Medicine & USMLE

Bordetella pertussis

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Bacteria - Gram Negative
  1. Neisseria spp: Overview
  2. Neisseria gonorrhoeae
  3. Neisseria meningitidis
  4. Haemophilus influenzae
  5. Bordetella pertussis
  6. Brucella
  7. Legionella pneumophila
  8. Pseudomonas aeruginosa: Overview
  9. Pseudomonas aeruginosa: Disease
  10. Salmonella Overview
  11. Salmonella typhi
  12. Salmonella enteritidis
  13. Shigella
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  15. Escherichia coli: Overview
  16. Enterohemorrhagic E. Coli (EHEC)
  17. Enterotoxigenic E. Coli (ETEC)
  18. Klebsiella pneumoniae
  19. Campylobacter jejuni
  20. Vibrio spp.
  21. Helicobacter pylori
  22. Borrelia burgdorferi (Lyme Disease)
  23. Leptospira interrogans
  24. Treponema pallidum: Overview
  25. Treponema pallidum: Diagnosis
  26. Congenital syphilis
  27. Chlamydia: Overview
  28. Chlamydia trachomatis
  29. Chlamydia pneumoniae vs. psittaci
  30. Rickettsia rickettsii
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  32. Anaplasma vs. Ehrlichia
  33. Coxiella burnetii (Q fever)

Bordetella pertussis

  • Characteristics
    • Gram negative coccobacillus
    • Aerobic
      • Colonizes mucosal surfaces with high oxygen content (e.g. lungs, airway)
  • Virulence factors
    • Pertussis toxin (an exotoxin)
      • activates adenylate cyclase by inhibiting Gi 
        • Increased intracellular cAMP leads to increased secretion of sodium, chloride, and water (edema), which impairs phagocytosis, allowing the bacteria to survive
      • Similar mechanism to Bacillus anthracis edema factor 
    • Tracheal cytotoxin  
      • Kills epithelial cells (cytotoxin) in airways, which impairs mucociliary escalator from clearing respiratory secretions
  • Disease
    • Infants are especially at risk
      • <6 months old – too young to vaccinate
      •  Unvaccinated children
    • 3 stages
      • Catarrhal
        • low-grade fevers and runny nose (coryza)
      • Paroxysmal
        • Causes whooping cough
          • paroxysms of intense cough followed by inspiratory “whoop” (gasp for air)
          • Technically a form of acute bronchitis
          • Severe coughing may cause vomiting (posttussive emesis)
      • Convalescent
        • Gradual recovery of bronchitis and cough
  • Prevention
    • Tdap, DTaP vaccines
      • The acellular pertussis vaccine currently available in the U.S. contains purified components of Bordetella pertussis and detoxified pertussis toxin (toxoid)
  • Diagnosis
    • Bordetella PCR and serology is the gold standard
      • Unlikely to be tested, given that this is too obvious
      • requires nasopharyngeal secretions on a special swab, as the bacteria will not grow on cotton
    • Culture in Bordet-Gengou agar
    • Modified Regan-Lowe medium selective for Bordetella
    • May be mistaken as viral infection due to lymphocytic infiltrate resulting from immune response
  • Treatment 
    • Macrolides
      • TMP-SMX may be used if allergic to macrolides