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GENUS BORDETELLAGENUS BORDETELLA

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Bordetella is a genus of small (0.2 - 0.7 µm), Gram-negative coccobacilli of the phylum proteobacteria. Obligate aerobes , non fermentative & highly fastidious. Three species are human pathogens B. pertussis, B. parapertussis, B. bronchiseptica); B. bronchiseptica is motile.

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B. pertussis and occasionally B. parapertussis cause pertussis. Some B. parapertussis strains can colonise sheep. B. bronchiseptica rarely infects healthy humans. It causes several diseases like kennel cough and atrophic rhinitis in dogs and pigs, respectively.

Causes several diseases in human and animals

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Obligate Obligate Aerobe.Aerobe.Fastidious.Fastidious.

Complex medium.Complex medium. ““Bordet – Gengou –Bordet – Gengou –

Glycerin – Potato Blood Glycerin – Potato Blood

Agar”.Agar”. Charcoal agar with Charcoal agar with

10% blood10% blood

Cultural charactersCultural characters

Can’t grow on Mac Can’t grow on Mac Conkey agar. Conkey agar.

Growth is slow (3 – 10 Growth is slow (3 – 10 days).Small, smooth, days).Small, smooth, dome shaped & opaque.dome shaped & opaque.

Viscid, grayish white and Viscid, grayish white and refractile.refractile.

Bisected pearls / Bisected pearls / Mercury drop.Mercury drop.

Confluent growth: Confluent growth:

“ “Aluminum paint” “Thumb print” appearance.

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Heat 55Heat 5500 C /30 minutes. C /30 minutes. Drying , disinfectants.Drying , disinfectants. Storage: At 0 – 4Storage: At 0 – 400 C. C. On dried droplets survive On dried droplets survive

upto Hours to days.upto Hours to days.

Non fermentor.Non fermentor. Biochemically Biochemically

inertinert Oxidase positive.Oxidase positive. Catalase positive.Catalase positive.

Survival conditions and Biochemical tests for identification

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1. Pertussis toxin:1. Pertussis toxin: Protein. M.W. 1,17,000 , A & B units.Protein. M.W. 1,17,000 , A & B units. Can be toxoided. Antibody is protective.Can be toxoided. Antibody is protective. Increased concentration of Increased concentration of cAMP cAMP in the in the

cell. cell. Lymphocytosis Lymphocytosis Increased sensitivity to histamine .Increased sensitivity to histamine . Islet cell activation Islet cell activation leads toleads to insulin secretion.insulin secretion. Hemaggulatinating property.Hemaggulatinating property.

Virulence factors contributing their Virulence factors contributing their pathogenesispathogenesis

Lipopolysacharide ,Activates the alternative pathway

of complement and release cytokines.

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Present on bacillary

surface.

Facilitates adhesion of

bacilli to ciliated columnar

epithelium of respiratory

tract.

Promotes secondary

infection

“Piracy of adhesions”

phenomenon.

2.Filamentous haemaggutinin:

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4. Invasive Adenylate cyclase:4. Invasive Adenylate cyclase: Responsible for hemolysis on blood agarResponsible for hemolysis on blood agar.. Activated by Activated by Calmodulin.Calmodulin. Release of cAMPRelease of cAMP..

5. Lethal toxin: 5. Lethal toxin: Inflammation & Necrosis.Inflammation & Necrosis.

6. Tracheal cytotoxin:6. Tracheal cytotoxin:

Normal product of breakdown of the Normal product of breakdown of the

cellwall.cellwall.

Induces production of IL-1 Induces production of IL-1 fever. fever.

Induces paralysis of ciliary escalator.Induces paralysis of ciliary escalator.

Inhibits DNA synthesis. Inhibits DNA synthesis.

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Pertussis An acute, highly contagious

respiratory pediatric disease. Source is patient in early stage Droplets, contaminated fomites. Incubation period is1 – 2 weeks. Onset is insidious.

Pathogenesis: They share everything including Bordetella

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1.Catarrhal stage:1.Catarrhal stage:

Stage of infectivity.Stage of infectivity.

Like common cold.Like common cold.

Low grade fever, running Low grade fever, running

nose, nasal congestion, nose, nasal congestion,

Sneezing.Sneezing.

Dry irritating cough.Dry irritating cough.

Clinical diagnosis difficult.Clinical diagnosis difficult.

Respond to antibioticsRespond to antibiotics. .

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2. 2. Paroxysmal phaseParoxysmal phase

•Bouts (paroxysms) of Bouts (paroxysms) of

coughing:coughing:

At the end of each boutAt the end of each bout a a

long inspiratory effort is long inspiratory effort is

usually accompanied by a usually accompanied by a

characteristic high-pitched characteristic high-pitched

sound sound “whoop”.“whoop”. •Duration of this stage is 1 Duration of this stage is 1

– 6 weeks.– 6 weeks.((Due to difficulty in expelling thick mucus from the airways in the

lungs. More in first 1-2 wks. and constant for another 2 wks).

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•During an attack,During an attack, the the

individual may become individual may become

cyanoticcyanotic due to lack due to lack

of of oxygenoxygen..

•Children and young Children and young

infantsinfants appear especially appear especially

ill and distressed.ill and distressed. Conjunctival hemorrhages &cyanotic patches on the face

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Convalescent stage (Recovery Convalescent stage (Recovery stage)stage)

3 – 4 weeks after an acute illness paroxysms are 3 – 4 weeks after an acute illness paroxysms are decreased.decreased.

Complications:Complications: Subconjunctival & Subconjunctival & Cerebral hemorrhage.hemorrhage. Subcutaneous emphysema.Subcutaneous emphysema. Bronchopneumonia & Lung collapse. Convulsions due to permanent brain damage. Anoxic encephalopathy. Developmental retardation

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Epidemiology:Epidemiology: Most infectious,air borne bacterial Most infectious,air borne bacterial

disease.disease. No reservoir. Chronic carrier state not No reservoir. Chronic carrier state not

seen.seen. World wide (600,000 million cases World wide (600,000 million cases

annually). annually).

6,00,000 deaths occurs in epidemics.6,00,000 deaths occurs in epidemics. Prominent in infants and children.Prominent in infants and children. In adolescents & adults presentIn adolescents & adults present

atypically as bronchitis.atypically as bronchitis.

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Lab diagnosis :Lab diagnosis :

1. Demonstration of antigen:1. Demonstration of antigen:

Nasopharyngeal secretions.Nasopharyngeal secretions.

By using calcium alginate /Dacron swabBy using calcium alginate /Dacron swab

Urine and Serum.Urine and Serum.

Immunofluorecent method.Immunofluorecent method.

False positive :False positive :

Staphylococci, Yeasts,Staphylococci, Yeasts,

Hemophilus, Moraxella. Hemophilus, Moraxella.

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3. Culture 3. Culture Best in early stages of disease.Best in early stages of disease.

No use with Transport medium.No use with Transport medium.

Requires 3 -10 days.Requires 3 -10 days.

Specimens:Specimens:

1. Cough plate method:1. Cough plate method:

2. Per oral swab:2. Per oral swab:

secretions from secretions from

posterior pharyngeal wall.posterior pharyngeal wall.

3. Per nasal swab: Better.3. Per nasal swab: Better.

With highest yieldsWith highest yields..

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2. Demonstration of antibody (late).2. Demonstration of antibody (late).

Serum, Nasopharyngeal secretions ( Ig A).Serum, Nasopharyngeal secretions ( Ig A).

Useful for retrospective diagnosis.Useful for retrospective diagnosis.

Increased antibody titer.Increased antibody titer.

Method:Method: Agglutination, Agglutination, ELISA. ELISA.

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IgM and IgAIgM and IgA antibodies antibodies are diagnostic. are diagnostic. Early/acute infection and Early/acute infection and followed by vaccination.followed by vaccination.

PCR testing:PCR testing: Quite Quite

sensitive. (Be aware of sensitive. (Be aware of cross reaction with cross reaction with Bordetella holmesii.)Bordetella holmesii.)

CBC :CBC : Elevated WBC Elevated WBC count with count with lymphocytosis.lymphocytosis.

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Specific immunization:Specific immunization:

Killed vaccine ( smooth phase I strain)Killed vaccine ( smooth phase I strain)

(Detoxication with 0.2% (Detoxication with 0.2% merthiolate)merthiolate)..

Types:Types:

1. Whole cell vaccine.1. Whole cell vaccine.

2. Acellular vaccine for below 7 yrs age2. Acellular vaccine for below 7 yrs age

protective components.protective components.

(PT + FHA + Factors 1,2,3)(PT + FHA + Factors 1,2,3)

Prevention of spreading and Prevention of spreading and Vaccine availabilityVaccine availability

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Available as:Available as:

1. Plain vaccine1. Plain vaccine

2. Alum absorbed vaccine PT2. Alum absorbed vaccine PT

3. Triple vaccine DPT or DTaP3. Triple vaccine DPT or DTaP

Dosage:Dosage:

‘‘3’ injections IM at 4 – 6 weeks.3’ injections IM at 4 – 6 weeks.

11stst dose at the age of 2 months. dose at the age of 2 months.

Vaccination is safe with protection rate Vaccination is safe with protection rate

of 90%.of 90%.

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Local soreness , fever , Local soreness , fever ,

shock, Convulsions, shock, Convulsions,

encephalopathyencephalopathy Provocate the Provocate the

poliomyelitis.poliomyelitis.

Contra indicated Contra indicated

incase of severe side incase of severe side

effects with previous effects with previous

dose.dose.

Side effects followed by vaccination

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•Erythromycin for 14

days.

•Cough suppressants.

•Corticosteroids.

•Pertussis immunoglobulins

:Limited success

Treatment for acute case

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During epidemics:During epidemics: Immunization is not 100% Immunization is not 100%

effective and slowly becomes effective and slowly becomes less effective.less effective.

Health care providers, Health care providers, adolescents & others at risk are adolescents & others at risk are advised to receive a booster advised to receive a booster dose.dose.

Un immunized children < 7 yrs Un immunized children < 7 yrs should be excused from school should be excused from school and public gatherings for 14 and public gatherings for 14 days.days.

Health warning Health warning announcements.announcements.

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PREVENTIVE MEASURES

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Created by

Dr P.S.Reddy MDProfessor, Dept. of Microbiology

Narayana Medical College,

Nellore AP, INDIA

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