Question

Three-year-old Michael is brought to the emergency room of a large metropolitan hospital by his parents. What began about a week ago as a seemingly mild cold has turned into a severe cough. Michael has experienced several “fits” of coughing in the past 24 hours. Each seems to become more violent. During the latest, he seemed unable to get air and had begun to turn blue in the hands, feet, nose, and lips. Between coughs, he noisily gasps for air. After a quick examination, the doctor readily admits him in respiratory isolation.

Laboratory Diagnosis

A nasopharyngeal swab is obtained and quickly sent to the laboratory for culturing in Bordet-Gengou medium containing fresh blood. After five days of incubation, tiny glistening colonies with a pearl-luster appearance were visible. A narrow zone of hemolysis is present around the colonies. Immunofluorescent staining revealed tiny coccobacilli.

1.

Which of these is the most likely cause of Michael’s symptoms?

		Pneumocystis carnii
		Diptheria
		Pertussis
		Tuberculosis

2. What is the common name of this infection? Explain the reason behind this name

3. If you were the physician, what prognosis would you give Michael’s parents (progression and outcome of the disease)? (Be sure to discuss the three stages of this infection.)

4. What standard “well baby” immunization procedure has Michael likely missed? Be specific. Knowing this, for what other diseases is Michael at risk? Explain.

5. What trend in yearly cases of pertussis peaked in 2012? What is the current recommendation for adults to protect themselves from this infection?

Answer 1

1. Michael’s symptom shows signs of infection of bacteria Bordetella pertussis.
2. This bacteria causes whooping cough. The patient is effected by severe cough which sounds like whoop.
3. Progression of the disease occurs in three stages:

1. Catarrhal stage: mild symptoms like common cold.
2. Paroxysmal stage: cough worsens and whooping
3. Convalescent stage: recovery phase.

Incubation period is 5-10 days