BACTERIAL CONJUNCTIVITIS Flashcards
what are the general bacterial conjunctivitis symptoms?
- unilateral –> bilateral
- redness
- pain
- photophobia
- Mucopurulent discharge
what are the general bacterial conjunctivitis signs?
- unilateral first, possibility to be bilateral.
- papillae
- purulent/mucopurulent discharge
- bulbar and palpebral conjunctiva injection
- chemosis
tx for acute bacterial conjunctivitis?
- Topical Abx –> trimethoprim/polymyxin B or fluoroquinolone qid x 5-7 days.
- F/U –> every 2-3 days initially –> then every 5-7 days when stable until resolved.
what is acute bacterial conjunctivitis? what species(s) is involved?
Bacterial infection most commonly due to:
In neonates:
* Chlamydia Trachomatis
* Neisseria gonorrhoeae
In children:
H. influenza
Strep pneumonia
In adults:
Staph aureus
S. epidermis
acute bacterial conjunctivitis is the most common cause of conjunctivitis in ____?
children <3 yrs old
symptoms of acute bacterial conjunctivitis?
- general bacterial conjunctivitis symptoms
- acute onset (24hrs)
signs of acute bacterial conjunctivitis?
- general bacterial conjunctivis signs
- acute onset (24hrs)
- no cornea involvment + preauricular lymphadenopathy
what is (hyper-acute) gonococcal conjunctivitis? what species is involved?
Rare bacterial infection that is due to:
* Neisseria gonorrhoeae
* Neisseria meningitidis
who gets gonococcal conjunctivitis?
- Sexually transmitted ocular disease (STD) that is most common in young adults’ w/ history of multiple sexual partners.
- May also be transmitted to infants thru vaginal birth canal in infected mothers.
why is gonococcal conjunctivitis improtant to catch early and treat agressively?
- organism involved is neisseria gonorrhoeae - which can invade an intact cornea!
symptoms of gonococcal conjunctivitis?
- general bacterial conjunctivitis symptoms
- hyper-acute onset (12-24hrs)
signs of gonococcal conjunctivitis?
- general bacterial conjunctivits signs
- hyperacute onset
- pseudomembrane
- postive preauricular lymphadenopathy – usually only in viral infx.
- corneal ulceration –> can progress to perforation.
w/u for gonococcal conjunctivitis?
- Thayer-Martin agar (chocolate agar) – used to culture both Neisseria gonorrhoeae & Haemophilus influenzae.
what is the pneumonic to remember types of organisms culture in a thayer-martin chocolate agar?
Hershey’s & Nestle Chocolate:
* Haemophilus influenzae
* Neisseria gonorrhoeae
tx for gonococcal conjunctivitis?
- If no cornea involvement – tx with ceftriaxone 1g IM plus azithromycin 1g po in single dose.
- If Cornea involvement – tx with ceftriaxone 1g IV + hospitalized
- If pt is allergic to penicillin or cephalosporin – use fluoroquinolones.
what is neonatal conjunctivitis (ohpthalmia neonatorum)?
- It is any conjunctival inflammation within the first month of life that can be from any source, non-infectious or infectious.
how do you get neonatal conjunctivitis?
- Usually due to transmitted infection from mother during delivery.
how to determine bacterial etiology for neonatal conjunctivitis?
“Rule of 5s” to predict the most likely bacterial etiology.
* Neisseria gonorrhoeae - 0-5 days
* Chlamydial Trachomatis - 5 days to 5 weeks
* Strep or H. influenzae - 5 weeks to 5 years
the most common infection source in neonatal conjunctivitis?
chlamydia
what is used as a prophylactic tx for neonatal conjunctivitis?
erthromycin oinment
tx for neonatal conjunctivitis?
- Suspected chemical toxicity –> d/c offending agent + ATs qid + reassess in 24 hrs.
- Suspected chlamydial infx –> azithromycin 20mg/kg po for 3 days
- Suspected gonorrhoeae –> ceftriaxone 25-50 mg/kg IM or IV as a single dose. Also tx for possible chlamydia coinfection –> azithromycin po for 3 days
- F/U –> daily
what are the 2 types of conjunctivitis caused by chlamydia? what serotype causes each?
- adult inclusion conjunctivis - caused by serotypes D-K
- trachoma - caused by serotypes A-C
who gets adult inclusion conjunctivitis? how does someone get adult inclusion conjunctivitis?
- occurs in sexually active adults.
- Most common via direct inoculation (hand-eye, genital-eye, etc.).
- Rare - via contaminated swimming pool water, or shared cosmetic.
signs for both chlamydial conjunctivitis?
- Unilateral - then bilateral
- Mucopurulent discharge (can be stringy)
- HUGE Follicles (limbal & palpebral) – inferiorly = for adult inclusion & supeior = trachoma.
- LIL Papillae – mainly in the inferior palpebral conj & fornices.
- Can involve cornea - SEI
only bacterial infection that causes follicles on palpebral and bulbar conj?
chlamydial bacterial infx
what are specific signs of late-stage trachoma?
- Arlts lines - linear white scarring of the superior tarsal conjunctiva.
- Herbert’s Pits - depression on the superior limbal conjunctiva after resolution of limbal follicles.
- Trichiasis, entropion
- Corneal neovas
- Severe corneal opacification
tx for both chlamydial conjunctivitis?
- single dose of oral azithromycin (1g) –> then daily use of oral doxycycline, tetracycline, or erythromycin for 1-2 wks.
- F/u shoud be every 2-3 wks until resolution.
- refer to specialist to r/o other STDs.
- tx all pt’s sexual partners.
