Clinical Bacteriology

cells contain enzymes (NADases) that

Haemophilus and Other Fastidious Gram-Negative hydrolyze V factor.
Bacilli  Clinical laboratories use CHOC agar for the
recovery of Haemophilus spp. from clinical
Haemophilus spp. specimens.
General Characteristics  Gram-negative  The lysing of the red blood cells by heat in the
 Pleomorphic preparation of CHOC agar releases both the X
o Small factor and the V factor and inactivates
coccobacilli NADases
in direct Sattelitism  phenomenon that
smears of helps in the
clinical recognition of
samples Haemophilus spp.
o Long that require V
filaments factor is
from colony satellitism.
growth  occurs when
 Non-motile organisms, like
 Facultative Staphylococcus
anaerobic, aureus,
carbohydrate Streptococcus
fermenter pneumoniae, or
 Obligate parasites Neisseria spp.,
on mucous produces V factor
membranes of as a by-product of
humans and metabolism
animals  Haemophilus isolate obtains X factor from the
Spp. associated in 3 pathogenic spp. SBA and V factor from one of these organisms.
human On SBA plates, tiny colonies of Haemophilus
 Haemophilus  Haemophilus may be seen growing around the V factor–
influenza influenza producing organism
 Haemophilus  Meningitis,
parainfluenzae epiglottitis Haemophilus species
 Haemophilus  Haemophilus Haemophilus Virulence Factors:
haemolyticus aegyptius influenza  Capsule
 Haemophilus  Pink eye “Pfeiffer’s Bacillus”  Most significant of
parahaemolyticus conjunctivitis all virulence factors
 Haemophilus  Haemophilus  Capsular
paraphrohaemolyticus ducreyi polysaccharide
 Haemophilus  Chancroid/ soft serve as a basis for
pittmaniae chancre serologic grouping
 Haemophilus o There are 6
aegyptius serotypes : a, b,
 Haemophilus ducreyi c, d, e, f
 serotype b capsule
 Haemophilus is derived from the Greek words is a unique polymer
“aima” and “philia” meaning “blood-lover.” composed of ribose,
 require growth factors present in blood: ribitol, and
o X factor = hemin or hematin (“X for phosphate
unknown”) (polyribitol
o V factor = nicotinamide adenine phosphate)
dinucleotide [NAD] = (“V for vitamin”)  antiphagocytic
 Haemophilus spp. with the prefix para require property and
only V factor for growth anticomplementary
 Both X and V factors are found within red blood activity of the type b
cells; however, only X factor is directly capsule are
available. important factors in
 Haemophilus spp. that are V factor dependent virulence
do not grow on SBA because the red blood  most invasive
cells are still intact, and the sheep red blood infections were
caused by

MA. PATRICIA VILLANUEVA 1

Clinical Bacteriology
encapsulated strains typable
of H. influenzae Haemophilus
belonging to influenzae (NTHi) :
serotype b (Hib) localized
 In unvaccinated  Conjunctivitis
children, type b is a  Sinusitis
leading cause of  Otitis media with
meningitis effusion / middle ear
 Not all strains of H. infections
influenzae are Haemophilus  genetically related to
encapsulated, aegyptius Haemophilus
referred to as non- “Koch-Weeks influenzae
typable H. Bacillus”  difficult to
influenzae (NTHi) differentiate H.
 Immunoglobulin A influenzae from H.
Proteases aegyptius and H.
 Haemophilus influenzae biogroup
influenzae is the aegyptius in the
only member of the clinical laboratory
genus that produces  Historical
IgA protease. background :
 This enzyme has the observed in
ability to cleave conjunctivitis
secretory IgA exudates from
 Adherence Egyptians by Koch
mechanisms in 1883
 Studies indicate that  Disease associated :
most NTHi strains “Pink Eye” = Acute
are adherent to Purulent
human epithelial Conjunctivitis
cells; most Haemophilus influenzae biogroup aegyptius
encapsulated  Non-encapsulated
serotype b strains  Historical background: a clone of H. influenzae
are not adherent biogroup aegyptius first caused a severe
 Outer Membrane systemic disease known as Brazilian Purpuric
Proteins & Fever (BPF) in Brazil in 1984
Lipopolysaccharides  Disease associated:
 Antibody directed  conjunctivitis, primarily in pediatric
against these populations
antigens may play a  Brazilian Purpuric Fever
significant role in  BPF characterized by:
human immunity  recurrent or concurrent conjunctivitis
 have a paralyzing  High fever
effect on the  Vomiting
sweeping motion of  Petechial / purpural rash
ciliated respiratory  Septicemia, shock, and vascular
epithelium collapse
Clinical  Mortality Rate : 70% within 48 hours
Manifestations: after onset
 Infections by
encapsulated, Haemophilus ducreyi  Strict human
serotype B strains pathogen
(Hib) : systemic  Not part of the
 Septicemia normal microbiota
 Meningitis  Extremely
 Arthritis fastidious
 Epiglottitis  Disease
 Tracheitis associated :
 Pneumonia Chancroid / “Soft
 Infections by non- Chancre”
encapsulated, non-

MA. PATRICIA VILLANUEVA 2

Clinical Bacteriology
o highly  CSF (for
communicable suspected
sexually meningitis)
transmitted  middle ear
genital ulcer exudate (for
disease suspected otitis
(GUD) media)
o facilitates the  joint fluids
transmission  upper and lower
of other STDs respiratory tract
o Incubation specimens;
Period : 4 – bronchial
14 days washing (for
Clinical Manifestations culture)
of Chancroid / “Soft  swabs from
Chancre”: conjunctiva (for
 nonindurated, suspected
painful lesion with conjunctivitis)
irregular edge  vaginal swabs
 generally, on the  abscess drainage
genitalia or  Haemophilus spp.
perianal areas are fastidious in
 Buboes = nature
suppurative (pus-  Most conventional
forming), enlarged, media do not
draining, inguinal support the growth
lymph nodes of Haemophilus
 Men have spp.
symptoms related  Haemophilus spp.
to the inguinal do not grow on
tenderness and MAC agar
genital lesions  Haemophilus spp.
 Most women are die rapidly in
asymptomatic clinical specimens;
Miscellaneous Haemophilus Species prompt
Haemophilus  found in the oral transportation and
parainfluenzae cavity processing are
 very low incidence vital for their
of pathogenicity isolation
 Disease For Haemophilus
associated : ducreyi :
endocarPrimary  genital sites first
Site of Infection : should be cleaned
mitral valve with sterile gauze
 symptoms appear moistened with
approximately 1 sterile saline
month after routine  a swab,
dental procedures premoistened with
Haemophilus  indigenous sterile phosphate-
parahaemolyticus microbiota of the buffered saline,
URT of adults should be used to
 Disease collect material
associated : from the base of
pharyngitis the ulcer
 as an alternative,
Laboratory Diagnosis pus can be
Specimen Processing  Sources of aspirated from
& Isolation specimen: buboes if they are
 Blood present
 direct plating on
selective media at

MA. PATRICIA VILLANUEVA 3

Clinical Bacteriology
the bedside is from respiratory
preferred instead specimens
of using transport For Haemophilus
media / specimen aegyptius:
processing in the  preferred culture
laboratory should media : enriched
occur soon after CHOC agar
collection for supplemented with
maximum recovery 1% Iso-VitaleX
 Preferred culture  duration of
media: Enriched incubation : 4 days
CHOC medium, Colony Morphology For Haemophilus
Nairobi biplate ducreyi :
 Optimum growth  On CHOC agar
temperature: 33°C  Small
 Duration of  Flat
incubation: 7 days  Smooth
 Nairobi biplate  Nonmucoid
medium  transparent to
components opaque
 GC agar base  tan or yellow
 2% bovine  Individual
hemoglobin + colonies can be
5% fetal calf pushed intact
serum + using a loop
Mueller Hinton across the agar
agar on one plate surface
side For Haemophilus
 5% influenzae :
chocolatized  on CHOC agar
horse blood on  Non-hemolytic
the other  Translucent
 3 mg/L of  Tannish
vancomycin on  Moist
both sides  Smooth
For Haemophilus  Convex
influenzae :  “mousy” or
 preferred culture bleach-like odor
media : CHOC  encapsulated
Agar, or Horse strains grow larger
Blood Bacitracin and more mucoid
Agar than the NTHi
 incubation strains
temperature : 33° - For Haemophilus
37°C parainfluenzae :
 duration of  tannish and drier
incubation : 18 - 24  medium to large
hrs size compared with
 incubation H. influenzae
condition : For Haemophilus
CAPNOPHILIC = parahaemolyticus :
5% - 10% carbon  resembles H.
dioxide parainfluenzae
 CHOC agar  on horse or rabbit
supplemented with blood agar, it is β-
bacitracin (300 hemolytic
mg/L) is an Microscopic  small, gram-
excellent medium Morphology negative bacilli
for the isolation of  pleomorphic :
Haemophilus spp. coccobacilli to long
filaments

MA. PATRICIA VILLANUEVA 4

Clinical Bacteriology
 “halos” = capsules Porphyrin  method for differentiating the
of Haemophilus Test heme-producing species of
influenzae may be Haemophilus
observed in Gram-  can be performed in agar, in
stained direct broth, or on a disk
smears as clear,  Test Principle :
non-staining areas o ability of the organism to
 other stains that convert the substrate δ-
may be used: aminolevulinic acid (ALA)
 Acridine into porphyrins or
orange porphobilinogen
 Methylene (intermediates in synthesis
Blue of X factor)
 “railroad tracks” / o incubation temperature :
“school of fish” = 35°C
Haemophilus o duration of incubation : 4 hrs
ducreyi appearing o porphobilinogen is detected
as pale staining by the addition of p-
gram-negative dimethylaminobenzaldehyde
coccobacilli (Kovacs’ reagent)
arranged singly or o red color forms if
in groups porphobilinogen is present
Laboratory  growth of gram- o porphyrins can be detected
Identification negative using an ultraviolet light with
pleomorphic a wavelength of about 360
coccobacilli on nm (Wood’s lamp).
CHOC agar Porphyrins fluoresce reddish
 no growth on SBA orange under ultraviolet
and MAC light.
o porphyrins can be detected
X & V Factor  traditional using an ultraviolet light with
Requirement approach : using a wavelength of about 360
impregnated strips, nm (Wood’s lamp).
or disks Porphyrins fluoresce reddish
 The Haemophilus orange under ultraviolet
Quad Plate light.
contains four o the organism on the bottom
zones: is exhibiting a positive
 media with X porphyrin reaction. The
factor only organism on the top is
 with V factor porphyrin-negative.
only  Species that are porphyrin
 with X and V negative cannot synthesize
factors heme and are X factor-positive
 with X and V (require hemin) when the
factors with impregnated strip is used
horse red blood  Haemophilus spp. that can
cells synthesize heme are porphyrin-
positive (X strip negative, do
not require hemin)
 In other words, if an organism
o is X factor dependent =
Porphyrin Negative
o requires V factor only =
Porphyrin Positive

Treatment
Treatment :  Invasive H.
Haemophilus influenzae infection
influenzae often requires
hospitalization

MA. PATRICIA VILLANUEVA 5

Clinical Bacteriology
Drugs of choice:  yellow
 cefotaxime  opaque zone
 ceftriaxone near the center
Alternative Drugs:  can either be X
 trimethoprim- factor-
sulfamethoxazole dependent or
 imipenem independent
 ciprofloxacin Aggregatibacter  small bacilli to
 chloramphenicol actinomycetemcomitan coccoid
 Ampicillin s  gram-negative
For non–life-threatening  nonmotile
H. influenzae infection: has been isolated from:  formerly in the
 amoxicillin  blood genus
clavulanate  lung tissue Actinobacillus
 oral second-  abscesses of the  normal oral
generation mouth microbiota in
 third-generation  brain humans
cephalosporin  sinuses  Disease
 trimethoprim- associated:
sulfamethoxazole  grow better with  periodontitis
Treatment : Drugs of choice: increased CO2  subacute
Haemophilus ducreyi  azithromycin concentration bacterial
 ceftriaxone  duration of endocarditis
 ciprofloxacin incubation : 24 – 48  divided into six
 erythromycin hrs serotypes (a
through f) based
HACEK Group on a surface
Aggregatibacter  Greek aphros and polysaccharides;
aphrophilus philia : “foam most common
loving” serotypes : a, b, c
 H. aphrophilus Virulence Factor :
and H.  collagenase =
paraphrophilus toxic to
have been polymorphonuclea
reclassified into r cells &
the single species, monocytes
Aggregatibacter Colony Morphology:
aphrophilus  “star shape with
 does not require, four to six points”
but grow better in Cardiobacterium  gram-negative
high hominis bacillus
concentrations of  pleomorphic
CO2  nonmotile
 most prevalent  Fastidious
species in the  grow slowly on
HACEK group SBA and CHOC;
involved in do not grow at all
endocarditis on MAC
 found in dental  Capnophilic =
plaque and requires 5% CO2
gingival scrapings Normal Microbiota of
Clinical the:
Manifestations  nose
 fever  mouth
 heart murmur,  throat
congestive  gastrointestinal
heart failure tract
 embolism Disease associated :
Colony Morphology :  endocarditis,
 convex primary site of
 granular

MA. PATRICIA VILLANUEVA 6

Clinical Bacteriology
infection : aortic  viral infections
valve can be a
 meningitis precursor to
Colony morphology : infections by
 “pitting” may be these organisms
produced on the  poor dental
hygiene or oral
Microscopic surgery is
morphology : associated with
 form rosettes infection.
 swellings  four species :
 long filaments or o Kingella kingae
sticklike structures o Kingella
in yeast extract denitrificans
Eikenella corrodens  fastidious o Kingella oralis
 gram-negative o Kingella potus
 coccobacilli  can grow on
 grow best with Neisseria
increased CO2 selective agar
and hemin (e.g., modified
 nonmotile Thayer-Martin
 asaccharolytic medium) and can
 45% of the resemble
isolates of E. Neisseria
corrodens “pit” gonorrhoeae
(make a Disease associated :
depression) or  K. denitrificans
corrode the = bacteremia,
surface of the abscesses
agar  K. kingae =
 normal biota of predilection for
the oral and bowel bones and
cavities joints,
 poor dental endocarditis
hygiene or oral Microscopic
surgery has also morphology :
been associated  resist
with infections decolorization in
Disease associated : the Gram stain
 infection from  coccobacillary to
human bites short bacilli
 “Clenched-fist  squared ends
Wounds”  in pairs or short
 Endocarditis chains
for
immunocompromised Capnocytophaga spp.
individuals : Colony morphology - Although flagella are
 periodontitis usually absent,
 meningitis gliding motility can
 empyema be seen on solid
 pneumonia surfaces.
 osteomyelitis - adherent and
 arthritis produce a yellow-
 postoperative orange pigment
tissue infections - resemble colonies of
for Drug abusers: Eikenella corrodens
 cellulitis - most are
Kingella spp.  colonize the upper nonhemolytic except
respiratory tract, for Capnocytophaga
especially the haemolytica (β-
tonsils hemolytic

MA. PATRICIA VILLANUEVA 7

Clinical Bacteriology
Microscopic - thin and often Biochemical Test  catalase positive
morphology fusiform (pointed Results :  oxidase positive
ends) resembling  indole positive
Fusobacterium  glucose
- coccoid, and curved fermenter
filaments may be  fructose
also seen fermenter
 weak to
Pasteurella spp. moderate acid
General characteristics - normal flora of production
respiratory tract and  non-gas
oral cavity of birds producer
and mammals Colony morphology: - on CHOC & SBA
- fastidious  grayish
- gram-negative colonies
- nonmotile - on SBA only:
- facultative anaerobic  optimum
- coccobacilli that temperature :
appear ovoid, 37°C
filamentous, or as  mucoid after 24
bacilli hrs
- Bipolar staining /  production of a
“safety pin” narrow green to
appearance = when brown halo
the poles of the cells around the
are more intensely colony after 48
stained is frequently hrs
observed
Species : - Pasteurella Brucella spp.
multocida; most - considered potential bioterrorism agent /
common isolate; category B select biological agents by the CDC
- has 5 serogroups (A, - normal flora of respiratory tract and oral cavity of
B, D, E, and F) birds and mammals
defined by capsular - Disease associated :
antigens;  Brucellosis = zoonotic disease that is
- has 3 subspecies : found throughout the world
 multocida  Undulant Fever / “Malta Fever”
 septica - Population at risk:
 gallicida  people handling animals & animal
- Pasteurella canis products
- Pasteurella stomatis  laboratory workers
- Pasteurella Modes of  aerosol
dagmatis Transmission  percutaneous
- Pasteurella bettyae  oral routes

Disease associated : - Pasteurellosis = Rare documented  sexual contact

zoonotic disease; modes of  breast feeding
acquired from transmission
exposure to infected Three clinical 1. Acute: 1 – 4 weeks
animals or products Stages after exposure
made from infected  fever
animals  malaise
- most common:  headache
cutaneous infection  anorexia
- systemic infections:  myalgia
 Septicemia 2. Subchronic /
 Arthritis Undulant Form :
 Endocarditis within a year
 Osteomyelitis  undulating fevers
 Meningitis = normal
temperatures in

MA. PATRICIA VILLANUEVA 8

Clinical Bacteriology
the morning  deerfly fever /
followed by high lemming fever /
temperatures in water rat
the afternoon / trappers’ disease
evening Most common form of
 arthritis tularemia :
 epididymoorchitis Ulceroglandular
3. Chronic: 1 year - ulcer forms at the
after exposure site of inoculation
 depression - enlargement of the
 arthritis regional lymph
 chronic fatigue nodes
syndrome other forms of
tularemia:
Four species - Brucella melitensis  pulmonary
associated with - Brucella abortus  glandular
humans - Brucella suis  oropharyngeal
- Brucella canis  oculoglandular
two additional species  typhoidal forms
isolated from marine - Francisella
animals: tularensis is a CDC
- Brucella ovis category A select
- Brucella neotomae biological agent
General - small Modes of transmission - ingestion
characteristics - gram-negative - inhalation
- aerobic - arthropod bite
- nonmotile - contact with infected
- unencapsulated tissues
- non-spore former - person-to-person
- appear as coccobacilli General - small
or bacilli Characteristics - nonmotile
- facultative intracellular - non–sporeforming
pathogens; can reside - gram-negative
within phagocytic cells - bacilli or coccoid
- must be handled under - strict aerobes
biosafety level 3 - fastidious; requires
conditions the following
Sources of - blood supplements :
Specimen - bone marrow  Cysteine
Appropriate culture - SBA  Cystine
media : - CHOC  Thiosulfate
- Modified Thayer-Martin Appropriate culture - CHOC
- Martin-Lewis media - Modified Thayer-
Incubation - 18 hours Martin
Note: - Buffered Charcoal
- Plates should be kept Yeast Extract
for 4 days before (BCYE)
reporting as negative. - Mueller-Hinton
Biochemical Test  oxidase positive - Tryptic Soy Broth
Results :  catalase positive (TSB)
 urease positive Note:
- MAC and EMB
Francisella tularensis agars do not support
three subspecies / - subsp. tularensis Francisella
boivars : (type A) tularensis growth
- subsp. holarctica Nature of Environment - optimum
(type B) temperature: 37°C
- subsp. mediasiatica - duration of
Disease associated :  Tularemia incubation: 48 hrs
 zoonotic disease
 rabbit fever

MA. PATRICIA VILLANUEVA 9

Clinical Bacteriology
- Plates should be  bloody sputum
checked daily for 14  dissemination
days. via the
Colony Morphology  gray-white circulatory
 smooth system =
 raised extrapulmonary
infections
Legionella pneumophila
- ranging from mild upper respiratory tract Pontiac Fever - incubation period : 2
infections to pneumonia days
- Historical background: In 1976, during an - flu-like symptoms :
American Legion convention in Philadelphia, fever, headache,
221 persons became ill with pneumonia, and 34 myalgia
of them died of a mysterious disease. - last 2 to 5 days
Virulence factor - ability to enter, - subside without
survive, and multiply medical intervention
within the host’s Epidemiology - found worldwide
cells, especially - natural sources :
bronchoalveolar lakes, rivers, hot
macrophages springs
- production of - human-made water
proteolytic enzymes supplies : hot water
- systems, cooling
Disease associated  Legionnaires’ towers, evaporative
Disease = febrile condensers, cold
disease + water systems,
pneumonia ornamental
 Pontiac Fever = fountains, whirlpool
febrile disease only, spas, humidifiers,
no pulmonary respiratory therapy
involvement equipment, industrial
Legionnaires’ Disease - incubation period : 2 process waters
/ Legionellosis – 10 days Factors that allow
- predominant Legionella spp. to
manifestation : colonize water
pneumonia supplies:
- “atypical  can tolerate
pneumonia” chlorine
- most cases are concentrations
brought by of 3 mg/L
serogroup 1  can multiply
- also implicated in over the
human infections: temperature
 Legionella range of 20° C
pneumophila to 43° C
serogroups 4  can survive for
and 6 varying periods
 Legionella at 40° C to 60°
longbeachae C
 Legionella  can adhere to
micdadei pipes, rubber,
Clinical plastics, and
Manifestations: sediment
 nonproductive  persists in
cough piped water
 fever systems even
 headache when flushed
 myalgia  ability to survive
 pulmonary and multiply
infiltrates within free-living
develop protozoa and in

MA. PATRICIA VILLANUEVA 10

Clinical Bacteriology
the presence of Colony Morphology  grayish white or
commensal blue-green
bacteria and  convex
algae  glistening
Laboratory Diagnosis  approx. 2 to 4
Sources of specimen  sputum mm in diameter
 bronchoalveolar  “ground-glass”
lavage appearance
 bronchial Identification Methods - L-cysteine
washings requirement
 environmental - Gram stain
sources - Direct Fluorescence
- When delays of Antibody (DFA)
more than 2 hours
between collection Bordetella spp.
and processing are General Characteristics:
unavoidable, - small gram-negative bacilli or coccobacilli
specimens should - obligate aerobic bacteria
be refrigerated. - optimum growth temperature : 35° C to 37° C
- if delays take - non-carbohydrate fermenter
several days : freeze - oxidize amino acids
at −70° C - catalase producer (variable for Bordetella
Microscopic - pleomorphic, weakly pertussis)
Examination staining, gram- - relatively inactive in biochemical test systems
negative bacilli Bordetella pertussis
Isolation & - Acid treatment must - inhibited by fatty acids, metal ions, sulfides, and
Identification first be done on peroxides, constituents found in many media
specimens - require protective substances; charcoal, blood,
contaminated by starch
other bacteria = Virulence factors - Filamentous
enhances isolation hemagglutinin (FHA)
of Legionella spp. and pertactin =
1. aliquot of the facilitate attachment
specimen is to ciliated epithelial
first diluted 1 : cells
10 with 0.2 N - Pertussis toxin (PT)
KCl-HCl = protein exotoxin;
2. allowed to modifies host
stand for 5 proteins by
minutes adenosine
3. proceed with diphosphate–ribosyl
inoculation to transferase
culture media - Adenylate cyclase
- optimum incubation toxin = inhibits host
temperature : 35° C epithelial & immune
to 37° C effector cells by
- duration of inducing
incubation : at least supraphysiologic
7 days; colonies concentrations of
usually visible in 3 - cyclic adenosine
5 days monophosphate
- fastidious, aerobic, - Tracheal cytotoxin =
do not grow on SBA causing ciliostasis,
- require L-cysteine; inhibiting DNA
most preferred synthesis, and
culture media : promoting cell death
Buffered Charcoal Disease associated Pertussis / “Whooping
Yeast Extract Cough”
(BCYE) with L-  incubation
cycteine period : 7 – 10

MA. PATRICIA VILLANUEVA 11

Clinical Bacteriology
days or 1 – 3 as possible into the
weeks nasopharynx,
 three phases : rotated, held a few
catarrhal, seconds, and then
paroxysmal, gently withdrawn
convalescent - methods :
1. Catarrhal =  Culture
sneezing, mild  DFA
cough, runny  PCR
nose, Microscopic - two-minute safranin
conjunctivitis; Examination or 0.2% basic
apnea & fuchsin as
respiratory counterstain
distress for enhances visibility
infants; highly - DFA staining may
infectious stage also be used
2. Paroxysmal = - should be used only
severe, along with culture
repetitive because the lack of
coughing + sensitivity
characteristic diminishes the
“whoop” sound clinical utility of a
at the end due to negative result, and
rapid gasping for false-positive results
air. Young can occur
children might o DFA should not
experience be used as
apnea, replacement for
pneumonia, or culture
both and require Isolation & - preferred culture
aid in Identification media:
maintaining a  Bordet-Gengou
patent airway. Potato Infusion
3. Convalescent Agar with glycerol
= within 4 weeks and horse or
of onset with a sheep blood
decrease in  Regan-Lowe
frequency and selective agar
severity of the with charcoal
coughing spells agar
Bordetella parapertussis supplemented
- Bordetella parapertussis contain the structural with 10% horse
gene for PT but do not express the complete blood and 40
operon. mg/L cephalexin
- generally causes a similar disease as pertussis - optimum incubation
with milder symptoms temperature : 35° C
Laboratory Diagnosis - duration of
Specimen Collection & - sources of specimen incubation : 7 days;
Handling : nasopharyngeal B. pertussis colonies
aspirate / swabs are detected in 3 – 5
- acceptable swab days; B.
material : calcium parapertussis
alginate or Dacron colonies are
polyester + flexible detected in 1 day or
wire shaft sooner
- two swabs are Colony Morphology - Small and shiny
collected, one - “mercury droplets”
through each of the
external nares; the
swabs should be
inserted as far back

MA. PATRICIA VILLANUEVA 12