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A Bordering Cough

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					      A Bordering Cough



A Case Study about Bordetella persussis
            by Janell Jones
Patient History

 A 6 year old boy with
  a persistent cough
  for 2 weeks
 During the last 2
  days he experienced
  vomiting after severe
  coughing episodes
Laboratory Findings

 Gram stain of
  sputum revealed
  small gram negative
  bacilli
 No growth on routine
  blood agar
 After 5 days, growth
  was recovered on
  Regan-Lowe agar
Gram Stain photo
www.vaccineinformation.org/photos/pertcdc001a.jpg

Courtesy of Centers for Disease Control and Prevention
Diagnosis

       Bordetella pertussis
              AKA
        Whooping Cough
Bordetella pertussis

 B. pertussis produces disease only in
  humans
 Pertussis is a highly contagious, acute
  infection of the upper respiratory tract
 Infection is transmitted from person to
  person by direct contact or airborne
  droplets
 Prior to mass immunization, an
  estimated 95 percent of people
  contracted Pertussis during their life time
Symptoms

 Initially, symptoms resemble those of a
  common cold (sneezing, runny nose, mild
  cough)
 Within two weeks, the cough becomes more
  sever and violent, coughing associated with
  vomiting and a characteristic intake of breathe
  that sounds like a “whoop”.
 Between these attacks of coughing the
  individuals appears and feels perfectly well
 Whooping cough lasts at least 3 weeks and can
  go on for 3 months or even longer
 Listen to a pertussis cough at this web
  site

    http://www.immunizationed.org/pertus.asp
Complications

 Middle ear infections
 Dehydration
 Pneumonia
 Convulsions (seizures)
 Brain damage from lack of oxygen
 Brief episodes of stopped breathing
Pathogenesis

 The bacteria enter the mouth or nasopharynx
    as aerosols
   The bacteria binds to ciliated cells in the
    respiratory mucosa
   B. pertussis produces a number of adhesins
    which aid in its ability to colonize
   B. pertussis produces only localized infections
   Pertussis causes about 300,000 deaths/year in
    un-immunized populations in the world
Who is at risk?

 Newborns until they have had their primary
  whooping cough shots
 Children who have not been immunized
 People over 10 years old but more likely over
  50 whose immunization is wearing off
 The over 50’s who never had the chance of
  immunization but never got the natural infection
  as children
Cultivation

 B. pertussis is fastidious (it doesn’t grow on
  typical blood agar)
 Growth after 3-5 days at 35oC in a humidified
  atmosphere without elevated carbon dioxide on
  Regan-Lowe medium
 Regan-Lower is a charcoal agar with 10%
  horse blood and cephalexin antibiotic
 It appears as small, smooth shiny colonies with
  a pearl-like luster resembling mercury droplets
  surrounded by a zone of hemolysis
Laboratory Identification

 Faintly-staining small gram-negative
  bacilli on Gram stain
 A strict aerobe that is nonfermentative
  and nonmotile
 Catalse and Oxidase positive
 Nitrate, Citrate and Urease negative
 Specimens are sent to the state health
  department for confirmation
Treatment

 For the average case of whooping cough, there
  is no treatment likely to make a difference to the
  course of the illness or materially reduce the
  symptoms
 However, treatment of cases with certain
  antibiotics such as erythromycin can shorten
  the contagious period (1st stage of the disease)
 Since diagnosis seldom occurs during this time,
  antibiotic therapy is usually ineffective at
  decreasing the length of the illness
Prevention

 The single most effective control
  measure is maintaining the highest
  possible level of immunization in the
  community
 A child needs five DTP shots (Diptheria,
  Tetanus, Pertussis) at 2, 4, 6 and 15
  months of age followed by a booster at
  4-6 years for complete protection
 People with Pertussis should stay away
  from infants and young children
Case Summary

 6 year boy diagnosed with whooping
  cough
 No antibiotics given
 Mother was advised to used a humidifier,
  encourage drinking plenty of fluids, and
  to return to ER if he had difficulty
  breathing
References

 Pertussis, CDC Public Health Image Library,
  http://phil.cdc.gov/phil/results.asp, Last
  accessed on 11/08/04.
     Credits
This case was prepared
            by
Janell Jones, MT(ASCP)
    while she was a
  Medical Technology
      student in the
   2004 MT Class at
   William Beaumont
         Hospital,
    Royal Oak, MI.

				
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posted:9/22/2012
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