Brucellosis, Meloidisis, Whooping Cough, Legionnaires Flashcards by Iseoluwa Ojo

Brucellosis is a bacterial disease caused by various Brucella species, which mainly infect ________________________

cattle, swine, goats, sheep and dogs.

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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.

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Brucellosis

The majority of cases are caused by _______________________________

ingesting unpasteurized milk or cheese from infected goats or sheep.

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Brucellosis

Person-to-person transmission is (common or rare?) .

Rare

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Brucellosis

The disease causes _____-like symptoms, including ______,_______,______, and ________

flu

fever, weakness, malaise and weight loss.

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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

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brucellosis

In addition, slaughterhouse and meat- packing employees have also been known to be exposed to the bacteria and ultimately become infected.

T/F

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brucellosis

Inoculation injuries have been implicated

T/F

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Brucella spp.

Gram (positive or negative?) (cocci or bacilli?)

Facultative, _____cellular organism

Negative ; coccobacillus

intra

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Brucella spp.

Multiple species
– Associated with certain hosts

Environmental persistence – Withstands ______
– Temperature, pH, humidity
– ______ and _______ materials, dust, soil

drying

Frozen and aborted

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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.

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•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

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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

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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

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Prognosis of brucellosis

(Commonly or Rarely?) fatal if treated

Case-fatality rate _____% (untreated)

–________ are necessary

Death usually caused by _______,______

Rarely

Antibiotics

endocarditis, meningitis

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Prognosis of brucellosis

About _____% of treated cases relapse due to _________________ or Infections requiring ___________

Failure to complete treatment

surgical intervention

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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

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Prevention and control of brucellosis

_________ in areas of high prevalence

Eradicate _______

Immunize

reservoir

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There’s No human vaccine for brucellosis

T/F

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Meliodosis

Background
Causatitive organism - _________ _______

Prevalent in __________

Burkholderia pseudomallei

south-east Asia

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Meliodosis

Background

Gram-_________ (cocci or bacillus?)

A potential _________

Negative ; bacillus

bioterror terrò threat

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Meliodosis

Background

characterized by ______ ,________

Mortality of up to _____%

sepsis, abscess formation

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Meliodosis

Background

Melioidosis mainly affects individuals who are in regular contact with ______ and _____

soil and water.

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Meliodosis
Early detection and adequate treatment of melioidosis can reduce morbidity and mortality significantly1

T/F

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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

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

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