussis is an endemic disease in both developing and developed countries, with sporadic outbreaks occurring all over the globe. Crowcroft et al. estimated that there were 48.5 million cases of pertussis worldwide in 1999, with approximately 295,000 deaths. Pertussis killed 195,000 people worldwide in 2008, according to Black et al. Africa was the source of a large number of deaths (83,580). A total of 136,000 cases were reported globally in 2013.

Estimating the global pertussis disease burden is difficult for a variety of reasons. To begin with, many countries have inadequate surveillance infrastructure, making timely reporting of clinically suspected pertussis cases difficult. Second, laboratory infrastructure for routine pertussis testing is limited in developing countries, and molecular diagnostic tests like PCR are not widely available. Third, inconsistent clinical identification of pertussis disease may obstruct case reporting in areas with a lack of trained health professionals. Furthermore, the WHO has noted that the use of a standardized set of pertussis case definitions within an overall surveillance framework for vaccine-preventable diseases or communicable diseases has been inconsistent.

The Burden Of Pertussis In Adolescents And Adults

During the last two to three decades, pertussis has become more common among adolescents and adults. Between 1991 and 1999, population-based studies estimated a pertussis incidence in adults of 133 to 507 per 100,000 person-years, equating to more than one million cases per year in North America. Pertussis incidences among people aged 11 to 19 and those aged 20 or older were around 28 and 21 per 100,000 in 2013. Although there are few published data on vaccine uptake coverage by age, city, or state, state-by-state differences in pertussis prevalence among adolescents and adults have been observed.

For example, the incidence of pertussis increased in Massachusetts for ten years (1989–1998), with 92% of cases reported among adolescents and adults by 1998. Only 47% of cases in this age group were reported nationwide. The majority of cases reported during the 2014 pertussis outbreak in California were among adolescents aged 9 to 16, with whites being more affected than other racial/ethnic groups. Part of the rise in reported cases among adolescents and adults has been attributed to waning immunity that occurs several years after primary childhood immunization. Pertussis transmission among household contacts is likely to be aided by this waning immunity.

An old man coughing with one of his hand closing his mouth and the other hand to his chest
An old man coughing with one of his hand closing his mouth and the other hand to his chest

Transmission Dynamics Of Pertussis

Pertussis is a highly contagious disease that can spread quickly from person to person via airborne droplets. Both commensal bacteria and pathogens, such as B. pertussis, can colonize the human nasopharynx. Coughing or sneezing infected people produce pertussis-containing droplets. The basic reproductive number (R0) for various infectious diseases, including pertussis, has been calculated through studies of disease transmission. A confirmed primary case in a completely susceptible population produces R0 secondary cases. Pertussis is far more infectious than polio, smallpox, rubella, mumps, and diphtheria, according to R0 estimates.

How To Avoid Pertussis

Immunity

Pertussis immunity is not permanent, whether it is acquired through natural infection or vaccination. Natural pertussis infection provides protection for 3.5 to 30 years; whole-cell pertussis vaccine provides protection for 5 to 14 years, and acellular vaccine provides protection for 4 to 7 years. Adolescents and adults are susceptible to B. pertussis infection as their immune systems deteriorate over time. The length of time since their last B. pertussis vaccination or illness appears to be strongly linked to the severity of their illness.

In acellular pertussis vaccine trials involving adolescents and adults, IgG or IgA enzyme-linked immunosorbent assays (ELISAs) were used to measure antibody to PT, FHA, PRN, or FIM. Van der Wielen and colleagues tested the immunogenicity and safety of acellular pertussis vaccines in 299 adults in 2000. IgG antibody titers to PT, FHA, and PRN were 73.1%, 98.2%, and 74.5%, respectively, at baseline before vaccination. IgG titers to PT, FHA, and PRN were 96.8%, 100%, and 98.9%, respectively, one month after vaccine administration.

Vaccination And Prophylaxis For Outbreak Control

Current DTaP immunization guidelines for infants and children, as well as Tdap guidelines for older children, pregnant women, and adults, provide critical information on the use of pertussis-containing vaccines in outbreak-affected populations. Individual immunization histories should be reviewed whenever possible to identify children who may require additional vaccines, as well as adolescents and adults who may require their first or repeat Tdap doses. According to new guidelines for the use of Tdap in pregnant women, all pregnant women should have their immunization histories reviewed and a vaccine offered to protect both the mother and her baby during delivery.

A girl laying down coughing with one of her hand covering her mouth and a nurse beside her with one of her hand on the girl's forehead
A girl laying down coughing with one of her hand covering her mouth and a nurse beside her with one of her hand on the girl's forehead

People Also Ask

What Precautions Are Used For Pertussis?

The best way to prevent pertussis (whooping cough) among babies, children, teens, pregnant women, and adults is to get vaccinated. Also, keep babies and other people at high risk for pertussis complications away from infected people. Two vaccines in the United States help prevent whooping cough: DTaP and Tdap.

What Are The Risk Factors Of Pertussis?

Risk factors for pertussis include lack of immunization or impaired immune responses to vaccination. Laboratory studies suggest that immune responsiveness to pertussis vaccines may be impaired by both infection and intrauterine exposure to HIV even in HIV-uninfected children [8–11].

How Does Pertussis Spread?

How is pertussis spread? Pertussis bacteria are spread through droplets produced during coughing or sneezing. These droplets don't travel very far through the air and usually only infect persons nearby.

How Do You Treat Pertussis In Adults?

Several antibiotics are available to treat pertussis. The most popular are azithromycin, clarithromycin and erythromycin. If you have had pertussis for three weeks or more, antibiotics will not be prescribed because the bacteria are already gone from your body.

Conclusion

Over the last five years, large outbreaks of pertussis have been reported, and the disease's reemergence has sparked international interest in learning more about the pathogen's virulence and genetic evolution. Pertussis has been recognized in adults, infants, and children for the past 20 years by scientists. The need to better understand the role of innate, humoral, and cell-mediated immunity, including the role of waning immunity, has been highlighted by increased recognition that older children and adolescents are at risk for disease and may transmit B. pertussis to younger siblings.

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About The Authors

Dr. Cooney Blades

Dr. Cooney Blades

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