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MD4001 Week 11 > 5. Infections of the sensory system > Flashcards

5. Infections of the sensory system Flashcards

1
Q

List the potential infection sites of the head?

A 
-Eyes
•Oral cavity
•“Upper” respiratory tract
•Ears
•Sinuses
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2
Q

What are the defence mechanisms of the eye?

A 
Eyelids
Lacrimal system
Conjunctiva
Cornea
Blood-ocular barrier
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3
Q

Bacterial conjunctivitis, causes…
Common condition?
Neonatal?
HAI (healthcare associated inf)

A

Common condition:
–Haemophilus influenzae
–Streptococcus pneumoniae
–Moraxellaspp.

Neonatal:
–Neisseria gonorrhoeae
–Escherichia coli
–Staphylococcus aureus
–Haemophilus influenza
–Chlamydia trachomatis

HAI:
–Pseudomonas aeruginosa

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4
Q

Clinical features of bacterial conjunctivitis?

A
  1. Hyperaemic red conjunctivae

2. Mucopurulent discharge

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5
Q

Bacterial conjunctivitis:

  • Samples
  • Lab investigations
  • Treatment?
A

Samples of:
Conjunctival swabs
Corneal scrapings

Lab investigations:

  • Cultures
  • NAAT

Treatment with local antibiotics:
Fusidic acid
Tetracycline
Chloramphenicol

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6
Q

Adenovirus infection of the eye:
Serotypes?
Clinical presentation?
Treatment

A

Serotypes: 3,4,7,8 and 10

Clinical presentations:

  • Purulent conjunctivitis
  • Enlarged ipsilateral periauricular lymph node
  • Corneal involvement: Punctate keratitis and subepithelial inflammatory infiltration

Treatment:

  • Symptomatic
  • Avoid topical steroids
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7
Q

Zaricella Zoster Virus (VZV) infection of eye:
Which CN?
Clinical presentation?
Treatment?

A

i.e. shingles

Ophthalmic dermatome of 5th cranial nerve

Clinical features:

  • Skin lesions
  • Anterior uveitis
  • Ocular perforation
  • Retinal involvement

Treatment:
-Aciclovir (antiviral treatment)
-Topical steroids (for severe inflammation)
To prevent primary infection, use live attenuated vaccine

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8
Q

HSV infection?

A

Herpies simplex virus inf

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9
Q

Most common infectious cause of blindness in developed world?

A

HSV inf of eye

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10
Q

HSV of eye clinical features?

A

Ulcerative blepharitis
Follicular conjunctivitis
Regional lymphadenopathy
Corneal involvement

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11
Q

Why do dendritic ulcers form?

A

HSV keratitis due to replication of HSV virus in the underlying corneal epithelium

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12
Q

Marker for infection in HSV virus?

A

Dendritic ulcer. Demonstrates:

  • Opacity
  • Corneal oedema
  • Keratitis
  • Inflammation in deeper tissue
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13
Q

Treatment of HSV eye infection?

A

Aciclover (antiviral)
Avoid steroids
Corneal grafting needed if repeated scarring

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14
Q 
Onchocerciasis (river blindness):
Cause?
Transmission?
Results in..
International control programme?
A 
Onchocerciasis (River Blindness)
•Caused by parasite Onchocerca volvulus
•Transmitted by blackfly
•W. Africa, S, America, C. America
•Lesions may lead to blindness
International control programme
–Mass treatment of whole populations
–Invermectin and doxycyline
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15
Q 
Trachomatis:
Causative agent?
Results in..
Location?
Presentations?
Treatment?
A

Trachomatis
Causative agent? Chlamydia trachomatis

Results in? Chronic keratoconjunctivitis

Location? Largely confined to the tropics

Presentation? Symptoms occur 3-10d post-infection:
–Lacrimation
–Mucopurulent discharge
–Conjuntiva linvolvement
–Follicular hypertrophy

Treatment with oral macrolides:
–azithromycin

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16
Q

How to eradicate trachomatis by 2020?

A

SAFE

Surgery: of inturned eyelids
Antibiotics
Facial cleanliness: Prevention transmission
Environmental change: More access to water and sanitation

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17
Q

Ocular manifestations and management in AIDS?

A

“Cotton wool spots”
Infarction of retinal nerve fibre layer
Cytomegalovirus inf (in later course)

Antiviral treatment: With IV ganciclovir
Maintain therapy to prevent relapse

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18
Q

Causes of endophthalmitis?
treatment

(Inflammation of interior of eye)

A

After…

  • Ocular op
  • Trauma
  • Inoculation of foreign body
  • Complication of systemic inf

Systemic antibiotic treatment or early vitrectomy

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19
Q

Vitrectomy?

A

Removal of vitreous homour

20
Q

Oral cavity infections due to poor dental hygiene?

A

Oral candiasis (thrush)
Caries
Gingivititis

21
Q

Normal microbiota of the RT

A

Bacteriodes spp.
Candida albicans
Oral streptococci
Haemophilus influenze

22
Q

RT host defences?

A 
Saliva
Mucus
Cila
Nasal secretions
Antimicrobial peptides
23
Q 
Common cold:
Pathophysiology?
Transmission?
Causative agent?
Clinical features?
Vaccine?
A

Common cold:
Pathophysiology?
Acute coryza

Transmission?
Aerosol and virus vaccinated hands

Causative agents?
Rhinociruses and coronaviruses

Clinical features?
Tiredness
Slight pyrexia
Malaise
Sore nose/pharynx
Nasal discharge (profuse, watery --> nucopurulent)
Sneezing

Vaccine? None

24
Q

Bacterial causative agents for acute pharyngitis and tonsillitis?

A

Streptococcus pyogenes

(Haemophilus influenzae
Corynebacterium diphtheriae)

25
VIral causative agents for acute pharyngitis and tonsillitis?
EBV CMV (HSV-1 Rhinovirus Coronavirus Adenovirus)
26
CMV? Transmission? Presentation characteristics? Treatment?
Cytomegalovirus Transmission? Body secretions Organ transplants Presentation characteristics? In healthy adults= Asymptomatic or mild Compromised immunity = Reactivation to cause disease Treatment? Gangciclovir Foscarnet Cidofovir
27
EBV Location of infection? Clinical features?
Replicates in B lymphocytes ``` Clinical features: i.e. glandular fever Fever Headache Malaise Sore throat Anorexia Palatal petachniae Cervical lymphadenopathy Sphlenomegaly Mild hepatitis ```
28
Glandular fever: Treatment Causative agent Complications?
Treatment: Note with antibiotics (ampicillin and amoxycillin) Avoid contact sports or heavy lifting in first month EBV cause Complications: - Burkitt's lymphoma - Nasopharyngeal carcinoma - Guillain-- Barre syndrome
29
Tonsilitis: Cause by? Clinical features? Treatment options?
•Caused by Streptococcus pyogenes ``` •Clinical features: –Fever –Pain in throat –Enlargement of tonsils –Tonsillar lymphadenopathy ``` Susceptible to treatment with penicillin Increasing resistance to erythromycin and tetracycline
30
Streptococcus pyogenes complications?
- Scarlet fever (from erythrogenic toxin from S. pyogenes) - Peritonsillar abscess - Otitiis media / sinusitis - Rheuamtic heart disease - Glomerulonephritis
31
Parotitis: Cause? Clinical features? Primary sites of replication?
Parotitis causes by Mumps virus Clinical features: - Fever - Malawi - Headache - Anorexia - Trismus - Severe pain and swelling of parotid glands Primary sites of replication: URT and eye
32
Parotitis: Treatment? Prevention? Complication?
Treatment: Mouth care Nutritional Analgesia Prevention: Acute immunisation MMR vaccine Complications: CNS involvement Epididymo-orchitis
33
``` Acute epiglottitis: Caused by? Clinical features? Diagnosis? Treatment? ```
Acute epiglottitis: Caused by? Haemophilus influenze. (in 75% of healthy people) ``` Clinical features? High fever Massive oedema of epiglottis Severe airflow obstruction leads to breathing diffocu;ties Bacteraemia ``` Diagnosis? Blood cultures NOT examination/swabs due to risk of obstruction Treatment? *Life threatening emergency* Requires urgent endotracheal intubation Intravenous antibiotics e.g. ceftriaxone or chloramphenicol
34
Causative agent of Diphtheria?
Corynebacterium diphtheriae
35
Diphtheria: Where? Transmission? Clinical features?
Where? Pharynx, larynx and nose Transmission? Aerosol ``` Clinical features? Sore throat Fever Formation of pseudomembrane Lymphadenopathy Oedema of anterior cervical tissue (bull neck) ```
36
Diphtheria: Diagnosis? Treatment? Prevention?
Diphtheria: Diagnosis? Clinically grounds due to rapid need for therapy Treatment? 1. Prompt IM anti-toxin therapy 2. Concurrent antibiotics (penicillin or erythromycin) 3. Strict isolation Prevention? Childhood immunisation with toxoid vaccine Booster doses given if travelling to endemic areas if 10+ yrs since primary vaccine
37
Laryngitis and tracheitis: Viral or bacterial origin? Difference between adult and children presentation?
Usually VIRAL origin e.g. - Parainfluenza virus - Respiratory syncytial virus - Influenza virus - Adenovirus Adults: Hoarseness, retrosternal pain Children: Dry cough, inspiratory stridor
38
Otitis and sinusitis: features
•Pathogen invasion of the air spaces associated with the URT –Middle ear –Outer ear –Sinuses Blockage of the eustachiantube or sinuses Mucosal swelling prevents muco-ciliary clearance of infection Exacerbated by local accumulation of inflammatory bacterial products
39
Otitis and sinusitis causative agents?
``` Main causative agents: –Respiratory syncytial virus (RSV) –Mumps virus –Streptococcus pneumoniae –Haemophilus influenzae –Bacteroides fragilis ```
40
What is otitis media?
Otitis media is a group of inflammatory diseases of the middle ear. The two main types are: 1. acute otitis media (AOM) 2. otitis media with effusion (OME). AOM is an infection of abrupt onset that usually presents with ear pain.
41
``` Otitis media: Who? Origin? Clinical features? Risk of development to... ```
Otitis media: Who? Infants and small children Origin? 50% viral: Respiratory Syncytial Virus (RSV) Also... S. pneumoniae and H. influenzae ``` Clinical features? Fever Diarrhoea / Vomiting Bulging ear drum and dilated vessels Fluid in middle ear ('glue ear") ``` Risk of development to... 1. Chronic suppurative otitis media 2. Hearing difficulties 3. Delayed learning development
42
otitis externa?
External ear inflammation
43
Otitis externa: Favoured by? Treatment?
``` Otitis externa: Favoured by? Staph. Aureus Candida albicans Pseudomonas aeruginosa ``` Treatment? Antibiotic ear drops containing polymyxin
44
Acute Sinusitis has similar aetiology and pathology to _____ _____
Acute Sinusitis has similar aetiology and pathology to otitis media
45
Acute sinusitis: Origin? (similar to otitis media) Clinical features? Treatment?
Origin? 50% viral: Respiratory Syncytial Virus (RSV) Also... S. pneumoniae and H. influenzae Clinical features: Facial pain Localised tenderness Treatment: Ampicillin Amoxycillin Oral cephalosporins (esp to target beta-lactamase-producing organisms)
46
What is keratoconjunctivitis
When only the cornea is inflamed, it is called keratitis; when only the conjunctiva is inflamed, it is called conjunctivitis. There are several potential causes of the inflammation: Keratoconjunctivitis sicca is used when the inflammation is due to dryness, leading to burn/itch/photo-sensitivity

MD4001 Week 11 (7 decks)

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