ABSTRACT
I. INTRODUCTION 368
II. PERTUSSIS AS A DISEASE: SOCIAL AND BIOLOGICAL FEATURES 368 A. Epidemiology 368 B. Pathology 369 C. Clinical Manifestations 371
III. PATHOGENESIS OF PERTUSSIS: AN OVERVIEW
IV. REGULATION OF VIRULENCE
V. VIRULENCE DETERMINANTS A. Pertussis Toxin (PT) B. Filamentous Hemagglutinin (FHA) C. Fimbriae D. Adenylate Cyclase Toxin (AC) E. Pertactin F. Tracheal Cytotoxin (TCT) G. Dermonecrotic Toxin (DNT) H. Other Proposed Virulence Determinants
VI. COOPERATION AMONG VIRULENCE FACTORS A. Adherence and Colonization B. Local Damage and Systemic Intoxication C. B. pertussis Interactions with the Host Immune System
VII. UNRESOLVED ISSUES A. The bvg Regulon and In Vivo Regulatory Signals B. Persistence and a B. pertussis Intracellular State
VIII. CONCLUSION
REFERENCES
379 379 381 385 387 388 389 390 390
391 391 392 392
394 394 394
I. INTRODUCTION
Far from becoming a disease of the past, pertussis (or whooping cough) continues to cause substantial morbidity and mortality around the world. Interest in the etiologic agent, Bordetella pertussis, reflects this practical problem as well as the increasingly apparent sophistication of this organism as a host-adapted pathogen.
