Case 2b Flashcards
What are some risk factors for ear infections?
Smoker in the home
Daycare
What would you do for the family in this case?
- Father smokes
- Child with left TM bulging, some redness
- Unhappy, holding ear
- Child has bacterial infection
- Give parents amoxicillin on hold - get script in a few days if it doesn’t clear up on its own
Is otitis media related to hearing problems? If not, what is?
No, Chronic middle ear effusion
When do you give tubes?
If chronic serous infection (not if recurrent infections that resolve)
What can viral cause in an ear infection?
Redness and fluid (usually)
What can bacteria cause in an ear infection?
Bulging TM
What do changes in mental status of activity indicate for a patient with an ear infection?
It could mean the infection spread to a dangerous area!
What should you give to children under 24 months with a bacterial infection?
Amoxicillin! (sometimes give clavulanate if the infection doesn’t resolve)
Where is the most likely place in catch an adenovirus in a group setting?
Swimming pool/pond
What symptoms does Type D-K chlamydia cause?
- Yellow discharge
- Viewed on Giemsa stain
- Intracytoplasmic inclusion bodies
What antibiotic should be used for chlamydia?
Azithromycin/Erythromycin
What is the mechanism of Azithromycin?
Inhibits translation - binds 23s rRNA of 50s subunit
If a baby has chlamydia eye infection, who else should you treat?
Mother + partners
What side effects can doxycycline cause?
Tendon & defects in children
-Not good for kids >8 and pregnant people
What is the mechanism of moxifloxacin?
Topoisomerase II (gyrase) and IV inhibitor -Inhibits DNA replication --> bactericidal
What organism is known to be the most resistant of all clinically relevant bacteria due to (1) expression of multi drug efflux pumps, (2) presence of mutant porin proteins,, (3) presence of a polysaccharide capsule?
Pseudomonas aeruginosa
What drug is effective against pseudomonas aeruginosa?
Polymyxin B
What is chorioretinitis?
Blurred vision and visual field defects
-It usually gets to the eyes through retinal arteries via blood borne route, often manifestation of systemic disease
What are the most common causes of chorioretinitis?
Toxoplasma and CMV (ganciclovir implant)
What does CMV retinitis look like on retina?
Begins in periphery and spreads like “brushfire”
What is the mechanism of ganciclovir?
It inhibits viral DNA synthesis
What should Trifluidine be used on?
Acyclovir resistant viruses
-HSV keratoconjunctivitis
What are the TORCH infections? What can they do?
Toxoplasmosis - chorioretinitis, neurologic deterioration
Other viruses - HIV
Rubella - deafness, chorioretinitis
Cytomegalovirus (CMV) - infected cells become swollen, most infections are asymptomatic
Herpes Simples
They cross the placenta and cause congenital disease.
What is toxoplasma?
- Most common parasitic disease
- Late term congenital infections are more likely to produce progressive blindness
- Causes a linear scar on eye
How do you diagnose toxoplasma?
IgM serology
How do you treat toxoplasmosa?
Folate synthesis inhibitors!
-Pyrimethamine and Sulfadiazine
What is acanthamoeba?
- Single cell, eukaryote
- Keratitis or granulomatous amebic encephalitis
- Can be found in soil, water, sewage, etc.
How do you treat acanthamoeba?
-Azoles
