TITLE: No Title
AUTHORS: 

[DESCRIPTION]
<p>The appropriate use of clinically accurate diagnostic tests is essential for the detection of pertussis, a poorly controlled vaccine-preventable disease. The purpose of this study was to estimate the sensitivity and specificity of different diagnostic criteria including culture, multi-target polymerase chain reaction (PCR), anti-pertussis toxin IgG (IgG-PT) serology, and the use of a clinical case definition.  An additional objective was to describe the optimal timing of specimen collection for the various tests. </p>
<p>Clinical specimens were collected from patients with cough illness at seven locations across the United States between 2007 and 2011. Nasopharyngeal and blood specimens were collected from each patient during the enrollment visit.  Patients who had been coughing for ≤ 2 weeks were asked to return in 2-4 weeks for collection of a second, convalescent blood specimen.  Sensitivity and specificity of each diagnostic test were estimated using three methods—pertussis culture as the “gold standard,” composite reference standard analysis (CRS), and latent class analysis (LCA). </p>
<p>Overall, 868 patients were enrolled and 13.6% were <em>B. pertussis</em> positive by at least one diagnostic test.  In a sample of 545 participants with non-missing data on all four diagnostic criteria, culture was 64.0% sensitive, PCR was 90.6% sensitive, and both were 100% specific by LCA.  CRS and LCA methods increased the sensitivity estimates for convalescent serology and the clinical case definition over the culture-based estimates.  Culture and PCR were most sensitive when performed during the first two weeks of cough; serology was optimally sensitive after the second week of cough.</p>
<p>Timing of specimen collection in relation to onset of illness should be considered when ordering diagnostic tests for pertussis. Consideration should be given to including IgG-PT serology as a confirmatory test in the Council of State and Territorial Epidemiologists (CSTE) case definition for pertussis.</p>

[BEFORE_START]
<ul>
<li><strong>Disclaimer:</strong> Names of vendors or manufacturers are provided as examples of suitable product sources; inclusion does not imply endorsement by the Centers for Disease Control and Prevention or the Department of Health and Human Services.</li>
</ul>
<p> </p>
<p>Reagents: Regan-Lowe agar plates with cephalexin (RL+C) and without cephalexin (RL-C); blood agar plates.</p>
<p> </p>
<p>Specimen Criteria: Acceptable specimens include isolates and nasopharyngeal aspirates or swabs. Swab should be polyester (such as Dacron), rayon, or nylon. Calcium alginate and cotton swabs are not acceptable. Regan-Lowe transport medium is recommended for specimens. Amies Charcoal transports are acceptable, but may decrease the probability of isolation. If only one swab is collected for both culture and PCR, the swab should be sent in Regan-Lowe transport.</p>

[GUIDELINES]
<p>Title: Standard Operating Procedure for Culture Identification and Differentiation of <em>Bordetella</em> species.</p>
<p> </p>
<p>Purpose: To describe the procedures used to identify and distinguish between <em>B.pertussis, B. parapertussis, B. bronchiseptica, </em>and<em> B. holmesii.</em></p>
<p> </p>
<p>Principle: <em>Bordetella</em> species are tiny gram-negative coccobacilli occurring singly or in pairs and may exhibit a bipolar appearance. They are strict aerobes and some members of the genus are motile. <em>B. pertussis</em> and <em>B. parapertussis</em> are non-motile, and produce no acid from carbohydrates. <em>B. pertussis</em> will not grow well on common blood agar bases or chocolate agar, whereas <em>B. parapertussis</em> will grow on blood agar and sometimes chocolate. Media for primary isolation consists of charcoal-based medium such as Regal-Lowe (RL) supplemented with glycerol, peptones and horse or sheep blood. The antibiotic agent cephalexin is added to reduce the growth of normal flora. <em>B. pertussis</em> may be recovered from secretions collected from posterior nasopharynx, bronchoalveolar lavage, and transbronchial specimens. <em>Bordetella</em>-like organisms (BLO) isolated from clinical specimens undergo phenotypic and biochemical observation to determine correct identification. Suspected <em>Bordetella</em> species isolates can also be phenotypically and biochemically tested to confirm identification.</p>

[STEPS]
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?. 
?.