Abstract
Pertussis, caused by Bordetella (B.) pertussis, a Gram-negative bacterium, is a highly contagious airway infection. Especially in infants, pertussis remains a major health concern. Acute infection with B. pertussis can cause severe illness characterized by severe respiratory failure, pulmonary hypertension, leucocytosis, and death. Over the past years, rising incidence rates of intensive care treatment in young infants were described. Due to several virulence factors (pertussis toxin, tracheal cytotoxin, adenylate cyclase toxin, filamentous hemagglutinin, and lipooligosaccharide) that promote bacterial adhesion and invasion, B. pertussis creates a unique niche for colonization within the human respiratory tract. The resulting long-term infection is mainly caused by the ability of B. pertussis to interfere with the host’s innate and adaptive immune system. Although pertussis is a vaccine-preventable disease, it has persisted in vaccinated populations. Epidemiological data reported a worldwide increase in pertussis incidence among children during the past years. Either acellular pertussis (aP) vaccines or whole-cell vaccines are worldwide used. Recent studies did not detect any differences according to pertussis incidence when comparing the different vaccines used. Most of the currently used aP vaccines protect against acute infections for a period of 6–8 years. The resurgence of pertussis may be due to the lack of herd immunity caused by missing booster immunizations among adolescents and adults, low vaccine coverages in some geographic areas, and genetic changes of different B. pertussis strains. Due to the rising incidence of pertussis, probable solution strategies are discussed. Cocooning strategies (vaccination of close contact persons) and immunizations during pregnancy appear to be an approach to reduce neonatal contagiousness. During the past years, studies focused on the pathway of the immune modulation done by B. pertussis to provide a basis for the identification of new therapeutic targets to enhance the host’s immune response and to probably modulate certain virulence factors.
Highlights
Specialty section: This article was submitted to Pediatric Critical Care, a section of the journal Frontiers in Pediatrics
Due to several virulence factors that promote bacterial adhesion and invasion, B. pertussis creates a unique niche for colonization within the human respiratory tract
Studies focused on the pathway of the immune modulation done by B. pertussis to provide a basis for the identification of new therapeutic targets to enhance the host’s immune response and to probably modulate certain virulence factors
Summary
Infection by B. pertussis is acquired via droplet route [5, 13]. In the susceptible child, the classical pre-vaccination textbook symptom trias is defined as: catarrhal stage with unspecific symptoms (e.g., fever, rhinitis, mild cough) which typically lasts for 1–2 weeks, followed by the paroxysmal stage where the cough evolves in the typical paroxysmal coughing spells followed by posttussive whooping and vomiting and duration of cough lasting 1–3 months. Infection by B. pertussis nowadays often causes unspecific mild symptoms, such as rhinitis and unspecific mild cough often not leading to a physician visit [5]. Newborns and young infants often first present with apnea or respiratory distress syndromes [5, 13, 16]. The first presentation of an acute infection is affected by several parameters: patient age, previous exposure. After introduction of routine vaccination in young infants, pertussis incidence first decreased. Type and frequency of complications depend on host-specific age and immunity. They most commonly present as bronchoalveolar pneumonia (any age) or apnea (newborns and young infants) and more rarely as respiratory distress syndrome, seizures, and other signs of encephalopathy [2, 5]
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