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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.

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A bordering cough

A Bordering Cough

A Case Study about Bordetella persussis

by Janell Jones


Patient history
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
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 photowww.vaccineinformation.org/photos/pertcdc001a.jpgCourtesy of Centers for Disease Control and Prevention


Diagnosis
Diagnosis

Bordetella pertussis

AKA

Whooping Cough


Bordetella pertussis
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
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


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


Complications
Complications

  • Middle ear infections

  • Dehydration

  • Pneumonia

  • Convulsions (seizures)

  • Brain damage from lack of oxygen

  • Brief episodes of stopped breathing


Pathogenesis
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
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
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
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
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
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
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
References

  • Pertussis, CDC Public Health Image Library, http://phil.cdc.gov/phil/results.asp, Last accessed on 11/08/04.


Credits
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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