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A Tribute to Bordet - Gengou
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Bordetella
• Jules Bordet and Gengou contributed for
discovery 1900
• Bodetella pertussis ( Intense cough )
• Other related Bacteria
B.parapertussis
B.brochoseptica
B.avium
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Bordetella pertussis ( B G bacillus )
• Gram negative
organism
• Small, ovoid,
coccobacillus.
• Length is 0.5 microns
• Have bipolar
metachromatic
granules when stained
with Toluidine blue
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Bodetella pertussis ( B G bacillus)
• Small ovoid
coccobacillus
• On repeated cultures
becomes become
larger thread like
bacilli.
• Non motile, Non
sporing
• Capsulated – loose on
repeated culturing
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Other characters
• Do not swell in the
presence of antigen.
• Loose clumps of
bacilli appear as
thumb print
appearance with clear
space between the
organisms.
• Freshly isolated
strains have fimbria.
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Culture Characters
• Aerobic
• Grows optimally at 350 to 370 c
• Preferred medium – Bordet Gengou glycerin
potato blood agar
• Blood for neutralizing inhibitory substances
formed during bacterial growth.
• Charcoal also serves the same purpose.
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Mercury Drop colonies on
Bordet- Gengou Medium
• Growth takes longer up
to 48 – 72 hours
• On blood agar appear
as small dome shaped
opaque viscid grayish
white refractile
• Resembles bisected
pearly or mercury
drops
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Aluminum paint appearance
• Colonies surrounded by hazy zone of
hemolysis
• Confluent growth presents as
aluminum paint.
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Biochemical Reactions
• In active – do not
ferment sugars
• Indole test +
• Reduce Nitrates
• Utilize citrates
• Splits urea
• Catalase +ve
• Oxidase +ve
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Pertussis: virulence factors
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Toxins
Pertussis Toxin
Adenylate Cyclase Toxin
Tracheal cytotoxin
Dermonecrotic toxin
Heat-labile toxin
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Adhesions
Filamentous hemagglutinin
Pertactin
Fimbriae
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Pertussigen
(an AB-toxin, oligopeptide)
•
Increases histamine and LPS sensitivity
•
Increases IgE levels
•
T-cell lymphocytosis
•
Impairs phagocyte functions
•
ADP- ribosylates the Gi protein
(results in increased cAMP)
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Adenylate Cyclase Toxin
• Invasive toxin
• Activated by host cell calmodulin
• Impairment of immune effector cells
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Pertussis Tracheal Toxin
• A Peptidoglycan-like molecule
• Binds to ciliary epithelial cells
• Inhibits ciliary movement
• Kills ciliary epithelial cells
Causes Pertussis
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Pertussis: dermonecrotic toxin
• Strong vasoconstrictor
• Causes ischemia
• Synergizes with tracheal toxin to causes
tracheal necrosis
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Pertussis: filamentous haemagglutinin
• Causes binding of bacteria to ciliated
epithelial cells
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B. pertussis: Lipopolysacchride
• Activates inflammatory cytokines
• Activates complement
• In larger quantities, causes shock and
cardiac arrest
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Whooping cough
• Whooping Cough (Pertussis) is a very
contagious disease which causes coughing
with little or no fever. The coughing may be
so severe that it leads to vomiting and
aspiration.
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How the name Whooping
derived
• Whooping cough causes uncontrollable
coughing. The name comes from the noise
patient makes when he takes a breath after
severe cough.
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Epidemiology
• Predominately a pediatric disease
• Highest in the 1st year of life
• Maternal antibodies are not protective.
• In early stage of infection droplets and fomites
contaminated by oropharengeal secretion are
infective.
• Non immune rarely escape infection
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Whooping cough stages
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Paroxysmal Stage
• Cough increases – distinctive bouts
• Violent spasms of continuous coughing
• With violent act of cough, air enters into
empty lung with characteristic whoop
Enters into next stage
• Leads to convalescence
• And severity of cough decreases
• Total disease lasts for 6- 8 weeks.
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Violent Paroxysms of cough
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Complications
Can you guess ??
b.
a.
c.
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Complications
• The violent bouts of cough leads to
Subconjuctival hemorrhage
Subcutaneous emphysema
Bronchopneumonia
Lung collapse
Neurological complications
Epilepsy, paralysis, mental retardation,
blindness, deafness.
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Diagnosis
• SPECIMEN:
• Cough plate method, post nasal/per oral
swab – West’s post nasal swab, per nasal
swab – Dacron/calcium alginate
• Transport medium – modified Stuart’s
medium, Mischulow’s charcoal agar
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Specimen collection
• Secretions from the nose or
throat
• Secretion from the posterior
pharyngeal wall are
collected with cotton swab
on a bent wire passed from
the oral cavity
• A West’s post nasal swab is
used for collection of
specimen.
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Cough Plate Method
• Culture plate held at 10-15 cm infront of
the mouth when the patient is coughing
spontaneously or induced cough
• Droplets of respiratory exhaled impinge on
the media.
• Helpful as bed side investigation
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Cough Plate Method
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Laboratory Diagnosis
• Microscopy
• Culture.
• Microscopy – Demonstration of Bacilli in
respiratory secretions.
• Fluorescent Antibody methods
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Serology
• Paired serum sample for detection of
antibodies
• Gel precipitation testing
• Complement fixation test
• Detection of Ig A by ELISA from
nasopharyngeal secretions.
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Prophylaxis
Early Immunization is best solution to
prevent the Pertussis
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Prophylaxis
• Alum absorbed vaccine is better
• Administered in combination with Diphtheria,
and tetanus toxoid
• B pertussis acts as an adjuvant
• Doses are given at the interval of 4 – 6 weeks
intervals, before 6 months, 3 doses are
completed.
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Booster doses
• A booster at the end of the 1st year
• Another dose at 4th year
• Complications with vaccination
Post vaccinial encephalopathy
5 – 10 million doses
Neurotic complications
Stop further vaccination
Do not vaccinate after 7 years
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Advantages of Acellular Vaccine
• An acellular vaccine containing whole antigen
• good antibody response with fewer side
effects than the traditional "whole cell"
version.
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Bordetella bronchiseptica
• Motile – peritrichate flagella
• 0.1% – whooping cough
• Pneumonia – immunocompromised
• Rx – Ceftazidime/Ciprofloxacin
• B. parapertussis – infrequent whooping
cough – pertussis vaccine no protection
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