1 / 18

A Bordering Cough

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.

MikeCarlo
Download Presentation

A Bordering Cough

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Bordering Cough A Case Study about Bordetella persussis by Janell Jones

  2. 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

  3. 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

  4. Gram Stain photowww.vaccineinformation.org/photos/pertcdc001a.jpgCourtesy of Centers for Disease Control and Prevention

  5. Diagnosis Bordetella pertussis AKA Whooping Cough

  6. 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

  7. 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

  8. Listen to a pertussis cough at this web site http://www.immunizationed.org/pertus.asp

  9. Complications • Middle ear infections • Dehydration • Pneumonia • Convulsions (seizures) • Brain damage from lack of oxygen • Brief episodes of stopped breathing

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

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

  18. 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.

More Related