Case study 9 pathogenic bacteriology 2009
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Case Study 9 Pathogenic Bacteriology 2009. Omar Ahmed Hank Hsieh Rochelle Songco. Case Summary. 5 ½-week-old male 10 day history of choking spells Repetitive coughing, turning red, gasping for breath Vomiting associated with choking spells in prior 2 days Pulse – 160 bpm (elevated)

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Case study 9 pathogenic bacteriology 2009

Case Study 9Pathogenic Bacteriology2009

Omar Ahmed

Hank Hsieh

Rochelle Songco


Case summary
Case Summary

  • 5 ½-week-old male

  • 10 day history of choking spells

  • Repetitive coughing, turning red, gasping for breath

  • Vomiting associated with choking spells in prior 2 days

  • Pulse – 160 bpm (elevated)

  • Respiratory rate – 72/min (elevated)

  • Chest radiograph is clear and trachea is normal

  • White cell count – 15,500/µL with 70% lymphocytes


Key information pointing to diagnosis
Key Information Pointing to Diagnosis

  • An elevated white cell count with 70% lymphocytes

  • Coughing spells, turning red, gasping for breath

  • Episodes of vomiting

  • Chest radiograph is clear indicating no pneumonia infection

  • No tracheal abnormalities

  • These are all consistent with a pertussis infection


The diagnosis for case 9
The Diagnosis for Case 9

  • Bordetella pertussis

  • Nasopharyngeal swab shown below

source: faculty.matcmadison.edu/mljensen


Classification gram stain results and microscopic appearance of bordetella pertussis
Classification,Gram Stain Results, and Microscopic Appearance of Bordetella pertussis

  • Genus: Bordetella

  • Gram-negative

  • Coccobacillus

  • Aerobic

source: historique.net/microbes


Diseases and pathogenesis of bordetella pertussis
Diseases and Pathogenesis of Appearance of Bordetella pertussis

  • Pertussis, which causes whooping cough

  • Infection of the respiratory tract

  • Children and young infants are most at risk

  • Most contagious before coughing begins


Diagnosis isolation identification of bordetella pertussis
Diagnosis/Isolation/Identification/ of Appearance of Bordetella pertussis

  • Diagnosis based on…

    • repetitive coughing with choking, vomiting, and gasping for breath

    • Elevated pulse and respiratory rate

    • Elevated lymphocyte levels

      • Caused by a blocking of homing of lymphocytes to the spleen and lymph nodes

    • Culture from nasopharyngeal swab is most common method of detection due to the bacterial presence in nose and throat

      • Bordet-Gengou medium

      • Charcoal-horseblood agar

      • Detection of Bordetella DNA by PCR

      • Detection of IgA antibodies with ELISA


Therapy prevention and prognosis of patient infected with bordetella pertussis
Therapy, Prevention and Prognosis of Patient Infected with Appearance of Bordetella pertussis

  • Erythromycin is the drug of choice against a pertussis infection

    • Reduces duration by 5-10 days but not the course of the infection

    • Bacteria is slow growing so cough persists

  • DTaP vaccine available for children

    • Reported cases down 97% from pre-vaccine era

  • Tdap booster vaccine for adolescents and adults


A marked decrease in L-selectin expression by leucocytes in infants withBordetella pertussisinfection: leucocytosis explained?

  • Hodge, Greg, et al, 2003, A marked decrease in L-selectin expression by leucocytes in infants withBordetella pertussisinfection: leucocytosis explained?, Respirology, 8: 157-162.

  • Blood collected from 11 infants with B. pertussis infection prior to antibiotic therapy. Control group of 11 infants with non-pertussis related hospital admission.

  • Full blood counts conducted for WBCs and also test of cell origin (lymphoid, granulocytic, or monocytic).

  • Patients with B. pertussis infection showed a much higher absolute number of neutrophils, monocytes, and lymphocytes compared to control

    • L-selectin is removed from leucocytes by pathogen

      • Prevents migration of leucocytes and homing and invasion of T and B cells to peripheral lymphoid tissues

  • Leukocytosis is consistent with an infection of Bordetella pertussis


Take home message bordetella pertussis
= Take Home Message = infants withBordetella pertussisinfection: leucocytosis explained?Bordetella pertussis

  • Pertussis is a respiratory infection which causes “whooping cough”

  • Typical symptoms are initially cold-like followed by a stage of rapid coughing and finally a recovery stage of coughing which can last for weeks or months.

  • Pathogen which causes this infection is Bordetella pertussis

  • Diagnostics include a nasopharyngeal swab culture, DNA PCR, and ELISA test for antibodies

  • Erythromycin is the primary antibiotic used against an pertussis infection

  • Most children recover from the illness but pneumonia, apnea, encephalopathy, and rib fractures are complications associated with a pertussis infection

  • Immunization is effective against pertussis infections

  • Disease is spread by coughing and sneezing

  • Non-vaccinated infants and adolescents at most risk


References
References infants withBordetella pertussisinfection: leucocytosis explained?

  • "Bordetella". National Center for Biotechnology Information. March, 09, 2009 <http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mme d.chapter.1684>.

  • "Vaccines VPD-VAC-Pertussis-main page". Centers for Disease Control and Prevention. March, 08, 2009

  • "Pertussis Bacterial Infections Merck Manual Home Edition". MERCK. March, 07, 2009 <http://www.merck.com/mmhe/sec23/ch272/ch272g.html >.

  • McQueen, Nancy. Winter 2009. Bordetella, Francisella, and Brucella


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