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Activated ADP ribosylating -enzyme

Activated ADP ribosylating -enzyme m

+ nicotinamide

Figure 23.14 Mode of Action of Pertussis Toxin The B portion of this A-B toxin attaches to receptors on the cell membrane.The B portion stays behind as the A portion enters the cell, becoming an enzyme activated by intracellular conditions. Activated A enzyme inactivates a G protein by ADP ribosylation, thereby maximizing cAMP production.

and then the incidence of tuberculosis began to rise (figure 23.16). The rise continued for the next 6 years in association with the expanding AIDS epidemic and increases in treatment-resistant cases. Fortunately, starting in 1993, with better funding of control measures and more aggressive treatment, tuberculo-

23.5 Bacterial Infections of the Lower Respiratory System 581

23.5 Bacterial Infections of the Lower Respiratory System 581

Figure 23.15 Number of Reported Pertussis Cases, by Year, United States, 1922-2000

sis resumed its slow retreat. In 1989, a Strategic Plan for the Elimination of Tuberculosis in the United States was published by the Centers for Disease Control and Prevention. The plan depends largely on increased efforts in identifying and treating people with the disease among the high-risk groups, particularly poor people, people with AIDS, prisoners, and immigrants from countries with high rates of tuberculosis. The high rates of tuberculosis and increasing percentage of treatment-resistant cases worldwide have put the strategic plan in jeopardy.

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