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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.

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A Bordering Cough

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  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.

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