Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

Pertussis: antibiotic resistance and additional testing information:

If you’ve read my recent blog posts, you are more in the know than most of the doctors currently are in regards to Pertussis. However, there are a few points that I want to clarify.

I think one of the most important things you can do is get tested. Again, my local doctors did not see the necessity in doing this, and I have a feeling that they aren’t the only doctors that hold this belief. This means that you need to be able to voice your reasoning for having it done and have enough confidence to possibly argue for it with them. You also need to be able to demand the right kind of testing, and here is why:

When my daughter had a positive test, I went to my doctor. I had an appointment scheduled at that time anyway, so I decided that I needed to have myself tested and treated. I was not very sick at that time. I was just starting to get a slight cough. I had already had the cold like symptoms 12 to 14 days prior, so I was a bit surprised that I hadn’t developed the severe coughing like everyone else had. I had only started coughing the night before my appointment.

I had not started researching Pertussis at that point, so I was pretty uninformed. My doctor did feel that it was necessary to be tested. He ordered a blood test because our local lab did not perform the nasopharyngeal swabs. They treated the nasopharyngeal tests as a “procedure”, and their phlebotomists were not skilled in performing “procedures”. Because of this, my GP ordered the blood testing.

If you’ve read my previous posts, then you would realize that having blood testing during the first few days of developing the “whooping” cough, would not be accurate. Having a blood test during this period can lead to false negatives because your antibodies do not have the time to build in response to the infection.

I also had to take my son to get tested. We took him to the Children’s Hospital urgent care department last Saturday. Now, my son by this time had his “whooping” cough for more than 4 weeks. The nurse that was in charge of his care was very reluctant in getting him tested. She did not see the need. I explained that it wasn’t for his care but so that health department could record his case. When I finally convinced them to do it, they were going to do the nasopharyngeal testing. This was the incorrect procedure. At this point I had researched it and I knew it, so I voiced my concerns and stated that he needed to have the blood test performed.

I’m sure you can understand that my correcting the nurse was not met with the best attitude. Actually, she did not come back, but they did both the nasopharyngeal and blood testing, and I was satisfied.

I got the call back today. My son’s nasopharyngeal test was negative (which is what I was expecting because it was beyond the time frame for that test to work), but his lab work showed he had recently had the infection.

So, I was right. If I hadn’t stood my ground, he wouldn’t have had the confirmation that he had it. The hospital has now contacted the community health department and his high school, which was the whole point of having him tested.

What does this mean for you?

You need to know about Pertussis. You need to know about testing, treatment, symptoms, etc because your doctor may or may not know about it. They make mistakes, and because Pertussis is rare and is making a comeback, in order to get the best care you and your family deserves, you might need to stand your ground against them. It’s hard to do even when you know you are correct, so you have to be absolute and persistent. The most important reason for getting a test is to proactively prevent it from spreading. It can kill babies and toddlers, and right now there is a country wide misbelief that if you have your vaccinations that you won’t get it.

The following is the chart used by the CDC to describe when the tests should be done:

Optimal timing for diagnostic testing (weeks).

Culture is best done from nasopharyngeal (NP) specimens collected during the first 2 weeks of cough when viable bacteria are still present in the nasopharynx.  After the first 2 weeks, sensitivity is decreased and the risk of false-negatives increases rapidly.

PCR should be tested from nasopharyngeal specimens taken at 0-3 weeks following cough onset, but may provide accurate results for up to 4 weeks of cough in infants or unvaccinated persons. After the fourth week of cough, the amount of bacterial DNA rapidly diminishes, which increases the risk of obtaining falsely-negative results.

For the CDC single point serology, the optimal timing for specimen collection is 2 to 8 weeks following cough onset, when the antibody titters are at their highest; however, serology may be performed on specimens collected up to 12 weeks following cough onset.

(So again, from the above information, the reason my son had a negative nasopharyngeal test was because he had his cough for more than 4 weeks, but he had a positive blood test. If I hadn’t demanded the blood testing, they would not have diagnosed him properly as having it. In my case, because I had only started coughing within a 24 hour period before my blood test was done, I got a false negative. I has not researched Pertussis when I had my blood test done, or I would have requested the nasopharyngeal swab.)

I found the following website is also a good reference on what tests should be ordered and why: http://labtestsonline.org/understanding/analytes/pertussis/tab/test

The other very important topic I wanted to discuss, is antibiotic resistant Pertussis.

Ok, Pertussis in and of itself isn’t a significant health issue compared to other communicable diseases, but the number of reports of people who have pertussis has been increasing every year. Again, this is for several factors mentioned in my previous posts. That said, there are also numerous reports of antibiotic resistant pertussis strains.

The general treatment for pertussis is the erythromycin family of drugs. However, since the 1940’s there have been cases of antibiotic resistant forms of pertussis. There have been additional cases reported from Arizona, California, Utah and Wyoming in the past 4 years. This year, there was a report in France.

In these cases, those treated with the erythromycin family of drugs did not recover as expected from pertussis. It seems that in these cases, the person continued to get worse even after receiving treatment. Now, as I reported previously, antibiotics do not stop the symptoms (generally) unless the treatment is started in the first few weeks of infection (before the cough begins or shortly after it begins). The symptoms from Pertussis are caused by the toxins that are  caused from the infection as well as the immune response our body has to the toxins. The reason a person is prescribed antibiotics is to kill the bacteria so that it does not continue to spread. So, I do not fully understand why having an antibiotic resistant form is significant. Unless, it is more contagious than its non mutated form. It also seems that with the antibiotic resistant form, the infection lasts longer and is more symptomatic.

The following provides the cases that were researched in France, as well as in the United States:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358168/

http://jmm.sgmjournals.org/content/57/12/1577.full

http://jac.oxfordjournals.org/content/early/2007/09/06/jac.dkm343.full.pdf

After further review of the above articles and others, I found that the importance of antibiotic resistant pertussis is that a person generally experiences an improvement with initial antibiotic treatment, but after a week or more, there is a sudden worsening of symptoms. This seems to be the alarm that indicates a person has an antibiotic resistant form of Pertussis.

I also find that it is important for medical evaluation and treatment if your symptoms do become worse. This is because Pertussis can cause pneumonia and other secondary infections to occur. So, if you are feeling better, but then start to run a fever or have trouble breathing, etc it is important to be re-evaluated.

I do not know with certainty if antibiotic resistant pertussis is contagious beyond the five days of antibiotic treatment. I would assume that it is. However, you would want to contact a specialist (I would suggest speaking with an infectious disease specialist).

I will try to update posts as I can with the most up to date information.

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