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pertussis
Bordetella pertussis
Dr.Aravind
Bordetella pertussis
Dr.Aravind
Virulent Factors
Adhesion:
Filamentous Haemagglutinin - Binds To Sulfatides Of Ciliated Cells. Pertussis toxin (B unit) Fimbreae Peractin
Exotoxins:
Invasive Adenylate cyclase toxin
Activated By Calmodulin Catalyses ATP To cAMP conversion Reduce Phagocytic Activity
Dr.Aravind
B Unit Binding
S2 Attaches To Lactosylceramide receptors Of Ciliated Cells S3 Attaches Glycoplipids receptors On Phagocytes S4 & S5 Unknown Receptors
Dr.Aravind
Tracheal Cytotoxin:
Cytotoxin Is A Peptidoglycan Fragment Binds To Ciliary Epithelial Cells Inhibits Ciliary Movement Kills Ciliary Epithelial Cells IL 1 Fever
Lipopolysaccharide:
Endotoxin In larger quantities, causes shock and cardiac arrest
Dr.Aravind
Epidemiology
Nasopharyngeal region Transmitted by droplet nuclei <1 year age group Now, no incidence because of vaccination Seen in adults (act as carriers)
Dr.Aravind
Pathogenesis
FHA, and Pertussis toxin
Pertussis toxin and Adenylate cyclase toxin destructs cells and signal transduction
Blood vessel
Dr.Aravind
Clinical features
Dr.Aravind
Stage
Length
Clinical Features
Stage 1: Catarrhal Usually 7-10 days; range of 4-21 Coryza Low-grade fever Mild, occasional cough (which gradually becomes more severe) Usually lasts 1-6 weeks, but may Paroxysms of numerous, rapid coughs due to difficulty Stage 2: persist for up to 10 weeks expelling thick mucus from the tracheobronchial tree. Paroxysmal Long aspiratory effort accompanied by a high-pitched "whoop" at the end of the paroxysms Cyanosis Vomiting and exhaustion Paroxysmal attacks: Occur frequently at night, with an average of 15 attacks per 24 hours. Increase in frequency during the first 1-2 weeks, remain at the same frequency for 2-3 weeks, and then gradually decrease. Usually 7-10 days; range of 4-21 Characterized by:Gradual recovery Stage 3: Less persistent, paroxysmal coughs that disappear in 2-3 Convalescent weeks Paroxysms often recur with subsequent respiratory infections Dr.Aravind for many months after the onset of pertussis.
Paroxysmal Stage
Catarrhal Stage
Dr.Aravind
Complications
In children: Pneumonia, seizures, encephalopathy 1% will die
In adults: Weight loss, Urinary incontinence, Syncope & Rib fractures from severe coughing
Dr.Aravind
Diagnosis
Specimens - Post / per nasal swab (no cotton swab) / cough plate
Culture Bordet Gengou Medium mercury drop pearl appearance
Treatment
Erythromycin Is The Drug Of Choice
Prevention
Vaccine Is Extremely Effective DTP Vaccine
Dr.Aravind