Evaluation of pertussis in U.S. Marine Corps trainees

One hundred twenty male U.S. Marine Corps trainees with histories of at least 7 days of cough underwent evaluation for Bordetella pertussis infection by culture, B. pertussis-specific polymerase chain reaction (PCR) analysis, and serology. Antibody levels in preexposure, acute-phase, and convalescent-phase serum samples were measured in a microagglutination assay and in enzyme linked immunosorbent assays (ELISAs) for IgG and IgA antibodies to pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae types 2 and 3. Culture and PCR analysis revealed that none of the patients were positive for B. pertussis; however, 20 of 120 trainees had serological evidence of B. pertussis infection. Of these cases, one was confirmed by a rise in the level of antibody to pertussis toxin, and six were classified as probable by increases in levels of antibodies measured by two or more assays. Of the 20 individuals with serological evidence of infection, 16 had rises in levels of antibodies to fimbriae or agglutinating antibodies. The utility of ELISA for detecting antibodies to fimbriae and the microagglutination assay for diagnosing pertussis in adults should be evaluated by application to larger and more diverse study populations. These results indicate that pertussis should be considered in the diagnosis of coughing illness in military populations.