A Tribute to Bordet - Gengou

1. A Tribute to Bordet - Gengou

2. Jules Bordet and Gengou contributed for discovery 1900 Bodetella pertussis ( Intense cough ) Other related Bacteria B.parapertussis B.brochoseptica B.avium Bordetella

3. 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

4. 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

5. 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.

6. 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.

7. 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

8. Aluminum paint appearance • Colonies surrounded by hazy zone of hemolysis • Confluent growth presents as aluminum paint.

9. Biochemical Reactions • In active – do not ferment sugars • Indole test + • Reduce Nitrates • Utilize citrates • Splits urea • Catalase +ve • Oxidase +ve

10. Pertussis: virulence factors

11. Pertussis Toxin Adenylate Cyclase Toxin Tracheal cytotoxin Dermonecrotic toxin Heat-labile toxin Toxins

12. Filamentous hemagglutinin Pertactin Fimbriae Adhesions

13. 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)

14. Invasive toxin Activated by host cell calmodulin Impairment of immune effector cells Adenylate Cyclase Toxin

15. Pertussis Tracheal Toxin • A Peptidoglycan-like molecule • Binds to ciliary epithelial cells • Inhibits ciliary movement • Kills ciliary epithelial cells Causes Pertussis

16. Pertussis: dermonecrotic toxin • Strong vasoconstrictor • Causes ischemia • Synergizes with tracheal toxin to causes tracheal necrosis

17. Pertussis: filamentous haemagglutinin • Causes binding of bacteria to ciliated epithelial cells

18. B. pertussis: Lipopolysacchride • Activates inflammatory cytokines • Activates complement • In larger quantities, causes shock and cardiac arrest

20. 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. Whooping cough

21. Whooping cough causes uncontrollable coughing. The name comes from the noise patient makes when he takes a breath after severe cough. How the name Whooping derived

22. 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 Epidemiology

23. Whooping cough stages

24. 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. Paroxysmal Stage

25. Violent Paroxysms of cough

26. Violent Paroxysms of cough

27. ComplicationsCan you guess ?? b. a. c.

28. The violent bouts of cough leads to Subconjuctival hemorrhage Subcutaneous emphysema Bronchopneumonia Lung collapse Neurological complications Epilepsy, paralysis, mental retardation, blindness, deafness. Complications

29. 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

30. 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.

31. 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 Cough Plate Method

32. Cough Plate Method

33. Microscopy Culture. Microscopy – Demonstration of Bacilli in respiratory secretions. Fluorescent Antibody methods Laboratory Diagnosis

35. Paired serum sample for detection of antibodies Gel precipitation testing Complement fixation test Detection of Ig A by ELISA from nasopharyngeal secretions. Serology

36. Early Immunization is best solution to prevent the Pertussis Prophylaxis

37. 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. Prophylaxis

38. 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 Booster doses

39. An acellular vaccine containing whole antigen good antibody response with fewer side effects than the traditional "whole cell" version. Advantages of Acellular Vaccine

40. Bordetella bronchiseptica Motile – peritrichate flagella 0.1% – whooping cough Pneumonia – immunocompromised Rx – Ceftazidime/Ciprofloxacin B. parapertussis – infrequent whooping cough – pertussis vaccine no protection