Brucellosis, Meloidisis, Whooping Cough, Legionnaires Flashcards
Brucellosis is a bacterial disease caused by various Brucella species, which mainly infect ________________________
cattle, swine, goats, sheep and dogs.
Brucellosis
Humans generally acquire the disease through _______ with _______, by ________ or ______ contaminated animal products, or by ___________
direct contact
infected animals
eating or drinking
inhaling airborne agents.
Brucellosis
The majority of cases are caused by _______________________________
ingesting unpasteurized milk or cheese from infected goats or sheep.
Brucellosis
Person-to-person transmission is (common or rare?) .
Rare
Brucellosis
The disease causes _____-like symptoms, including ______,_______,______, and ________
flu
fever, weakness, malaise and weight loss.
brucellosis
__________ the bacteria that causes brucellosis may also lead to infection.
This risk is generally greater for people in _______ that _____ with the bacteria.
Breathing in
laboratories
work
brucellosis
In addition, slaughterhouse and meat- packing employees have also been known to be exposed to the bacteria and ultimately become infected.
T/F
T
brucellosis
Inoculation injuries have been implicated
T/F
T
Brucella spp.
Gram (positive or negative?) (cocci or bacilli?)
Facultative, _____cellular organism
Negative ; coccobacillus
intra
Brucella spp.
Multiple species
– Associated with certain hosts
Environmental persistence – Withstands ______
– Temperature, pH, humidity
– ______ and _______ materials, dust, soil
drying
Frozen and aborted
Brucellosis Clinical presentation
fever
sweats
malaise
anorexia
headache
pain in muscles, joint, and/or back fatigue
Some signs and symptoms may ________________. Others may ________ or _______
persist for longer periods of time
never go away or reoccur.
•Disease in Humans
•Incubation period
– Variable; _______ to _______
•Multisystemic
– Any organ or organ system
–_______ fever
•Flu-like illness
– May ____ and ______
– Chronic illness possible
5 days to three months
Cyclical; wax and wane
Diagnosis in Humans(Brucellosis)
Isolation of organism
–_____,______, other tissues
Serum agglutination test
–____________ or _________
– Samples ________ apart
Immunofluorescence
– Organism in clinical specimens
• •
PCR
Blood, bone marrow
Four-fold or greater rise in titer
2 weeks
Treatment of Choice for brucellosis
Combination therapy
–________ for ____ weeks + _______ for ____ wk or ________ for __ wk
– In pregnancy: ______ +_________
CNS cases treat for _________
– Same for ________ cases plus surgical _______
Doxycycline; 6
streptomycin; 2
rifampicin; 6
rifadin; co-trimoxazole
6-9 months; endocarditis ; replacement of valves
Prognosis of brucellosis
(Commonly or Rarely?) fatal if treated
Case-fatality rate _____% (untreated)
–________ are necessary
Death usually caused by _______,______
Rarely
<2
Antibiotics
endocarditis, meningitis
Prognosis of brucellosis
About _____% of treated cases relapse due to _________________ or Infections requiring ___________
5
Failure to complete treatment
surgical intervention
Prevention and Control of brucellosis
________ about risk of transmission
__________ if dealing with infected animals/ tissues
Avoid ________________
Education
Wear proper attire
consumption of raw dairy products
Prevention and control of brucellosis
_________ in areas of high prevalence
Eradicate _______
Immunize
reservoir
There’s No human vaccine for brucellosis
T/F
T
Meliodosis
Background
Causatitive organism - _________ _______
Prevalent in __________
Burkholderia pseudomallei
south-east Asia
Meliodosis
Background
Gram-_________ (cocci or bacillus?)
A potential _________
Negative ; bacillus
bioterror terrò threat
Meliodosis
Background
characterized by ______ ,________
Mortality of up to _____%
sepsis, abscess formation
40
Meliodosis
Background
Melioidosis mainly affects individuals who are in regular contact with ______ and _____
soil and water.
Meliodosis
Early detection and adequate treatment of melioidosis can reduce morbidity and mortality significantly1
T/F
T
Meliodosis
It is a predominantly seasonal disease with three-quarter of cases present during the ______ season.
rainy
Meliodosis
The known hot spots of melioidois are located in _________ in ________ and _______, where annual incidence is up to ___ cases per 100,000 persons
Northern Territory in Australia and northeast Thailand
50
Meliodosis
Other foci however have been identified recently – most importantly the well documented emergence of melioidosis in ________.
Brazil5
Meliodosis
The global burden of melioidosis is estimated to be around ________ human melioidosis cases per year worldwide, from which _________ people die
165,000
89,000
Meliodosis in Africa
Reported patients with melioidosis in Africa are (numerous or few?) and _______
Due to _________ and _________
However, the isolated case reports on the presence of B. pseudomallei in the soil and animals in East and West Africa (amongst others in ______, The Gambia, Kenya, Uganda, and Gabon)
Few; isolated
Under recognition and under reporting.
Nigeria
Meliodosis: Laboratory diagnosis
oxidase-(positive or negative?) , Gram-(positive or negative?) bacteria that are not __________ are further tested to determine whether they are B. pseudomallei by using ______ and identification methods.
positive; negative
Pseudomonas aeruginosa
subculture
Meliodosis: Laboratory diagnosis
B. pseudomallei will be identified by colony morphology (_______), ________ oxidase test result, inability to assimilate __________, antimicrobial drug susceptibility
metallic sheen
positive; arabinose
Meliodosis: Laboratory diagnosis
antimicrobial drug susceptibility:
resistant to ________ and ______ and susceptible to _________
B. pseudomallei–specific ____________ which is (slow or rapid?)c (simple or complex?) to learn and (expensive or inexpensive?)
indirect haemagglutination assay (IHA),
gentamicin and colistin
amoxicillin-clavulanic acid
latex-agglutination.; rapid; simple
Inexpensive
Pertussis
Pertussis is a (mildly or highly?) contagious respiratory infection commonly known as ‘______________’.
highly
whooping cough
Pertussis (whooping cough)
It is caused by the bacterium- ________
It was one of the most common ______ disease world wide before
_______ became widely available
Bordetella pertussis
Childhood ; vaccines
Pertussis (whooping cough)
In developing countries, the average case fatality rate (CFR) for pertussis has been estimated at almost ___% in infants aged <1 year and at ____% in children aged 1–4 years
4
1
Large scale vaccination programmes were associated with a steep decline in the number of pertussis cases and deaths in children
T/F
T
Pertussis (whooping cough)
Despite high vaccination coverage (in 2014, 86% coverage with ___ doses of a pertussis containing vaccine), pertussis remains ________________ and continues to be a public health concern
3
endemic in all countries
Epidemiology of Pertussis Mode of transmission
Person to person via
–___________ from ____ or ______
– Direct contact with ________ from ________ of infectious person
Aerosolized droplets from cough or sneeze
secretions from respiratory tract
Epidemiology of Pertussis
____% - secondary attack rate
80
Epidemiology of Pertussis
________ and ______ are important sources of disease for _______ and ———
Older children and adults
infants and young children
Epidemiology of Pertussis
Infants <_________ of age greatest risk for complications and death
12 months
Clinical presentation of pertussis
Mostly _____hood disease
Incubation period of ______ day
Patients develop ______ symptoms, including _____ with characteristic “ ______ ”
child; 9–10
catarrhal; cough; whoop
Clinical presentation of pertussis
Cough is particularly severe at (day or night?) and frequently followed by ______
In very young infants, pertussis may initially present as ______ and _____
In previously immunized adolescents and adults, a ___________ may be the only manifestation, without the characteristic “whoop”
night; vomiting
apnea and cyanosis
persistent cough
Clinical presentation of pertussis
Pertussis is a ____-week disease divided into ______,_______, and ______ stages, each lasting from _____ weeks.
6
catarrhal, paroxysmal, and convalescent
1-2
Clinical presentation of pertussis
Older children, adolescents, and adults may not exhibit distinct stages.
Symptoms in these patients include ___________, feelings of ______ or _______, and ________
uninterrupted coughing
suffocation or strangulation, and headaches
Clinical presentation of pertussis
The cough can last for __________.
It has been called the “______ day cough.”
6-10 weeks
100
Clinical presentation of pertussis
How long a person is ill depends on _____, other health conditions, and whether ___________ is given in the _____ stage of illness.
age
antibiotic treatment
early
Gold standard for testing for pertussis in the laboratory is by??
Culture
Laboratory Criteria for Diagnosis of Pertussis
Isolation of Bordetella pertussis from a clinical specimen (_____)
Positive polymerase chain reaction (PCR) assay for B. pertussis DNA
Culture
Pertussis Complications
________
_____ disturbance
___________
_________
Complications among infants
Death
Syncope
Sleep
Incontinence
Rib fractures
Pertussis Complications
Complications among infants
________ (22%)
________(2%)
__________________(<0.5%)
Pneumonia
Seizures
Encephalopathy
Pertussis Complications
Death
_______, particularly those who _____________________, are at risk for complications and mortality.
Infants
have not received a primary vaccination series
Treatment of pertussis
Aim is to eradicate ________
Treatment duration usually _____ with _________ (EES), newer Macrolides _____ days
nasopharyngeal carriage
14 days; erythromycin sulfate
5-7
Macrolides-______ ,______,________
_________ eradicates naso-pharyngeal carriage in pertussis the fastest
erythromycin, azithromycin, and clarithromycin
Azithromycin
Treatment of pertussis
______________ has been reported with oral EES in infants younger than 6 weeks
______________ is an alternative to erythromycin-resistant strain, or for intolerance to macrolides
Hypertrophic pyloric stenosis
Trimethoprim-sulfamethoxazole
Penicillins, first and second generation cephalosporins are effective against pertussis
T/F
F
Penicillins, first and second generation cephalosporins are not effective
Two types of pertussis vaccines are available:
–_____________ vaccines
– _____________ vaccines
Whole-cell (wP)
Acellular (aP)
Two types of pertussis vaccines are available:
– Whole-cell (wP) vaccines based on ______________
– Acellular (aP) vaccines based on ____________________
killed B. pertussis organisms
one or more highly purified individual pertussis antigens
Pertussis
Many high-income countries have replaced _____ with _____ vaccines as a means of decreasing the _______ of the vaccine
wP
aP
reactogenicity
Pertussis vaccines are produced as ————————
combinations with other antigens
How many stand-alone pertussis vaccines are currently available
??
no stand-alone pertussis vaccines are currently available
PERTUSSIS: WHO
WHO recommends a ___-dose primary series
with the first dose administered at _______ of age;; subsequent doses should be given ________ apart
The series should be completed by ___________ of age
3
6 weeks
4–8 weeks
6 months
PERTUSSIS: WHO
for those who have not completed the schedule, vaccine may be given later than 6 months of age
T/F
T
at the earliest opportunity
PERTUSSIS: WHO
For children whose vaccination series has been interrupted, the series should be resumed by repeating previous doses
T/F
F
the series should be resumed without repeating previous doses
PERTUSSIS: WHO
A booster dose is recommended for children aged _________, preferably during the ______ year of life
1–6 years
second
Legionella pneumophilia causes ________ pneumonia
Atypical
Legionella pneumophila
(Small or large?), gram- ________ (cocci or bacillus?)
• Beta-________ producer
• Enters and replicates inside ________
Small; negative ; bacillus
lactamase
macrophages
Legionella pneumophila
• Causative agent of “________ disease”
•causes ________ pneumonia syndrome
Legionnaire’s
Fulminant
Legionella pneumophila
• Historically associated with __________ in air-conditioning systems
•_________ test for diagnosis
contaminated water
Urinary antigen
The most common form of transmission of Legionella is _________ of __________ produced in conjunction with water sprays, jets or mists
Infection can also occur by ________ of contaminated _________, particularly in __________- patients.
inhalation of contaminated aerosols
aspiration
water or ice
susceptible hospital
Legionnaires’ disease has an incubation period of _________ days (but up to 16 days has been recorded in some outbreaks).
2 to 10
Legionnaires’ disease
Death occurs through ________ with _______ failure and/or shock and ________ failure.
progressive pneumonia
respiratory
multi-organ
Legionnaires’ disease
Untreated Legionnaires’ disease usually worsens during the ________
first week.
Legionnaires’ disease
Of the reported cases 75–80% are over _____ years and 60–70% are (male or female?) .
50
Male
Legionellosis varies in severity from a ________ illness to a serious and sometimes fatal form of _______ and is caused by exposure to Legionella species found in ______ and ______
mild febrile
pneumonia
water, and soil
Legionellosis
It is often categorized as being ______,______, or _______ acquired based on the type of exposure
community, travel or hospital
Legionellosis
_________ Legionella pneumophila is the most common cause of cases including outbreaks
Waterborne
Legionella pneumophila and related species are commonly found in __________________________
Other species including L. __________ can be found in _____
lakes, rivers, creeks, hot springs and other bodies of water
longbeachae; soil
Legionella can survive and grow as parasites within free- living _______ and within ________ which develop in water systems
protozoa
biofilms
Symptoms of legionellosis
The non-pneumonic form (______ disease) is a/an (acute or chronic?) , self-limiting _____-like illness usually lasting _____ days. The incubation period is from a few and up to ______
Characterized by fever, chills, headache, malaise and muscle pain (myalgia)
Pontiac
Acute ; influenza
2–5 ; 48 hours
Symptoms of legionellosis
_________ disease, the pneumonic form, has an incubation period of __________
symptoms are fever, loss of appetite, headache, malaise and lethargy
Some patients may also have mild cough, muscle pain, diarrhoea and confusion.
_______ phlegm or ______ occurs in about one-third of the patients
Legionnaires’
2 to 10 days
Blood-streaked ; hemoptysis
Symptoms of legionellosis
Legionnaires’ disease, the pneumonic form
The severity of disease ranges from a _______ to a (slowly or rapidly?) fatal _______.
mild cough
Rapidly
pneumonia
Symptoms of legionellosis
Legionnaires’ disease
Death occurs through ______________ with ________ failure and/or shock and ______ failure
progressive pneumonia
Respiratory
Multi-organ
Laboratory diagnosis of legionella
______ of lower respiratory secretions (e.g., sputum, bronchoalveolar lavage) on selective media and the _________ test
Legionellaurinary antigen
Laboratory diagnosis of legionella
___________ [BCYE] agar) is confirmatory and an important method for diagnosis
Isolation of Legionella can come from lower respiratory secretions, lung tissue, pleural fluid, or a normally sterile site
Culturing specimens can detect Legionella species and serogroups that the __________ does not.
Buffered Charcoal Yeast Extract
urinary antigen test
Which is a more specific method of diagnosis of legionella
Culture or urinary antigen test
urinary antigen test
Which is a more sensitive method of diagnosis of legionella
Culture or urinary antigen test
Culture
The ________________ can detect Legionella infections in some cases for days to weeks after treatment
urinary antigen test
