(2nd shifting) Lec 3: Bordetella by Maria Cielo B.

Malihan, MD, DPPS, FPSDBP August 13, 2010

 Glucose and lactose- (+) acid former, (-) gas

OUTLINE
A. Cultures
 Does not require X and Y factors
I. Bordetella species that cause diseases in humans
II. Bordatella species of clinical importance  Virulent B. Pertussis – can hemolyse red blood cells in media
III. Bordatella Pertussis  Media of choice – Bordet Gengou medium (potato-blood-glycerol
A. Culture media) that contains penicillin G
B. Variations  Charcoal-containing media is preferred
C. Epidemiology  Conditions: 35-37C for 3-7 days in a moist environment
D. Determinants of Pathogenicity
1. Pertussis Toxin (pertussigen)
2. Hemagglutinin
3. Adenylate cyclase
4. Dermonecrotic Toxin
5. Lipopolysaccharide
6. Tracheal toxin
7. 69 kDa Outer membrane protein
8. Pili
E. Couse of the disease
F. Diagnosis
G. Immunity
H. Treatment
I. Prophylaxis
J. Prevention
IV. Bordetella parapertussis
V. Bordetella bronchiseptica
small, transparent hemolytic colonies (“mercury drop” or “pearl colonies”)
I. BORDETELLA SPECIES THAT CAUSE DISEASES IN HUMANS
B. Variations
VIRULENT FORM AVIRULENT FORM
Glad Nickay Ricobear Teacher Dadang Niňa Arlene Vivs Paulfie Rico Ren Mai Revs Mavis Jepay Yana Mayi

 When isolated from  Non-hemolytic

patients and cultured  Non-toxin producing
on enriched media  Due to low frequency
B. pertussis Pertussis  Causes hemolysis in mutation in the genes
red blood cells  Under certain
B. parapertussis Similar illness as pertussis
 Produces pertussis environmental conditions
B. bronchiseptica (bronchicanis) Respiratory illness, bacteremia
toxin
B.hinzii
B. holmseii Bacteremia in
C. Epidemiology
immunocompromised patients
 Pertussis is a disease mainly of children
B. trematum Wound, otitis media
 Highly communicable

II. BORDETELLA SPECIES OF CLINICAL IMPORTANCE

 B.pertussis
 B.parapertussis
 B. Bronchiseptica

Organism Biochemical Tests

Oxidase test Urease test
B. pertussis + -
B. parapertussis - +
B. bronchoseptica + +

III. BORDETELLA PERTUSSIS

 Causes whooping cough
 Gram (-) coccobacillus D. Determinants of Pathogenicity
 Capsulated
Serge Hung Tope Ag

 Strictly aerobic 1. Pertussis Toxin: Histamine Sensitizing Factor (HSF), Lymphocytosis

 Non-motile Promoting Factor (LPF), and Islet Activating Factor (IAF)
 (+) bipolar metachromatic granules on toluidine staining  Exotoxin
 An AB-toxin, oligopeptide

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  Increases histamine and LPS sensitivity  Inibits non-ciliated cell differentiation, hindering the repair of the
 Increases IgE levels mucosa
 T-cells lymphocytes
 Impairs phagocyte function 7. 69 kDa Outer Membrane Protein
 Responsible for paroxysmal coughing  Adherence of the bacteria to the ciliated epithelial cells
 Enhanced insulin secretion
 ADP-riosylates the GI protein (results in increased cAMP, the 8. Pili
effects similar to that of cholera toxin)  Adherence of the bacteria to the ciliated epithelial cells

2. Hemagglutinins E. Course of the disease

 2 types
o Filamentous protein (FHA or TOX) – for adherence of the
organism
o Pertussis Toxin-Hemagglutinin (TOX-HA) – adherence of
toxins to cells, leukocytesosis-promoting factor
 Can enhance the adherence of other respiratory pathogens (H.
influenzae, St. pneumoniae)

 The bacteria survives briefly outside the human host

 Attachement to ciliated respiratory epithelial cells due to: F-HA,
PT, 69 kDa protein
 Mode of transmisison: respitratory route (droplet), no vectors
B. pertussis: interaction with pneumocyte  Source: cases and carriers
 Organism attaches to epithelial surfaces of trachea and bronchi
3. Adenylate Cyclase  Most deaths occur in infants under one year of age
 Exotoxin  B. Pertussis is a common cause of prolonged cough (4-6 weeks)
 Hemolysin that produces pores in red blood cells in adults
 Activated by calmodulin  INCUBATION :
 Catalyses ATP to cAMP conversion o Duration: 7-10 days
 Impairs normal phagocytic function (chemotaxis) o Symptoms: none
 Activated by calmodulin  CATARRHAL:
o During the catarrhal stage, the patient is infectious but not very
ill
o Duration: 1-2 weeks
o Symptoms: rhinorrhea, malaise, fever, sneezing, anorexia
o Multiplication of bacteria on the epithelial surface of the
trachea and bronchi and interferes with ciliary action
o No bacteremia
 PAROXYSMAL:
o Duration: 2-4 weeks
o Symptoms: repetitive cough with whoops, vomiting,
Pertussis: adenylate cyclase toxin leukocytosis
o Toxins irritate surface cells
4. Dermonecrotic Toxin (heat labile toxin) o Rapid exhaustion, vomiting, cyanosis
 Strong vasoconstrictor o Infants: whoop and complications
 Causes ischemia o Children: paroxysmal coughing
 Synergizes with tracheal toxin  causes tracheal necrosis o 5-20 forcible hacking coughs in 15-20 seconds
o Necrosis of epithelial cells with PMN infiltration and
5. Lipopolysaccaharide (heat –stable endotoxin)
peribronchial inflammation
 Activates inflammatory cytokines
 CONVALESCENT:
 Activates complement
o Duration: 3-4 weeks (or longer)
 In larger quantities  causes shock and cardiac arrest
o Symptoms: diminshed paroxysmal cough, development of
secondary complications (pneumonia, seizures,
6. Tracheal Toxin
encephalopathy)
 A peptidoglycan-like molecule
o Secondary bacterial infection from H. influenzae and
 Inhibits DNA synthesis
Staphylococcus species
 Binds to ciliary cells, inhibits ciliary movement, kills ciliary o Atelectasis due to obstruction of smaller bronchioles by mucus
epithelial cells  causes pertussis
plugs

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 o Encephalitis is rare o Oxygen inhalation and sedation may prevent anoxic damage to the
F. Diagnosis brain
 Cultures:
o Isolation best in the catarrhal stage
o Specimen: V. BORDETELLA BRONCHISEPTICA
 Saline nasal wash – preferred specimen  Small, gram (-) bacilli
 Nasopharyngeal swab  Inhabits the respiratory tract in canines
 Coughing on the plate  May cause chronic respiratory infections in humans with underlying
o Culture on Bordet-Gengou medium (potato-glycerol-blood diseases
agar medium)
o Antibiotics in the media inhibit other respiratory flora but ---------------------------end of trans--------------------------
permitting the growth of the organism
o Can perform immunofluorescence staining or by slide
Detox muna ng mas toxic na sodoku..
agglutination
 Direct Microscopic Examination (FA)
o Less sensitive
 Polymerase Chain reaction
o The most sensitive method for diagnosis
o If available, the PCR test should replace direct flourescent
antibody test
 Serology
o Of little help
o Rise in antibody titers occur until the third weed of illness
o Titers do not correlate with immune status

G. Immunity
 Immunity follows:
o Infection
o Vaccination
 Second infection-mild
 Reinfection in occuring years later as adults may be severe
 Defense: antibody prevents attechment of the bacteria to the cilia
of the respiratory epithelium

H. Treatment
 Erythromycin is the drug of choice
o Catarrhal stage – promotes the elimination of the organisms
and may have propylactic value
o Shortens period of communicability
o If given during paroxysmal stage – rarely alters the clinical
course
 Supportive measures:
o Suctioning
o Hydration
o Nutrition
o Electrolyte balance
o Oxygen inhalation and sedation may prevent anoxic damage
to the brain

I. Prophylaxis
 Erythromycin for 5 days
 Booster dose after exposure

J. Prevention
 Vaccine is extremely effective
 3 doses of pertussis vaccine during the first year of life followed
by booster series for a total of 5 doses
 Acellular vaccine (pertussis toxin, filamentous hemagglutinin,
fimbrial proteins and 69 kDa protein or pertactin
 The same product should be used throughout the immunization
series

IV. BORDETELLA PARAPERTUSSIS

 Causes disease similar to pertussis but generally less severe
 Infection is subclinical

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