Brucellosis, meloidosis, whooping cough, legionnairres

Question 1

Brucellosis
• Brucellosis is a bacterial disease caused by various —— species, which mainly infect ——, ——-, ——-, ——- and ——-.

Answer 1

• Brucellosis is a bacterial disease caused by various Brucella species, which mainly infect cattle, swine, goats, sheep and dogs.

Question 2

Brucellosis.
• Humans generally acquire the disease through

Answer 2

.
• Humans generally acquire the disease through direct contact with infected animals, by eating or drinking contaminated animal products, or by inhaling airborne agents.

Question 3

Brucellosis
• The majority of cases are caused by ingesting ——— or ——- from infected goats or sheep.

Answer 3

.
• The majority of cases are caused by ingesting unpasteurized milk or cheese from infected goats or sheep.

Question 4

Brucellosis.
• Person-to-person transmission is common. T or F
.

Answer 4

F •.
• Person-to-person transmission is rare.

Question 5

Brucellosis
• The disease causes — -like symptoms, including ——-, ———, ——— and ——-.

Answer 5

• The disease causes flu-like symptoms, including fever, weakness, malaise and weight loss.

Question 6

• Breathing in the bacteria that causes brucellosis can not lead to infection.
T or F

Answer 6

F • Breathing in the bacteria that causes brucellosis may also lead to infection.

Question 7

Brucellosis .
• This risk is generally greater for people in ——— that work with the bacteria.
• In addition, ——— and ———employees have also been known to be exposed to the bacteria and ultimately become infected.
• ——— injuries have been implicated

Answer 7

• This risk is generally greater for people in laboratories that work with the bacteria.
• In addition, slaughterhouse and meat-packing employees have also been known to be exposed to the bacteria and ultimately become infected.
• Inoculation injuries have been implicated

Question 8

Brucellosis
List the Populations at Risk

Answer 8

Populations at Risk
• Occupational disease
– Cattle ranchers/dairy farmers – Veterinarians
– Abattoir workers
– Meat inspectors
– Lab workers
• Hunters
• Travelers
• Consumers
– Unpasteurized dairy products

Question 9

Brucella spp.
• Gram positive coccobacillus T or F
– ———- organism
• ——- species
– Associated with certain hosts
• Environmental persistence; include:

Answer 9

Brucella spp.
F • Gram negative coccobacillus
– Facultative, intracellular organism
• Multiple species
– Associated with certain hosts
• Environmental persistence
– Withstands drying
– Temperature, pH, humidity
– Frozen and aborted materials, dust, soil

Question 10

Brucellosis
Clinical presentation include:

Answer 10

Clinical presentation
• fever
• sweats
• malaise
• anorexia
• headache
• pain in muscles, joint, and/or back
• fatigue
• Some signs and symptoms may persist for longer periods of time. Others may never go away or reoccur.

Question 11

Brucellosis

Disease in Humans
• Incubation period
– Variable;—— to ——
• Multisystemic
– Any organ or organ system
– ——- fever
• Flu-like illness
– May wax and wane
– Chronic illness not possible T or F

Answer 11

Disease in Humans • Incubation period
– Variable; 5 days to three months
• Multisystemic
– Any organ or organ system – Cyclical fever
• Flu-like illness
– May wax and wane
– F - Chronic illness possible

Question 12

Brucellosis
Diagnosis in Humans
• Isolation of organism
– ——-, ———, other tissues
• Serum agglutination test
– —- -fold or —— in titer
– Samples how many weeks apart
• Immunofluorescence
– Organism in —— specimens
• ——

Answer 12

Diagnosis in Humans • Isolation of organism
– Blood, bone marrow, other tissues
• Serum agglutination test
– Four-fold or greater rise in titer – Samples 2 weeks apart
• Immunofluorescence
– Organism in clinical specimens
• PCR

Question 13

Brucellosis
Treatment of Choice
• Combination therapy
– Doxycycline —mg bd for — weeks + streptomycin —g/d im for — wk or rifampicin —mg/d for — wk
– In pregnancy: ———+ ———

• CNS cases treat — to — months
– Same for ———- cases plus surgical replacement of ———

Answer 13

Treatment of Choice • Combination therapy
– Doxycycline 100mg bd for 6 weeks + streptomycin 1g/d im for 2 wk or rifampicin 600mg/d for 6 wk
– In pregnancy: rifadin+ co-trimoxazole
• CNS cases treat 6-9 months
– Same for endocarditis cases plus surgical replacement of valves

Question 14

Brucellosis
Treatment of Choice
• Combination therapy include

Answer 14

– Doxycycline 100mg bd for 6 weeks + streptomycin 1g/d im for 2 wk or rifampicin 600mg/d for 6 wk

Question 15

Brucellosis
Prognosis
• Rarely fatal if treated
– Case-fatality rate <—% (untreated)
– ——— necessary
– Death usually caused by ———, ——-
• About —% of treated cases relapse
– Failure to complete treatment
– Infections requiring surgical intervention

Answer 15

Prognosis
• Rarely fatal if treated
– Case-fatality rate <2% (untreated)
– Antibiotics necessary
– Death usually caused by endocarditis, meningitis
• About 5% of treated cases relapse
– Failure to complete treatment
– Infections requiring surgical intervention

Question 16

Prevention and Control
• Education about risk of transmission to which people?

• Wear proper attire if dealing with infected animals/ tissues like:
———, ——-, ——-
• Avoid consumption of ———products

Prevention and Control
• Immunize in areas of high prevalence
– ——— and ——
– -
– there’s a human vaccine T or F
• Eradicate reservoir
– Identify, segregate, or cull
infected animals

Answer 16

Prevention and Control • Education about risk of transmission
– Farmer, veterinarian, abattoir worker, butcher, consumer, hunter, public
• Wear proper attire if dealing with infected animals/ tissues
– Gloves, masks, goggles
• Avoid consumption of raw dairy products

Prevention and Control
• Immunize in areas of high prevalence
– Young goats and sheep
– Calves
– F -No human vaccine
• Eradicate reservoir
– Identify, segregate, or cull
infected animals

Question 17

Meliodosis
Background
• Causatitive organism - ———-
• Gram-——- bacillus and potential ——— agent
• Prevalent in ———-
• characterized by ———, —— formation
• Mortality of up to ——%
• Melioidosis mainly affects individuals who are in regular contact with —— and ——.

Answer 17

Background
• Causatitive organism - Burkholderia pseudomallei
• Gram-negative bacillus and potential bioterror threat agent
• Prevalent in south-east Asia
• characterized by sepsis, abscess formation
• Mortality of up to 40%
• Melioidosis mainly affects individuals who are in regular contact with soil and water.

Question 18

Meliodosis
background
• what can reduce morbidity and mortality significantly1
• It is a predominantly seasonal disease with how many of cases present during the —— season.

Answer 18

background
• Early detection and adequate treatment of melioidosis can reduce morbidity and mortality significantly1
• It is a predominantly seasonal disease with three-quarter of cases present during the rainy season.
• Early detection and adequate treatment of melioidosis can reduce morbidity and mortality significantly

Question 19

Meliodosis
Epidemiology
• The known hot spots of melioidois are located in Northern Territory in ——— and ———, where annual incidence is up to —— cases per ——- persons
• Other foci however have been identified recently – most importantly the well documented emergence of melioidosis in ——-.
• The global burden of melioidosis is estimated to be around ——- human melioidosis cases per year worldwide, from which ——— people die

Answer 19

Epidemiology
• The known hot spots of melioidois are located in Northern Territory in Australia and northeast Thailand, where annual incidence is up to 50 cases per 100,000 persons
• Other foci however have been identified recently – most importantly the well documented emergence of melioidosis in Brazil5.
• The global burden of melioidosis is estimated to be around 165,000 human melioidosis cases per year worldwide, from which 89,000 people die

Question 20

Meliodosis in Africa
• Reported patients with melioidosis in Africa are few and isolated,
• Under ——- and under ——-.
• However, the isolated case reports on the presence of B. pseudomallei in the soil and animals in —— and —— Africa (amongst others in Nigeria, ——, Kenya, ——-, and Gabon)

Answer 20

Meliodosis in Africa
• Reported patients with melioidosis in Africa are few and isolated,
• Under recognition and under reporting.
• However, the isolated case reports on the presence of B. pseudomallei in the soil and animals in East and West Africa (amongst others in Nigeria, The Gambia, Kenya, Uganda, and Gabon)

Question 21

Meliodosis
Laboratory diagnosis
• oxidase-——, Gram-——bacteria that are not Pseudomonas aeruginosa are further tested to determine whether they are B. pseudomallei by using —— and ——- methods.

Answer 21

Laboratory diagnosis
• oxidase-positive, Gram-negative bacteria that are not Pseudomonas aeruginosa are further tested to determine whether they are B. pseudomallei by using subculture and identification methods.
,

Question 22

Meliodosis
Laboratory diagnosis
• B. pseudomallei will be identified by colony morphology (———), (positive/negative?) oxidase test result, inability to as similate ——-,
• antimicrobial drug susceptibility (resistant to ——- and —— and susceptible to ——— ——- acid)

Answer 22

• B. pseudomallei will be identified by colony morphology (metallic sheen), positive oxidase test result, inability to as similate arabinose,
• antimicrobial drug susceptibility (resistant to gentamicin and colistin and susceptible to amoxicillin-clavulanic acid)

Question 23

Meliodosis
Laboratory diagnosis
• B. pseudomallei–specific latex-agglutination.
• The latex agglutination is slow , complex to learn and expensive T or F

Answer 23

• B. pseudomallei–specific latex-agglutination.
F • The latex agglutination is rapid, simple to learn and inexpensive

Question 24

Is indirect haemagglutination assay (IHA) a laboratory diagnosis for Meliodosis?

Answer 24

Yes

Question 25

Pertussis
• Pertussis is a very contagious respiratory infection commonly known as ‘———-’.
• It is caused by the bacterium-———
• It was one of the most common ——— disease world wide before vaccines became widely available
• In developing countries, the average case fatality rate (CFR) for pertussis has been estimated at almost —% in infants aged <— year and at —% in children aged — to —years
• Large scale ——— programmes were associated with a steep decline in the number of pertussis cases and deaths in children
• Despite high vaccination coverage (in the year—-, —% coverage with — doses of a pertussis containing vaccine), pertussis remains ——— in all countries and continues to be a public health concern

Answer 25

Pertussis (whooping cough)
• Pertussis is a very contagious respiratory infection commonly known as ‘whooping cough’.
• It is caused by the bacterium- Bordetella pertussis
• It was one of the most common childhood disease world wide
before vaccines became widely available
• In developing countries, the average case fatality rate (CFR) for pertussis has been estimated at almost 4% in infants aged <1 year and at 1% in children aged 1–4 years
• Large scale vaccination programmes were associated with a steep decline in the number of pertussis cases and deaths in children
• Despite high vaccination coverage (in 2014, 86% coverage with 3 doses of a pertussis containing vaccine), pertussis remains endemic in all countries and continues to be a public health concern

Question 26

Epidemiology of Pertussis
Mode of transmission
■ Person to person via
– ——— from —— or ——-
– Direct contact with ——— from respiratory tract of infectious person
■ —% - secondary attack rate
■ Older children and adults are important sources of disease for ——- and ——-
■ Infants <— months of age greatest risk for complications and death

Answer 26

Epidemiology of Pertussis
Mode of transmission
■ Person to person via
– Aerosolized droplets from cough or sneeze
– Direct contact with secretions from respiratory tract of infectious person
■ 80% - secondary attack rate
■ Older children and adults are important sources of disease for infants and young children
■ Infants <12 months of age greatest risk for complications and death

Question 27

Pertussis
Spread
• Close person to person contact via aerosolized droplets from ———of patients with disease
• —% of nonimmune household contacts acquire the disease
• Adolescents and adults (—% of reported cases in 2004) are the major source of infection in ——- children
• Infants and young children are infected by older siblings who have ——- to ——- disease (—-% of reported cases)

Answer 27

Spread
• Close person to person contact via aerosolized droplets from respiratory secretions of patients with disease
• 90% of nonimmune household contacts acquire the disease
• Adolescents and adults (27% of reported cases in 2004) are the major source of infection in unvaccinated children
• Infants and young children are infected by older siblings who have mild to asymptomatic disease (43% of reported cases)

Question 28

Pertussis
Clinical presentation
• Mostly ——— disease
• Incubation period of — to —day
• Patients develop ——- symptoms, including cough with characteristic “——”
• Cough is particularly severe at ——— and frequently followed by ———
• In very young infants, pertussis may initially present as ——- and ——-
• In previously immunized adolescents and adults, a persistent cough may be the only manifestation, without the characteristic “——-”

Answer 28

Clinical presentation
• Mostly childhood disease
• Incubation period of 9–10 day
• Patients develop catarrhal symptoms, including cough with characteristic “whoop”
• Cough is particularly severe at night and frequently followed by vomiting
• In very young infants, pertussis may initially present as apnea and cyanosis
• In previously immunized adolescents and adults, a persistent cough may be the only manifestation, without the characteristic “whoop”

Question 29

Pertussis
Clinical presentation
•pertussis is a — -week disease divided into ——, ——, and ——- stages, each lasting from — to — weeks.
• Older children, adolescents, and adults may not exhibit distinct stages. Symptoms in these patients include ———-, feelings of ———- or ——-, and ———-
• The cough can last for — to —weeks. It has been called the “———-.”
• How long a person is ill depends on ——-, other health conditions, and whether antibiotic treatment is given in the —— stage of illness.

Answer 29

Clinical presentation
• Pertussis is a 6-week disease divided into catarrhal, paroxysmal, and convalescent stages, each lasting from 1-2 weeks.
• Older children, adolescents, and adults may not exhibit distinct stages. Symptoms in these patients include uninterrupted coughing, feelings of suffocation or strangulation, and headaches
• The cough can last for 6-10 weeks. It has been called the “100 day cough.”
• How long a person is ill depends on age, other health conditions, and whether antibiotic treatment is given in the early stage of illness.

Question 30

Pertussis Laboratory Testing
1.) Culture
Specimen:
Advantages:
Disadvantages:

2.) PCR
Specimen:
Advantages:
Disadvantages:
Comments:

3.) DFA
Specimen:
Disadvantages:
Comment:

4.) serology
Specimen:
Advantages:
Disadvantages:
Comment:

Answer 30

Pertussis Laboratory Testing
1.) Culture
Specimen: NP Swabs or aspirates
Advantages:•Gold standard
•100% Specific
Disadvantages:•Relativelv insensitive
•Difficult to isolate
•Most successful during
the catarrhal stage
•Takes 7-10 days to get
the result

2.) PCR
Specimen: NP Swabs or aspirates
Advantages: Results available quickly
Disadvantages:- Sensitivity & specificity
Varies
-•Calcium alginate swabs
cannot be used to collect
NP swabs for PCR
Comments: Use with culture

3.) DFA
Specimen: NP Swab
Advantages: Rapid results
Disadvantages: •Not confirmatory
No use for surveillance
Comment: Use with culture and/or PCR

4.) serology
Specimen: blood
Advantages:
Disadvantages: -No standardized test
available
-No use for Surveillance
Comment: Use with culture and/or PCR

Question 31

Pertussis

Laboratory Criteria for Diagnosis
■
■

Answer 31

Laboratory Criteria for Diagnosis
■ Isolation of Bordetella pertussis from a clinical specimen (Culture)
■ Positive polymerase chain reaction (PCR) assay for B. pertussis DNA

Question 32

Pertussis Complications
.

Answer 32

Pertussis Complications
■ Syncope (temporary loss of consciousness/faint)
■ Sleep disturbance
■ Incontinence
■ Rib fractures
■ Complications among infants – Pneumonia (22%)
– Seizures (2%)
– Encephalopathy (<0.5%)
■ Death
– Infants, particularly those who have not received a primary
vaccination series, are at risk for complications and mortality.

Question 33

Pertussis

■ Complications among infants

Answer 33

– Pneumonia (22%)
– Seizures (2%)
– Encephalopathy (<0.5%)

Question 34

Pertussis

■ Complications among infants
– Pneumonia (—%)
– Seizures (—%)
– Encephalopathy (<—%)

Answer 34

■ Complications among infants
– Pneumonia (22%)
– Seizures (2%)
– Encephalopathy (<0.5%)

Question 35

Pertussis
Treatment
• Aim is to eradicate ————
• Treatment duration usually — days with ———, newer ——— for — to — days

Answer 35

Treatment
• Aim is to eradicate nasopharyngeal carriage
• Treatment duration usually 14 days with erythromycin sulfate (EES), newer Macrolides 5-7 days

Question 36

Pertussis
Treatment
• Macrolides-examples:
• ——— eradicates naso-pharyngeal carriage the fastest
• Hypertrophic pyloric stenosis has been reported with oral ——- in infants younger than — weeks
• ———— is an alternative to erythromycin-resistant strain, or for intolerance to ———
• Penicillins, first and second generation cephalosporins are effective.T or F

Answer 36

Treatment
• Macrolides-erythromycin, azithromycin, and clarithromycin
• Azithromycin eradicates naso-pharyngeal carriage the fastest
• Hypertrophic pyloric stenosis has been reported with oral EES in infants younger than 6 weeks
• Trimethoprim-sulfamethoxazole is an alternative to erythromycin-resistant strain, or for intolerance to macrolides
F • Penicillins, first and second generation cephalosporins are not effective

Question 37

Pertussis
Immunisation
• Two types of pertussis vaccines are available which are

Answer 37

Immunisation
• Two types of pertussis vaccines are available:
– Whole-cell (wP) vaccines based on killed B. pertussis organisms
– Acellular (aP) vaccines based on one or more highly purified individual pertussis antigens

Question 38

Pertussis
Immunisation
• Two types of pertussis vaccines are available:
– Whole-cell (wP) vaccines based on ————-
– Acellular (aP) vaccines based on ———-

• The wP vaccines were introduced in mid-20th century and included in the Expanded Programme on Immunization since ———
• Many high-income countries have replaced — with —- vaccines as a means of decreasing the ———- of the vaccine
• Pertussis vaccines are produced as combinations with other antigens;;
-stand-alone pertussis vaccines are currently available T or F

Answer 38

Immunisation
• Two types of pertussis vaccines are available:
– Whole-cell (wP) vaccines based on killed B. pertussis organisms
– Acellular (aP) vaccines based on one or more highly purified individual pertussis antigens
• The wP vaccines were introduced in mid-20th century and included in the Expanded Programme on Immunization since 1974
• Many high-income countries have replaced wP with aP vaccines as a means of decreasing the reactogenicity of the vaccine
• Pertussis vaccines are produced as combinations with other antigens;;
F- no stand-alone pertussis vaccines are currently available

Question 39

Pertussis

WHO recommendations
• WHO recommends a how many -dose primary series, with the first dose administered at — weeks of age;; subsequent doses should be given— to —weeks apart
• The series should be completed by — months of age;; for those who have not completed the schedule, vaccine may be given later than — months of age, at the earliest opportunity
• For children whose vaccination series has been interrupted, the series should be resumed without repeating previous doses T or F
• A booster dose is recommended for children aged — to —years, preferably during the —— year of life

Answer 39

WHO recommendations
• WHO recommends a 3-dose primary series, with the first dose administered at 6 weeks of age;; subsequent doses should be given 4–8 weeks apart
• The series should be completed by 6 months of age;; for those who have not completed the schedule, vaccine may be given later than 6 months of age, at the earliest opportunity
• For children whose vaccination series has been interrupted, the series should be resumed without repeating previous doses
• National programmes using alternate primary vaccination schedules with adequate surveillance should continue using these schedules and continue to monitor disease trends
• A booster dose is recommended for children aged 1–6 years, preferably during the second year of life

Question 40

Legionella pneumophila
• Small, gram-———bacillus
• ———— producer
• Enters and replicates inside ————
• Causative agent of “———- disease”
• Fulminant ———- syndrome
• Historically associated with contaminated ——- in ———systems
• ————— test for diagnosis

Answer 40

Legionella pneumophila
• Small, gram-negative bacillus
• Beta-lactamase producer
• Enters and replicates inside macrophages • Causative agent of “Legionnaire’s disease”
• Fulminant pneumonia syndrome
• Historically associated with contaminated
water in air-conditioning systems • Urinary antigen test for diagnosis

Question 41

Legionella
Key facts- WHO
• The bacterium L. pneumophila was first identified in ——, as the cause of an outbreak of severe pneumonia in a convention centre in the USA in ——.
• The most common form of transmission of Legionella is———-
• Infection can also occur by aspiration of contaminated —— or ——, particularly in susceptible hospital patients.

Answer 41

Key facts- WHO
• The bacterium L. pneumophila was first identified in 1977, as the cause of an outbreak of severe pneumonia in a convention centre in the USA in 1976.
• The most common form of transmission of Legionella is inhalation of contaminated aerosols produced in conjunction with water sprays, jets or mists
• Infection can also occur by aspiration of contaminated water or ice, particularly in susceptible hospital patients.

Question 42

Legionella
Key facts - WHO
• Legionnaires’ disease has an incubation period of — to — days (but up to — days has been recorded in some outbreaks).
• Death occurs through progressive pneumonia with ——- failure and/or —- and ———- failure.
• Untreated Legionnaires’ disease usually worsens during the —— week.
• Of the reported cases — to —% are over — years and — to — % are (male/female?)

Answer 42

Key facts - WHO
• Legionnaires’ disease has an incubation period of 2 to 10 days (but up to 16 days has been recorded in some outbreaks).
• Death occurs through progressive pneumonia with respiratory failure and/or shock and multi-organ failure.
• Untreated Legionnaires’ disease usually worsens during the first week.
• Of the reported cases 75–80% are over 50 years and 60–70% are male.

Question 43

Legionella
Legionellosis varies in severity from a mild —— illness to a serious and sometimes fatal form of ——- and is caused by exposure to Legionella species found in ——-, and ——
It is often categorized as being ——-, ——- or ——— acquired based on the type of exposure
———— Legionella pneumophila is the most common cause of cases including outbreaks
Legionella pneumophila and related species are commonly found in ———, ———, ——-, hot springs and other bodies of water
Other species including L. longbeachae can be found in ——-
Legionella can survive and grow as parasites within free-living ——— and within ——- which develop in water systems

Answer 43

•
• • •
•
•
Legionellosis varies in severity from a mild febrile illness to a serious and sometimes fatal form of pneumonia and is caused by exposure to Legionella species found in water, and soil
It is often categorized as being community, travel or hospital acquired based on the type of exposure
Waterborne Legionella pneumophila is the most common cause of cases including outbreaks
Legionella pneumophila and related species are commonly found in lakes, rivers, creeks, hot springs and other bodies of water
Other species including L. longbeachae can be found in soil
Legionella can survive and grow as parasites within free-living protozoa and within biofilms which develop in water systems

Question 44

Legionella
Risk factors
For community-acquired and travel-associated legionellosis include:

For hospital-acquired pneumonia are:

The most susceptible hosts are ———- patients, including ———— recipients and ——— patients and those receiving ————- treatment.
Delay in ———- and administration of appropriate ——— treatment, increasing —— and presence of ——- are predictors of death from Legionnaires’ disease

Answer 44

Risk factors
For community-acquired and travel-associated legionellosis include: smoking,
heavy drinking
pulmonary-related illness
immuno-suppression
chronic respiratory or renal illnesses.

For hospital-acquired pneumonia are:
recent surgery
intubation
mechanical ventilation aspiration
presence of nasogastric tubes
use of respiratory therapy equipment

The most susceptible hosts are immuno-compromised patients, including organ transplant recipients and cancer patients and those receiving corticosteroid treatment.
Delay in diagnosis and administration of appropriate antibiotic treatment, increasing age and presence of co-existing diseases are predictors of death from Legionnaires’ disease

Question 45

Legionella

Symptons
1.) The non-pneumonic form (——- disease) is an acute, self-limiting influenza-like illness usually lasting — to — days. The incubation period is from a few and up to —- hours
• symptoms of the non pneumonic form includes:

2.) ————’ disease, the pneumonic form, has an incubation period of — to —- days
symptoms are:
• Some patients may also have mild cough, ———, ——— and ———.
Blood-streaked phlegm or hemoptysis occurs in about how many of the patients
• The severity of disease ranges from a ——- to a rapidly fatal ———. Death occurs through progressive pneumonia with respiratory failure and/or shock and multi-organ failure

Answer 45

Symptons
• The non-pneumonic form (Pontiac disease) is an acute, self-limiting influenza-like illness usually lasting 2–5 days. The incubation period is from a few and up to 48 hours
• fever, chills, headache, malaise and muscle pain (myalgia)
• Legionnaires’ disease, the pneumonic form, has an incubation period of 2 to 10 days symptoms are fever, loss of appetite, headache, malaise and lethargy
• Some patients may also have mild cough, muscle pain, diarrhoea and confusion. Blood-streaked phlegm or hemoptysis occurs in about one-third of the patients
• The severity of disease ranges from a mild cough to a rapidly fatal pneumonia. Death occurs through progressive pneumonia with respiratory failure and/or shock and multi-organ failure

Question 46

Legionella

Laboratory diagnosis
• culture of ———— on selective media and the Legionella ————- test
• ————— agar) is confirmatory and an important method for diagnosis
• Isolation of Legionella can come from:

• Culturing specimens can detect Legionella species and serogroups that the ———— test does not.
• The urinary antigen test can detect Legionella infections in some cases for d—— to —— after treatment

Answer 46

Laboratory diagnosis
• culture of lower respiratory secretions (e.g., sputum, bronchoalveolar lavage) on selective media and
the Legionellaurinary antigen test
• Buffered Charcoal Yeast Extract [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 urinary antigen test does not.
• The urinary antigen test can detect Legionella infections in some cases for days to weeks after treatment

Question 47

Legionella
Test
1.) Culture
Sensitivity%:
Specificity%:

2.) Urinary antigen for L. pneumophila serogroup’ (Lp1)
Sensitivity%:
Specificity%:

3.) Polymerase Chain Reaction (PCR)
Sensitivity%:
Specificity%:

4.) Direct Fluorescent Antibody (DA) Stain
Sensitivity%:
Specificity%:

5.) Paired serology
Sensitivity%:
Specificity%:

Answer 47

Test
1.) Culture
Sensitivity: 20-80
Specificity: 100

2.) Urinary antigen for L. pneumophila serogroup’ (Lp1)
Sensitivity: 70-100
Specificity: 95-100

3.) Polymerase Chain Reaction (PCR)
Sensitivity: 95-99
Specificity: >99

4.) Direct Fluorescent Antibody (DA) Stain
Sensitivity: 25-75
Specificity: >95

5.) Paired serology
Sensitivity: 80-90
Specificity: >99

Question 48

Legionella
Prevention include;

Answer 48

Prevention
• Implementing water safety plans
• Good maintenance of devices, including regular cleaning and disinfection and applying other physical (temperature) or chemical measures (biocide) to minimize growth