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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.