BORDETELLA, HAEMOPHILLUS AND BRUCELLA
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| 🇬🇧 | 🇬🇧 |
| What is the name and causative agent of a disease first decribed by Bordet et al. in 1900, a disease that causes violent paroxysmal productive cough in children. | Whooping cough, caused by Bordetella pertussis |
| The incubation period and site of infection for B. petussi is | 7-10 days, it infects the cilia of respiratory epithelium of infected children. |
| Transmission of whooping cough is by | Direct or droplet contact with naso[pharygeal secretion of an infected person. |
| The infection of whooping cough has 2 infection periods | 1) from predrome- 3wks after paroxysmal cough 2) 5 days after starting antibiotic treatment( what is the antibiotic treatment?) |
| What is the reservoir of bordetella pertussis | Humans. there are no animal or insect vectors known. whooping cough is a child-hood infection |
| The virulence factors of B. pertussis include | 1) adhesins: filamentous heagglutinin(FHA) rbc agglutination, and fimbriae/pilli for adherence 2) toxins which include: pertusis toxin, adnylate cyclase toxin/hemolysin, tracheal cytotoxins and lethal toxins( dermonercrotic toxins) |
| The epidemiology of whooping cough | Most severe in infants under 1 yr old. more than half of infant that get it will be hospitalised and some even die. in adults the disease is less severe and my not be recognised, althought infected adults can spread to infants. |
| Clinical symptoms of pertussis | 1) catherrhal stage:first stage. lasts for 1-2 wks most infective stage. runny nose, nasal congestion, sneezing occassional cough, low grade fever. 2) paroxysmal stage: 2nd stage classical whooping cough and inspirational whoops, more at night where an average of 15 attacks in 24hrs. lasts for 1-6wks 3) convalescent stage: 3rd stage. cough with many complications: secondary bacterial pneumonia sub-conjugal hemorrhage, convulsions. lasts for weeks or months |
| Lab diagnosis. | 1)culture: naso-pahrygeal swab is most convenient. there is also a cough plate of bordet-gengou media where patient coughs directly into. 2)fbc show leukocytosis, with ablolute lymphocytosis of 70-80% 3) DIT: serology withe ELISA and Indirect hemagglutination test. 4) PCR |
| What does whooping cough look like on culture media | Greyish, smooth, opaque white refractile colonies resembling pearls or mercury droplets. |
| Identification of B. pertussis | Gram neg coccobaccilli, non motile and non sporeforming. oxidase and catalase pos. nitrate and urea negative |
| Treatment | Erythromycin makes illness less contagious, give early to reduce symptoms. tetracycline, chloraphenicol and ampicillin |
| Further measures to prevent spread of whooping cough | Vaccination with DTP and persons with close contact should be treated with erythromycin |
| The haemophilus species have 3 subgroups that are of clinical improtance, what are they | 1)H. influezae: causes meningitis, otitis media, cellulitis, pneuonia, epiglottitis and bronchitis 2)H. ducreyi: soft sore or chancroid 3)H aegyptius: conjunctivitis |
| The blood loving organism requires which factors to grow | Factor X and V which are available on chocolate agar. |
| Microscoptic features of H. influenzeA | Gram neg coccobaccili: non sporin non motile. some starins posses polysaccharide capsule. 6 strains. a,b,c,d,e and f. strain b (Hib) causes 95% of invasive disease |
| Before introduction of vaccines, leading cause of bacterial meningitis and other invasive bacterial disease inchidren under 5 is? | Hib. The vaccine is Hib conjugate vaccine |
| Mode of transmission | Droplets discharge from upper resp tract. most common portal of entry is nasopharynx. |
| Infectious period | As long as organism is present. non infectious within 24-48 hrs after start of antibiotics |
| Reserviours | Humans. children and adults are carriers |
| Virulence factors of H influenzae | 1) capsular polusaccharide 2) lipopolysaccharide 3)IgA protease 4)pili |
| Clinical presentationof H. influenzae | 1)meningitis: fever, headaches, stiffneck, photophobia, seizures and coma in infants, poor feeding and bulging fontanelle in chidren 2mths-2 years: mortality and neurological complications are high. 2) epiglottis: second most common infection of H. influenzae in children 3-18months. sudden onset sore throat and fever, shortness of breath, obstructied airways, difficulty to swallow. life threatening 3) pnemonia 4) celluitis 5) septic arthritis. |
| Specimen for lab diagnosis of H. influenzae | Specimen: csf and blood, nasopharyngeal swab, pus, sputum, aspirate from join and throat swab |
| Lab diagnosis of H. influenzae | 1)gram stain and culture on chocalte agar for factor X and V. satellitism with stap aureus. 2)capsular detection by quellung rxn or latex agglut. test. 3)slide agglut. test. |
| Lab identification of H. influenzae | Gram neg coccobacilli. require factor X and V from chocolate agar. presence of 5-10% cO2 to enhance growth. cannot grow on nutrient agar. catalase and oxidase pos. satellitsim for S. aurus which acts as a source of factor V(NADP co enzyme) FActor X is found in blood. |
| Treatment of H. influnzae | 1) sulphonaides: trimethoprim-sulphamethoxazole 2) chloramphenicol 3) ciprofloxacin 4)ampicillin 5) cefotaxime 6) ceftazidime |
| Preventation and control of H. influnzae | PRP vaccine, conjugate PRP antibiotic chomoprophylaxis with rifampin. |
| Causative agent of soft sore or chancroid | H. ducreyi. |
| Virulence factor of H, ducreyi | Pilli, outer embrane protien |
| Microscopic characteristics of H ducreyi | Gram negative coccobaccili: shows bipolar staining. occurs in parrallel chains "school fish r rail road track" grow on CAM- chorioallantonic membrane of live chick embryo grow on chacolate agar with factor X but not V |
| Treatment of H ducreyi | Azithromycin, ceftrixone, cipro and tetracyclin |
| H. aegyptius causes highly infectious form of acute conjunctivitis, what are its microscopic characteristics? | Gram negative bacillus: requires the same growth factor as H. influenzae( factor X and V on chocolate agar). thus sometimes called H. influeza biotypeIII. |
| Brucellosis is bacteria infection contracted from due to unpasturised dairy products. what is the microscopic characteristic of the organism involved? | Brucella species: gram negative coccobacillus. occupational disease of vets. |
| Incubation period of Brucela sp | 5days-several weeks. presents an undulating fever pattern. |
| Various sp of brucella include | B. abortus: cattle and buffalomost important cause of human brucellosis in Uk B melitensis: sheep and goat: malta and mediterranean fever and potentia agent for bio terrorism. B Suis : pigs: common in swine rearing areas in US. B. Canis: dog: common in dog handlers.Treat with Minocycline and streptomycin. |
| Virulence factors of Brucella | Lippopolysaccharide. |
| Clinical presentation of Brucella infection | Acute infection is non specific and chronic infection in incompletely treated patients. duration of illness: weeks- months. |
| Lab diagnosis | Blood culture: serolgicall: four-fold rise in titre and 1:640 or more i acute disease. ELISA in animal: atibody in milk by milk ring test and rose bengal test. |
| Treatment | Gold standard: doxycycline plus streptomycin gentamycin for 3-4 wks doxycycline plus rifapin for 4-6wks rifampin plus cipro: who therapy. relapse is common on therapy with singe dose. |
| Primary prevention | Minimal exposure and pasturisation of dairy product. vaccinatio for animals. no vaccine for humans. |