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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
slide4
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
slide8
Listen to a pertussis cough at this web site

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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