Whooping cough

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Pertussis, also known as whooping cough, is a highly contagious disease spread by the bacteria. B. pertussis - a small, aerobic gram-negative rod. B. pertussis produces:

At one time it was considered a childhood disease.  Now however, there has been a general shift in the age distribution of pertussis toward older groups.

It has been around a very long time.  The earliest mention of pertussis, or whooping cough, is of an outbreak in Paris in 1414. This was published in Moulton’s The Mirror of Health, in 1640. Another epidemic of pertussis took place in Paris in 1578 and was described by a contemporary observer, Guillaume de Baillou.

Bahaodowle Razi, a Persian physician from the 15th century (AD), also reported two epidemics in Harat and one in Rey (in old Persia). He named it as Sorfe-ie-Am (meaning public cough).

 Pertussis was well known throughout Europe by the middle of the 18th century. Jules Bordet and Octave Gengou described in 1900 the finding of a new “ovoid bacillus” in the sputum of a 6-month-old infant with whooping cough. They were also the first to cultivate Bordetella pertussis at the Pasteur Institute in Brussels in 1906.

Symptoms

Whooping cough is an airborne disease which spreads easily through the coughs and sneezes of an infected person. People are infectious to others from the start of symptoms until about three weeks into the coughing fits.  The period of time between infection and the onset of symptoms is usually seven to ten days. It is rarely as long as 42 days.

• First stage - Initially, symptoms are similar to those of the common cold with a runny nose, fever, and mild cough.
• Second stage - This is then followed by weeks of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person tries to inhale. 
  The cough may cause fainting, or vomiting after coughing. The cough from pertussis has been documented to cause “subconjunctival haemorrhages, rib fractures, urinary incontinence, hernias, and vertebral artery dissection.” Violent coughing can cause the pleura to rupture, leading to a pneumothorax.
  Fits can occur on their own or can be triggered by yawning, stretching, laughing, eating, or yelling; they usually occur in groups, with multiple episodes on an hourly basis throughout the day or night. This stage usually lasts two to eight weeks, or sometimes longer.
• Third stage - A gradual transition then occurs to the convalescent stage, which usually lasts one to two weeks. This stage is marked by a decrease in paroxysms of coughing, both in frequency and severity, and a cessation of vomiting. A tendency to produce the "whooping" sound after coughing may remain for a considerable period after the disease itself has cleared up.

Thus this period of coughing fits may last for 10 or more weeks, hence the phrase "100-day cough".

Common complications include pneumonia, encephalopathy, earache, and seizures. Most healthy older children and adults fully recover, but those with comorbid conditions have a higher risk of morbidity and mortality.

Children less than one year old may have little or no cough and instead have periods where they cannot breathe.  Pertussis can cause severe paroxysm-induced cerebral hypoxia, and 50% of infants admitted to hospital suffer apneas.  Many children less than a year of age require hospitalization. Infection in newborns is particularly severe.

Pertussis is fatal in an estimated 1.6% of hospitalized US infants under one year of age. First-year infants are also more likely to develop complications, such as: pneumonia (20%), encephalopathy (0.3%), seizures (1%), failure to thrive, and death (1%).

Diagnosis

 Diagnosis is by collecting a sample from the back of the nose and throat. This sample can then be tested by either culture or by polymerase chain reaction.

Cause

Pertussis is theoretically caused by the bacterium Bordetella pertussis.  But as we have seen above there are two stages of infection, with the second stage being much the nastiest part.  The bacteria can be recovered from the person only during the first three weeks of illness, rendering culturing and DFA useless after this period.  So from this we can deduce that the body may actually be capable of fighting the bacteria, eradicating it from the system.  Another clue, this time from Wikipedia.  According to Wikipedia “antibiotics may be used if started within three weeks of the initial symptoms, but otherwise have little effect in most people.”

Now perhaps they are ineffective because after that time the body has defeated the bacteria and is now having to compete with something far more nasty – and what that something is may be a virus.

It has long been known that Bordetella pertussis can harbour bacteriophage.  Bacteriophage are viruses that use the host bacteria like a Trojan horse to enter another host.  They are extremely tiny, very difficult as a consequence to detect:

Bordetella pertussis bacteria are not 'friendly' bacteria, but on the other hand they are nowhere near as nasty as the phages they appear to harbour:

So there are a number of different types of bacteriophage that have used his bacteria and they do not harm their bacterial host.  Furthermore they are capable of living autonomously – in us for example.

 

Bordetella toxins

In other words one of the characteristics of the Bordetella pertussis is that it releases toxins.

One difference between the different species of Bordetella is that B. pertussis produces PT and the other species do not. Bordetella parapertussis shows the most similarity to B. pertussis and was therefore used for research determining the role of PT in causing the typical symptoms of whooping cough. Rat studies showed the development of paroxysmal coughing, a characteristic for whooping cough, occurred in rats infected with B. pertussis. Rats infected with B. parapertussis or a PT-deficient mutant of B. pertussis did not show this symptom; neither of these two strains produced PT.

So one effect of the toxin is hypoglycaemia – low blood sugar in simple terms.  The overall effect of this is that we will be exhausted and all we will want to do is lie down and go to sleep.

The toxin also modifies our immune system response and causes a very large increase in lymphocytes.  A lymphocyte is one of the subtypes of white blood cell in a vertebrate's immune system. They include natural killer cells (NK cells) (which function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic adaptive immunity), and B cells (for humoral, antibody-driven adaptive immunity). They are the main type of cell found in lymph, which prompted the name lymphocyte.

PT is also able to cross the blood–brain barrier by increasing its permeability.  There is more

But we also find that …………….

Put simplistically it fights some viruses.  Superficially it appears to produce activities that guarantee its own survival long enough to release the toxins needed.  In effect it inhibits our immune response to it, but not to the viral pathogens.  All of which appear to point to an almost beneficial role for the toxin if the objective is to help fight viruses, including the phage viruses with which it is infected.

This leads one to ask the question is it really a toxin?

If the damage done is via the phages, then perhaps the toxin is being released by the bacteria to help us fight the phages.  This is pure hypothesis, but the toxin released appears to act in our defence, not against us.  If we lie down exhausted and sleep, the immune system can get to work, and if it results in the increase in lymphocytes, then these may be the troops needed to fight the phages – or even other viruses.

Prevention

Vaccination - The strategy used by the medical profession to combat whooping cough is prevention by vaccination with the pertussis vaccine.  Initial immunization is recommended between six and eight weeks of age, with four doses to be given in the first two years of life.

In other words, immunization does not confer lifelong immunity; furthermore, a 2011 CDC study indicated that protection may only last three to six years. Infection induces incomplete natural immunity that wanes over time.  The paper above also seems to imply that those who have been vaccinated stand a greater chance of catching the disease as their immunity fades, than those who have not been vaccinated.

It is as if Nature was trying to make sure we had the disease – however bizarre this may sound.

Antibiotics – the second part of the strategy used by the medical profession is the use of antibiotics

Despite this, reported fatalities from pertussis in infants increased substantially from 1990-2010.

Epidemiology

The World Health Organization recommended some while back, that a pertussis incidence of <1 case per 100,000 population be achieved in Europe by 2000. Available data indicate that this goal was not achieved, and the incidence is actually rising in some countries.

Although attempts are made to monitor the incidences of the disease, different case definitions, methods of diagnosis and reporting and surveillance systems make direct intercountry comparisons difficult, and pertussis is not a statutory notifiable disease in every country. Nevertheless the general consensus is that reported incidences are probably considerably lower than the actual incidence of pertussis; underreporting is common.

Prolonged cough may be the only clinical feature in adolescents or adults, who may present for diagnosis late (precluding laboratory confirmation) or not at all. When they do present, their condition is often misdiagnosed because, in part, clinicians continue to perceive pertussis as a childhood disease.

The consensus appears to be that despite generally high coverage with the DTP and DTaP vaccines, the incidence is increasing in the USA, Australia, Canada and Europe, possibly worldwide.

All sorts of figures appear to be flying around about the incidence of the disease.  In one part of the Wikipedia description it says “An estimated 16 million people worldwide are infected per year. Most cases occur in the developing world, and people of all ages may be affected”, then using a different source they say “Worldwide, whooping cough affects around 48.5 million people yearly.  In 2013, it resulted in about 61,000 deaths – down from 138,000 deaths in 1990.”

Before vaccines, an average of 178,171 cases were reported in the U.S., with peaks reported every two to five years; after vaccinations were introduced in the 1940s, incidence fell but in 2012, rates in the United States reached a high of 41,880 people; this is the highest it has been since 1955 when numbers reached 62,786.  In the U.S. pertussis in adults has increased significantly since about 2004.

In conclusion

We do not believe that the bacterium Bordetella pertussis is as straightforward as it is described.  The toxin that it produces has an extremely complex activity which seems to be anti-viral in action.  As the bacteria is a host to viruses, some of this activity may be directed to the bacteriophage it contains, but if the research conducted on the toxins is correct then the toxin is a more general antiviral.  The fact that the symptoms in most people are not as severe as the full blown version indicate an almost protective role even though this may sound bizarre.

And to use antibiotics, if this is the case, is indeed unwise.  We may be killing a beneficial bacteria, whose side effects are only ever severe if the viral infection or infections against which it is fighting are severe.

References and further reading

• Zh Mikrobiol Epidemiol Immunobiol. 1980 May;(5):85-90.  [Bordetella pertussis bacteriophage]. [Article in Russian]  Lapaeva IA, Mebel' SM, Pereverzev NA, Siniashina LN.
• Zentralbl Bakteriol Mikrobiol Hyg A. 1988 Aug;269(2):147-55.  Bacteriophages of Bordetella sp.: features of lysogeny and conversion.  Holzmayer TA1, Karataev GI, Rozinov MN, Moskvina IL, Shumakov YL, Motin VL, Mebel SM, Gershanovich VN, Lapaeva IA.  1Gamaleya Institute of Epidemiology and Microbiology, USSR Academy of Medical Sciences, Moscow.
• Iran Red Crescent Med J. 2015 Jul 1;17(7):e13454. doi: 10.5812/ircmj.13454. eCollection 2015.  The First Report of Epidemic Pertussis by Bahaodowle Razi From the 15th Century Anno Domini.  Yarmohammadi H1, Bahmani Kazeruni MH2, Soofi A3, Zargaran A4.
• Pediatr Infect Dis J. 2005 May;24(5 Suppl):S10-8.  Epidemiology of pertussis.  Tan T1, Trindade E, Skowronski D.  1Feinberg School of Medicine, Division of Infectious Disease, Children's Memorial Hospital, 2300 Children's Plaza, Box 20, Chicago, IL 60614-3394, USA.
• J Virol. 2000 Sep;74(18):8767-70.  The B-oligomer of pertussis toxin inhibits human immunodeficiency virus type 1 replication at multiple stages.  Alfano M1, Pushkarsky T, Poli G, Bukrinsky M.  1The Picower Institute for Medical Research, Manhasset, New York 11030, USA
• Curr Opin Pharmacol. 2007 Jun;7(3):272-8. Epub 2007 Apr 5.  Immunomodulation in the pathogenesis of Bordetella pertussis infection and disease. Carbonetti NH1.   1Department of Microbiology & Immunology, University of Maryland School of Medicine, HH 324 Baltimore, MD 21201, USA. ncarbone@umaryland.edu

All the prints on this page are by Katharine Jones, whose website can be found using this LINK

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