Clinical Microbiology II MLTS 143 Matthew Coburn 28 Aug 10

1. Source (and date of source) and why it got your interest: I came across this article on the ABC local news website for the San Francisco area. It peaked my interest because I had thought that Whooping cough was a rarity these days due to vaccines and because this most recent outbreak is happening pretty close to home (west coast USA). 2. Organism plus Diseased caused: Bordetella pertussis which is the causative agent of pertussis or whooping cough (2). 3. Description: Bordetella pertussis can be described as gram negative coccobacilli (bacilli) (2, 3). It can also be described as gram-staining poorly. When grown on the proper media, Bordetella pertussis forms very distinct mercury droplet colonies that are approximately 1-2mm in size and are high convex or domed (2). On Bordet-Gengou Agar, the colonies are hemolytic (3). 4. How the organism is detected: Four common methods of detection exist in the laboratory. While bacterial culture is still considered the gold standard, it is only 30-50% sensitive, requires a long time to grow (about 7-14 days), and can be used in the first 1-3 weeks of infection (2, 3). Also, Bordetella pertussis requires special media to grow; either Bordet Gengou Agar or Regan-Lowe Charcoal Agar (2). When it does grow on these media, the colonies have a very distinct mercury droplet appearance (2). Direct fluorescent antibody testing can also be used but as it lacks specificity and sensitivity, and carries a false positive rate as high as 85% (2). Polymerase Chain reaction assays are becoming the new favorite for laboratories. They are sensitive and quick, but the results still must be confirmed by cultures or by the patient history (2, 3). The fourth method is using serology and is used for patients in the later stages of the illness, when the organism is no longer in the nasopharynx (2, 3). 5. Treatment: Erythromycin can be an effective treatment if taken before the onset of coughing spasms. After this point, the drugs of choice are azithromycin or clarithromycin with the secondary choice being TMP-SMX (2, 3). 6. Why is it a public health concern? Bordetella pertussis is always a public health concern. In fact, it is one of the diseases that is of great concern to public health and is reported to infection control and public health once it has been isolated and confirmed (2). The illness pertussis or whooping cough has three distinct stages in children. The first stage is the catarrhal stage where a child shows acute upper respiratory trace symptoms like runny nose, low fever, mild cough, and possibly conjuctival infection (2, 3). This stage lasts approximately 1-2 weeks. The next stage is the most severe and can last 3-4 weeks. This is the paroxysmal stage. It consists of paroxysmal coughing that is frequently accompanied by vomiting (2, 3). The final stage is the convalescent stage. Here, the paroxysmal coughing has declined to be replaced by a non-productive cough which persists for weeks (2, 3). Adults mostly only have a non-productive coughing stage that lasts for 4-6 weeks and because of this, the infection can be missed (2). Since adults do not know they are infected, they are the primary way that pertussis is transferred to children. A vaccine program is in place but however the vaccine is only effective for individuals seven years old or younger, and imparts only 10-12 years of protection (2). This means that most adults and older adolescents are vulnerable, and makes them the primary reservoirs for infections in young children (1, 2). Young children are the main concern for this disease. So far this year, the California Department of Public

Clinical Microbiology II MLTS 143 Matthew Coburn 28 Aug 10

Health has been able to confirm over 3,000 cases of whooping cough (1). This is an increase of over sevenfold from all of last year already and it is not even September yet. The main concern is children catching pertussis when they arrive back in school this fall (1). The health authorities are urging children to get vaccinated, and are warning if there is an outbreak, non-vaccinated children may be forced to stay home from school (4). So far in California, 8 people have died from whooping cough, including 7 infants (1). 7. References 1. Schools warn about whooping cough epidemic. ABC Local news [Online]. 2010 Aug 23 [cited 2010 Aug 26]; Available from: http://abclocal.go.com/kgo/story?section=news/health&id=7625251 2. Kipke, Leila. Clinical Microbiology I (course pack). Northern Alberta Institute of Technology (CNC); 2006: p.3-8 Module F. 3. Lehman DC, Mahon CR, Manuselis G. Textbook of Diagnostic Microbiology. 3rd edition. St. Louis: Saunders; 2007: p.495-500. 4. Parents Warned: No Vaccine Could Mean No School. Fox news [Online]. 2010 Aug 25 [cited 2010 Aug 26]; Available from: http://www.foxnews.com/story/0,2933,600145,00.html