Pertussis pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

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Overview

Pertussis is primarily a toxin-mediated disease caused by the bacterium Bordetella pertussis. The bacteria attach to the cilia of the respiratory epithelial cells, produce toxins that paralyze the cilia, and cause inflammation of the respiratory tract, which interferes with the clearing of pulmonary secretions. Until recently, it was thought that Bordatella pertussis did not invade the tissues; however, recent studies have suggested that the bacteria are present in alveolar macrophages.

Pathophysiology

• Pertussis is an acute infectious disease caused by the bacterium Bordetella pertussis. Bordetella pertussis is a fastidious, gram-negative bacterium requiring special media for isolation. Bordetella pertussis produces multiple antigenic and biologically active products responsible for the clinical features of pertussis and an immune response to one or more produces immunity following infection. These products include:
  • Pertussis toxin
  • Filamentous hemagglutinin (FHA)
  • Agglutinogens
  • Adenylate cyclase
  • Pertactin
  • Tracheal cytotoxin

• Humans are the only reservoir for Bordatella pertussis, and the incubation period varies from 1 to 3 weeks, and is usually about 10 days. Although asymptomatic carriers have been reported, they have a low probability of transmitting the disease as they are not actively coughing. Pertussis is highly contagious, and highest rates of transmission occurs with exposure to the infected individual at 5 feet or less.

• Infection occurs through direct contact with the aerosolized mucus of infected persons, usually during coughing and sneezing. The bacterium adheres to the ciliated epithelium of the nasopharynx and proliferates in the lower respiratory system. In addition, the bacterium produces toxins that paralyze the cilia, and cause inflammation of the respiratory tract, which interferes with the clearing of pulmonary secretions.

• In a small number of cases, the bacteria may move further to the pulmonary alveoli, causing Bordatella pneumonia. The bacteria does not however cross the respiratory epithelium to the bloodstream, and therefore sepsis is not seen.