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Microbiology · Bacteriology: Bordetella pertussis
Sample itemA 4-month-old unimmunised infant has paroxysms of cough ending in an inspiratory whoop with post-tussive vomiting. Total leucocyte count is 38,000 per microlitre with 75% lymphocytes. Which toxin action best explains the lymphocytosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Pertussis toxin ADP-ribosylates Gi, so lymphocytes cannot leave the blood
Pertussis toxin ADP-ribosylates the Gi regulatory protein and impairs chemokine-driven extravasation of lymphocytes, so they accumulate in the blood, producing a marked absolute lymphocytosis without a lymphoid reaction. The other toxins contribute to local damage and impaired phagocyte killing but do not cause lymphocytosis.
Option by option
A. Adenylate cyclase toxin kills lymphocytes in the marrow and triggers compensatory release
Adenylate cyclase toxin enters phagocytes and raises cAMP to impair their killing; it is not a marrow toxin.
B. Dermonecrotic toxin causes lymphocyte proliferation in the spleen
Dermonecrotic toxin causes local vasoconstriction and tissue necrosis and has no role in lymphocytosis.
C. Pertussis toxin ADP-ribosylates Gi, so lymphocytes cannot leave the blood (correct)
Correct. Blocked lymphocyte homing produces lymphocytosis with an otherwise normal-looking lymphocyte population.
D. Tracheal cytotoxin destroys ciliated cells and releases lymphocytes from the mucosa
Tracheal cytotoxin damages ciliated epithelium and impairs mucociliary clearance but does not mobilise lymphocytes.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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