WBR0048

Author	[[PageAuthor::William J Gibson (Reviewed by Rim Halaby, M.D. [1] and Yazan Daaboul)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Microbiology
Sub Category	SubCategory::Pulmonology, SubCategory::General Principles, SubCategory::Infectious Disease
Prompt	[[Prompt::A 5-year-old male child is brought to his pediatrician by his mother for a 12-day history of increasingly severe cough. His temperature is 38.7°C (101.6°F), blood pressure is 110/78 mmHg, heart rate is 108/min, and respiratory rate is 98%. During physical examination, the patient experiences paroxysmal coughing spells and is unable to breathe. Further history reveals the child immigrated from rural India with his family 3 months ago and has not received any medical care before his visit today. Initial lab testins reveals lymphocytosis. Which of the following media could be used to culture the causal organism?]]
Answer A	AnswerA::Eaton’s Agar
Answer A Explanation	[[AnswerAExp::Eaton’s agar is used to culture Mycoplasma pneumoniae.]]
Answer B	AnswerB::Charcoal yeast extract
Answer B Explanation	[[AnswerBExp::Charcoal yeast extract is used to culture Legionella pneumophila.]]
Answer C	AnswerC::Tellurite agar
Answer C Explanation	[[AnswerCExp::Tellurite agar is used to culture Corynebacterium diphtheriae.]]
Answer D	AnswerD::Bordet-Genou agar
Answer D Explanation	[[AnswerDExp::Bordetella pertussis may be cultured on Bordet-Genou Agar.]]
Answer E	AnswerE::Lowenstein-Jensen
Answer E Explanation	[[AnswerEExp::Lowenstein-Jensen agar is used to culture Mycobacterium tuberculosis.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::The patient in this vignette is suffering from pertussis, or whooping cough, an infection caused by the organism Bordetella pertussis. The patient’s immigration history suggests that he did not receive routine vaccinations, placing him at higher risk for whooping cough, a very rare infection in USA and other developed countries due to the practice of routine vaccination (part of DTaP vaccine). Whooping cough is characterized by fits of paroxysmal coughing, and in 50% of patients an inspiratory “whoop” that can be appreciated as the patient attempts to draw air through a partially closed glottis. B. pertussis is a gram negative, aerobic coccobaccilus which can be cultured on Bordet-Genou agar. It is a highly infectious organism that is transmitted by direct contact of respiratory secretions or via airborne transmission of infected secretions. Pertussis has 3 stages: Catarrhal stage (7-10 days): non-specific symptoms, such as mild cough, rhinorrhea, and low-grade fever. Patients are most contagious in this stage. Paroxysmal stage (2-3 weeks): Paroxysmal coughing spells, especially at night Convalescent stage (several weeks): Gradual improvement of symptoms Lymphocytosis is frequently observed among patients with pertussis because pertussis toxin (PT), or lymphocyte-promoting factor (LPF), induced by the organism, causes lymphocytosis, IL-4, and IgE secretion due to impaired entry of lymphocytes into lymph nodes and blockage of lymphocyte extravasation. The treatment of pertusses includes supportive therapy and antibiotics, especially early in the course of the disease. Antibiotics may not be helpful if prescribed more than 3 weeks of illness. Other household family members may be prescribed a 14-day course of prophylactic erythromycin. Educational Objective: Bordetella pertussis causes whooping cough and is cultured on Bordet-Genou agar. References: Mu HH, Cooley MA, Sewell WA. Studies on the lymphocytosis induced by pertussis toxin. Immunol Cell Biol. 1994;72(3):267-70. First Aid 2014 page 122]]
Approved	Approved::Yes
Keyword	WBRKeyword::Microbiology, WBRKeyword::Respiratory, WBRKeyword::Cough, WBRKeyword::Bacteria, WBRKeyword::Laboratory
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::