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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
Q

VIral causative agents for acute pharyngitis and tonsillitis?

A

EBV
CMV

(HSV-1
Rhinovirus
Coronavirus
Adenovirus)

26
Q

CMV?
Transmission?
Presentation characteristics?
Treatment?

A

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
Q

EBV
Location of infection?
Clinical features?

A

Replicates in B lymphocytes

Clinical features:
i.e. glandular fever
Fever
Headache
Malaise
Sore throat
Anorexia
Palatal petachniae
Cervical lymphadenopathy
Sphlenomegaly
Mild hepatitis
28
Q

Glandular fever:
Treatment
Causative agent
Complications?

A

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
Q

Tonsilitis:
Cause by?
Clinical features?
Treatment options?

A

•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
Q

Streptococcus pyogenes complications?

A
  • Scarlet fever (from erythrogenic toxin from S. pyogenes)
  • Peritonsillar abscess
  • Otitiis media / sinusitis
  • Rheuamtic heart disease
  • Glomerulonephritis
31
Q

Parotitis:
Cause?
Clinical features?
Primary sites of replication?

A

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
Q

Parotitis:
Treatment?
Prevention?
Complication?

A

Treatment:
Mouth care
Nutritional
Analgesia

Prevention:
Acute immunisation
MMR vaccine

Complications:
CNS involvement
Epididymo-orchitis

33
Q 
Acute epiglottitis:
Caused by?
Clinical features?
Diagnosis?
Treatment?
A

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
Q

Causative agent of Diphtheria?

A

Corynebacterium diphtheriae

35
Q

Diphtheria:
Where?
Transmission?
Clinical features?

A

Where?
Pharynx, larynx and nose

Transmission?
Aerosol

Clinical features?
Sore throat
Fever
Formation of pseudomembrane
Lymphadenopathy
Oedema of anterior cervical tissue (bull neck)
36
Q

Diphtheria:
Diagnosis?
Treatment?
Prevention?

A

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
Q

Laryngitis and tracheitis:
Viral or bacterial origin?
Difference between adult and children presentation?

A

Usually VIRAL origin e.g.

  • Parainfluenza virus
  • Respiratory syncytial virus
  • Influenza virus
  • Adenovirus

Adults: Hoarseness, retrosternal pain
Children: Dry cough, inspiratory stridor

38
Q

Otitis and sinusitis: features

A

•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
Q

Otitis and sinusitis causative agents?

A 
Main causative agents:
–Respiratory syncytial virus (RSV)
–Mumps virus
–Streptococcus pneumoniae
–Haemophilus influenzae
–Bacteroides fragilis
40
Q

What is otitis media?

A

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
Q 
Otitis media:
Who?
Origin?
Clinical features?
Risk of development to...
A

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
Q

otitis externa?

A

External ear inflammation

43
Q

Otitis externa:
Favoured by?
Treatment?

A 
Otitis externa:
Favoured by?
Staph. Aureus
Candida albicans
Pseudomonas aeruginosa

Treatment?
Antibiotic ear drops containing polymyxin

44
Q

Acute Sinusitis has similar aetiology and pathology to _____ _____

A

Acute Sinusitis has similar aetiology and pathology to otitis media

45
Q

Acute sinusitis:
Origin? (similar to otitis media)
Clinical features?
Treatment?

A

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
Q

What is keratoconjunctivitis

A

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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