Editing Whooping cough (section)

==Mechanism==
After the bacteria are inhaled, they initially adhere to the [[ciliated]] [[epithelium]] in the [[nasopharynx]]. Surface proteins of ''B. pertussis'', including filamentous [[hemagglutinin]] and [[pertactin]], mediate attachment to the epithelium. The bacteria then multiply.<ref name="Top2017">{{cite book|last1=Top|first1=Karina A.|last2=Halperin|first2=Scott A.|editor1-last=Kasper|editor1-first=Dennis L.|editor2-last=Fauci|editor2-first=Anthony S. |title=Harrison's Infectious Diseases|date=2017|publisher=McGraw-Hill Education|location=New York|isbn=978-1-259-83597-1|pages=502–506|edition=3|chapter=Pertussis and other Bordetella infections}}</ref><ref name=Kilgore2016>{{cite journal | vauthors = Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ | title = Pertussis: Microbiology, Disease, Treatment, and Prevention | journal = Clinical Microbiology Reviews | volume = 29 | issue = 3 | pages = 449–86 | date = July 2016 | pmid = 27029594 | pmc = 4861987 | doi = 10.1128/CMR.00083-15 }}</ref> In infants, who experience more severe disease, the bacteria spread down to the lungs.<ref name=Kilgore2016/>

The bacteria secrete several toxins. [[Tracheal cytotoxin]] (TCT), a fragment of [[peptidoglycan]], kills ciliated [[Epithelium|epithelial cells]] in the airway and thereby inhibits the [[Mucociliary clearance|mechanism]] which clears the airways of mucus and debris.<ref name=Hewlett2014>{{cite journal | vauthors = Hewlett EL, Burns DL, Cotter PA, Harvill ET, Merkel TJ, Quinn CP, Stibitz ES | title = Pertussis pathogenesis—what we know and what we don't know | journal = The Journal of Infectious Diseases | volume = 209 | issue = 7 | pages = 982–5 | date = April 2014 | pmid = 24626533 | pmc = 3952676 | doi = 10.1093/infdis/jit639 }}</ref> TCT may contribute to the cough characteristic of pertussis.<ref name=Melvin2014>{{cite journal | vauthors = Melvin JA, Scheller EV, Miller JF, Cotter PA | title = Bordetella pertussis pathogenesis: current and future challenges | journal = Nature Reviews. Microbiology | volume = 12 | issue = 4 | pages = 274–88 | date = April 2014 | pmid = 24608338 | pmc = 4205565 | doi = 10.1038/nrmicro3235 }}</ref>  [[Pertussis toxin]] causes [[lymphocytosis]] by an unknown mechanism. The elevated number of white blood cells leads to [[pulmonary hypertension]], a major cause of death by pertussis.<ref name=Hewlett2014/><ref name=Kilgore2016/> In infants who develop [[encephalopathy]], [[cerebral hemorrhage]] and cortical atrophy occur, likely due to [[hypoxia (medical)|hypoxia]].<ref name=Kilgore2016/>