Fatal Bordetella pertussis infection: report of two cases with novel pathologic findings.

We report two infants less than 2 months of age who died of Bordetella pertussis infection: one of primary B. pertussis infection and the other of secondary bronchopneumonia. We describe histopathologic findings in the lung, including transmission and immunoelectron microscopy, studies showing close association between B. pertussis organisms and ciliated cells. A novel finding in both cases was striking dilatation and inspissation of proteinaceous material in pancreatic ducts, reminiscent of changes described in cystic fibrosis. The possible mechanism for these changes may be related to cellular and molecular actions of pertussis toxin-a powerful inhibitor of G proteins and adenyl cyclase important in cellular signal transduction.