Intranuclear Inclusions in Pertussis

Abstract

For many years pathologists have teen interested in a peculiar type of pneumonia that frequently complicates certain epidemic diseases, termed interstitial bronchopneumonia because of the cellular infiltration in the walls of the bronchioles and alveoli, and commonly seen in epidemic influenza, measles and pertussis. Dr. Muckenfuss and I have been impressed by the similarity of the pneumonia produced by vaccine virus in the rabbit's lung to human interstitial pneumonia. We, therefore, suspected that a virus might be concerned with human interstitial pneumonia in measles, influenza and whooping cough. Measles is a virus disease, and many investigators now believe that the primary etiological agent of epidemic influenza may also be a virus. On the other hand, the Bordet-Gengou bacillus is almost universally regarded as the etiological agent of pertussis; although a critical study of the relation of this bacterium to the disease reveals many discrepancies. (Löwenthal and St. Zurukzoglu.) Furthermore, a vaccine prepared from the bacillus is of doubtful value both as a prophylactic and as a curative agent. Pertussis sometimes is complicated by encephalitis, as are the known virus diseases such as measles and vaccinia. Finally, the interstitial character of the pneumonia associated with pertussis is similar to that seen in other virus diseases and therefore suggests the possibility of a virus in pertussis also. Since inclusion bodies are associated with many virus diseases, we examined the sections from 35 cases of pertussis and found intranuclear inclusions in the lungs of 12. These were found in the cells lining the alveoli as well as in the bronchial epithelium. The cells containing the inclusions were always larger than their neighbors and their cytoplasm more basophilic. In a few cases, they were found in liver cells about areas of necrosis and, under the same circumstances, in cells of the adrenal.