Respiratory Case Study: Possible Pertussis Infection

Author: Leah Ames, MS, MLS(ASCP)CM
Reviewer: Laurie Bjerklie, MA, MLS(ASCP)CM and Joshua J. Cannon, MS, MLS(ASCP)CMSHCM
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Continuing Education Credits

P.A.C.E.® Contact Hours: 1 hour(s)

Florida Board of Clinical Laboratory Science CE Credit Hours

Florida Board of Clinical Laboratory Science CE - General (Molecular Pathology): 1 hour(s)

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This course describes the clinical symptoms of Bordetella pertussis infection. Proper specimen collection and transport for diagnosis of B. pertussis along with laboratory testing procedures that aid in its diagnosis are presented. Advantages and disadvantages for each testing procedure including culture, nucleic acid amplification testing (NAAT), direct fluorescent antibody staining, and serology are discussed. Treatment options for pertussis infection including available vaccines are presented in this course.

Objectives

  • Identify the clinical symptoms of Bordetella pertussis infection.
  • Describe proper specimen collection and transport for diagnosis of B. pertussis.
  • Identify laboratory testing procedures that aid in the diagnosis of B. pertussis.
  • Discuss advantages and disadvantages for each testing procedure including culture, nucleic acid amplification testing (NAAT), direct fluorescent antibody staining, and serology.
  • Explain the principles of NAAT testing for B. pertussis.
  • Discuss treatment options for pertussis infection.
  • Identify available vaccines that can help to prevent infection with B. pertussis.

Course Outline

  • Case Presentation
    • Case Study
    • Pathogenesis and Virulence Factors
    • Epidemiology and Transmission
    • Clinical Course and Significance of the Disease
    • Table 1: Stages and Clinical Features of Pertussis
    • Complications
    • Case Study, continuedThe clinician calls the laboratory to obtain instructions for the collection of the specimen. Which of these specimens and collection techniques would be most appropriate for the recovery of Bordetella pertussis? Consider your response and click on a choice to reveal why it is appropriate or why it would be suboptimal for the recovery of B. pertussis.
    • Proper Specimen Collection and Transport
  • Laboratory Workup
    • Identification by Culture Methods
    • Case Study, continued: Laboratory Testing
    • Case study, continued Upon arrival in the laboratory, one of the swabs is used for culture. Which one of these selective media is an appropriate choice for B. pertussis culture?
    • Case Study, continuedAfter four days of incubation at 37°C, small, shiny colonies are observed on the Regan-Lowe agar. A Gram stain of the culture is performed, with the results shown below. How would you describe the Gram stain result?6. Bordetella pertussis - Public Health Image Library(Phil). Centers for Disease Control and Prevention, 1954, https://phil.cdc.gov/Details.aspx?pid=2121. Acce
    • Nucleic Acid Amplification Testing (NAAT)
    • Genomic Insertion Sequences
    • Single-Copy Gene Targets
    • Positive Predictive Value
    • Addressing False-Positive NAAT Results
    • True or false: Insertion sequences can move around and insert into different locations on the genome, changing the overall genetic sequence of the bacteria. When this happens, the base pair sequence of the actual insertion sequence will also change.
    • Direct Fluorescent-Antibody Staining (DFA)
    • White Blood Cell (WBC) Count
    • Case Study, continued: IgA, IgM and IgG Antibody Testing
    • Table 2: Advantages and Disadvantages of Laboratory Tests for Identification of B. pertussis
    • Clinical Stages of Pertussis and Optimal Timing for Diagnostic Testing
    • Which of these tests may be performed late in the course of B. pertussis infection?
    • How does the prevalence of a particular pathogen in a given area correlate to positive predictive values?
  • Case study conclusion
    • Case Study Conclusion
    • Treatment and Dosing for Pertussis
    • Prevention
    • Which of the following antibiotics is recommended for infants less than one month old for treatment of Bordetella pertussis infection?
  • References
    • References

Additional Information

Level of instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, laboratory supervisors, and laboratory managers. This course is also appropriate for MLS and MLT students and pathology residents.
Author information: Leah Ames, MS, MLS(ASCP)CM is a medical technologist in the Molecular Diagnostics department at Alverno Clinical Laboratories. She also serves as adjunct faculty for molecular diagnostics in the CLS program at Northern Illinois University and is an instructor of molecular diagnostics for Franciscan St. Margaret Health School of Medical Technology. Leah holds an M.S. degree in Clinical Laboratory Science from Michigan State University and a B.S. in Molecular and Integrative Physiology from the University of Illinois.
Reviewer information:
Laurie Bjerklie, MA, MLS(ASCP)CM is currently an Education Developer for MediaLab and LabCE. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 15 years of experience in higher education and has held program director and faculty positions in both MLT and MLS programs.
Joshua J. Cannon, MS, MLS(ASCP)CMSHCM received his Bachelor of Science and Master of Science in Medical Laboratory Science from Thomas Jefferson University in Philadelphia, PA. He holds Medical Laboratory Scientist and Specialist in Hematology certifications through the ASCP Board of Certification. He was a professor at Thomas Jefferson University for seven years before transitioning into his current role as Education Developer at MediaLab. His areas of expertise and professional passions include clinical hematology and interprofessional education.