Real-time PCR-based detection of Bordetella pertussis and Bordetella parapertussis in an Irish paediatric population

Novel real-time PCR assays targeting the Bordetella pertussis insertion sequence IS481, the toxin promoter region and Bordetella parapertussis insertion sequence IS1001 were designed. PCR assays were capable of detecting <= 10 copies of target DNA per reaction, with an amplification efficiency of >= 90%. From September 2003 to December 2009, per-nasal swabs and nasopharyngeal aspirates submitted for B. pertussis culture from patients <= 1 month to >15 years of age were examined by real-time PCR. Among 1324 patients, 76 (5.7%) were B. pertussis culture positive and 145 (10.95%) were B. pertussis FOR positive. Of the B. pertussis PCR-positive patients, 117 (81%) were aged 6 months or less. A total of 1548 samples were examined, of which 87 (5.6%) were culture positive for B. pertussis and 169 (10.92%) were B. pertussis FOR positive. All culture-positive samples were FOR positive. Seven specimens (0.5%) were B. parapertussis culture positive and 10 (0.8%) were B. parapertussis FOR positive, with all culture-positive samples yielding FOR-positive results. A review of patient laboratory records showed that of the 1324 patients tested for pertussis 555 (42%) had samples referred for respiratory syncytial virus (RSV) testing and 165 (30% were positive, as compared to 19.4% of the total 5719 patients tested for RSV in this period. Analysis of the age distribution of RSV-positive patients identified that 129 (78%) were aged 6 months or less, similar to the incidence observed for pertussis in that patient age group. In conclusion, the introduction of the real-time FOR assays for the routine detection of B. pertussis resulted in a 91% increase in the detection of the organism as compared to microbiological culture. The incidence of infection with B. parapertussis is low while the incidence of RSV infection in infants suspected of having pertussis is high, with a similar age distribution to B. pertussis infection.