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Block 9 week 3 > EENT Infections - Hunter > Flashcards

EENT Infections - Hunter Flashcards

1
Q

What is otitis externa?

A

An infection of the external auditory canal.

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2
Q

What is a common nickname for otitis externa and why?

A

It is called swimmer’s ear because it is most common in swimmers and divers who frequently get water trapped in the external canal.

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3
Q

What are the predisposing factors for otitis externa?

A
  1. high environmental temperatures
  2. trauma from mechanical removal of cerumen
  3. follows insertion of foreign objects in canal
  4. associated with chronic dermatologic disease such as eczema
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4
Q

What organisms are the most common causes of otitis externa?

A

Gram-negative bacilli.

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5
Q

What specific organism is the major pathogen associated with otitis externa?

A

Pseudomonas aeruginosa

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6
Q

Pseudomonas aeruginosa is the most common cause of what?

A
  1. otitis externa/swimmer’s ear

2. malignant otitis externa

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7
Q

What is another organism that causes otitis externa?

A

Staphylococcus aureus. Although it is a less common cause than Pseudomonas.

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8
Q

Describe a typical presentation of otitis externa.

A

May present with ear pain, itching and discharge with a swollen and erythematous external canal. Fever is usually lower than 38.3 degrees C and the pinna may be tender. It may also be painful to chew for many patients.

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9
Q

What is standard treatment for otitis externa of bacterial origin?

A
  1. dicloxacillin or ciprofloxacin

2. less severe cases use ofloxacin ear drops

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10
Q

What findings are more associated with malignant otitis externa than with otitis externa?

A
  1. a temperature greater than greater than 38.3 degrees C
  2. severe pain associated with ear canal and surrounding areas
  3. presence of a purulent exudate
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11
Q

How does malignant otitis externa usually start?

A

Often begins as infection of external auditory meatus - often with otorrhea. Especially in immunocompromised adults with diabetes.

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12
Q

Why is malignant otitis externa so dangerous?

A

Necrotizing infection can spread to the cartilage, bone (mastoid process), blood vessels and brain. Can be fatal if untreated.

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13
Q

What is the treatment for malignant otitis externa?

A
  1. Imepenem

2. referral to otolaryngologist for surgical debridement

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14
Q

What is otitis media?

A

Bacterial infection of the inner ear mucosa with exudate production.

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15
Q

Otitis media is especially associated with what population?

A

Children. 50% experience an episode before age 1 and 80% by age 3.

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16
Q

What is the most frequent diagnosis in febrile children?

A

Acute Otitis media.

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17
Q

Does otitis media affect boys more often than girls?

A

yes.

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18
Q

Otitis media often presents with what other two conditions?

A
  1. purulent conjunctivitis

2. rhinosinusitis

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19
Q

What population is especially at risk for recurrent otitis media?

A

Persons with immune deficiencies.

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20
Q

What microorganism is the most common cause of acute otitis media?

A

Streptococcus pneumoniae

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21
Q

What are some other types of microorganisms that are common causes of acute otitis media?

A
  1. Streptococcus pneumoniae
  2. nontypeable Haemophilus influenzae
  3. Moraxella catarrhalis
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22
Q

What are some other less common causes of acute otitis media?

A
  1. Staphyloccus aureus

2. Streptococcus pyogenes

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23
Q

What is the most common cause of acute otitis media in babies younger than 6 weeks of age?

A

Gram-negative bacilli such as E. coli, Klebsiella pneumonia and pseudomonas aeruginosa.

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24
Q

Acute otitis media is often preceded by what

A

Upper respiratory tract viral infection.

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25
Q

What causes a bulging tympanic membrane in acute otitis media?

A

A blocked eustachian tube prevents mucosal absorption of air, causing negative pressure in the middle ear and production of a serous effusion.

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26
Q

What clinical findings are definitive for a diagnosis of acute otitis media?

A

Pain, fever, middle ear effusion.

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27
Q

Can cases of otitis media resolve without antibiotic treatment?

A

Yes. Acetaminophen can be given for the pain but if the patient remains symptomatic by day 3 then antibiotic therapy should be started.

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28
Q

What antibiotic treatment is given for acute otitis media?

A

Amoxicillin.

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29
Q

What is Hordeola?

A

Also called styes. They are infections that present as purulent papules that occur at the lid margin.

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30
Q

What organism causes 90-95% of all cases of Hordeola?

A

Staph aureus.

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31
Q

Hordeola can occur as a complication of what?

A

Blepharitis - inflammation of the eyelid due to blockage and infection of the Zeiss or Moll sebaceous glands (sweat glands) or the meibomian glands (make tears) in the tarsal plate.

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32
Q

What is one major difference between a hordeola and a chalazia?

A

Chalazia are granulomatous lesions that are not painful.

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33
Q

What are some ways of treating a hordeola?

A
  1. many drain spontaneously - especially if warm compresses are applied
  2. external hordeolas can be lanced to drain or nearby eyelashes can be epilated
  3. internal hordeolas can be treated with warm compresses plus oral dicloxacilllin
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34
Q

What contributes to prevention of hordeolas?

A

good hygiene of the eyelid margin

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35
Q

What microorganism is a common cause of hordeolas?

A

Staph aureus.

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36
Q

What is orbital cellulitis?

A

Acute infection of the tissues immediately surrounding the eye.

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37
Q

When should orbital cellulitis be suspected?

A

When the patient has had recent sinusitis, facial trauma, surgery or dental work.

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38
Q

Most cases of orbital cellulitis result from..?

A

Ethmoid sinusitis.

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39
Q

What pathogen is primarily involved in orbital cellulitis?

A

Staph aureus, but H. influenzae and anaerobes may also be involved.

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40
Q

What meds are used to treat orbital cellulitis?

A

Nafcillin, ceftriaxone and metronidazole.

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41
Q

10% of orbital cellulitis cases result in….?

A

Some vision loss.

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42
Q

What are the two types of orbital cellulitis and which one is more serious?

A
  1. preseptal cellulitis - infection of tissues surrounding eye anteriorly
  2. post-septal cellulitis - infection of the tissues surrounding the eye posteriorly - this is the more serious type
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43
Q

What are some serious complications of orbital cellulitis?

A

Brain abscesses, meningitis, cavernous venous thrombosis.

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44
Q

What are some clinical findings of orbital cellulitis?

A

Proptosis (bulging eyelid), Opthalmoplegia (paralysis or weakness of eye muscles), edema and erythema of the eyelids, pain on eye movement, fever, headache, malaise, dark red discoloration of the eyelids, chemosis (edema of the conjunctiva) and hyperemia of the conjunctiva.

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45
Q

What is conjunctivitis?

A

Inflammation of the palpebral and bulbar conjunctiva. Also called pink eye (due to inflammatory blood vessel dilation) and occurs at any age.

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46
Q

30% of all eye complaints to family physicians are….?

A

Conjunctivitis.

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47
Q

What is keratitis?

A

Inflammation of the cornea.

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48
Q

What is keratoconjuntivitis?

A

Inflammation of the cornea and the palpebral and bulbar conjunctiva. Most organisms causing conjunctivitis also cause keratitis.

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49
Q

What is the most common cause of viral conjunctivitis?

A

Adenoviruses.

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50
Q

What is a less common but more serious cause of conjunctivitis?

A

HSV-1 and HSV-2

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51
Q

What organisms can cause purulent conjunctivitis?

A
  1. Staph aureus
  2. Strep pneumoniae
  3. Haemophilus influenzae
  4. Moraxella catarrhalis
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52
Q

What organism causes hyper purulent conjunctivitis?

A

Neisseria gonorrhoeae - can cause significant corneal damage.

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53
Q

What organism causes follicular (inclusion) conjunctivitis?

A

Chlamydia trachomatis - usually in sexually active teenagers and young adults in US. Globally it is the leading cause of trachoma, which is the leading cause of unctuous blindness in the world.

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54
Q

What is ophthalmia neonatorum?

A

Conjunctivitis in newborns (often spreads rapidly to the cornea too causing corneal perforation) within the first month of life. This is caused by maternal infection with Neisseria or Chlamydia which the baby picks up via passage through the birth canal. There is a 30-50% transmission rate during vaginal delivery.

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55
Q

Describe the pathogenesis of conjunctivitis.

A

Infectious agents adhere to the conjunctiva and overwhelm normal defense mechanisms (e.g., tearing, lysozyme): clinical symptoms of redness, discharge, and irritation.

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56
Q

Conjunctiva is a serious concern in what population?

A

Conjunctivitis usually is a self-limited process; however, in immunocompromised patients and in patients with certain infectious agents, conjunctivitis can cause serious infections of the cornea that threaten loss of sight.

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57
Q

Chlamydial conjunctivitis can lead to what?

A

Conjunctival scarring and vision loss.

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58
Q

Viruses and Chlamydia can cause what?

A

Can cause lymphatic tissue in the conjunctiva to hypertrophy, resulting in follicle formation.

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59
Q

Why does the eye look red in viral conjunctivitis?

A

Blood vessels dilate.

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60
Q

What sensations may the patient with conjunctivitis feel in the eye?

A

Fullness, burning or a feeling of grit or a foreign body in the eye. Also there may be excessive tearing and a purulent discharge if the cause is bacterial.

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61
Q

Does conjunctivitis usually cause vision impairment?

A

No - the cornea and pupil appear normal.

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62
Q

What is the treatment for viral conjunctivitis?

A

Supportive care such as artificial tears and cold compresses.

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63
Q

How is Herpes conjunctivitis treated?

A

Acyclovir

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64
Q

Both Neisseria and Chlamydia can cause Ophthalmia neonatorum. Which one presents faster if transmitted?

A

Neisserial causes present within 2-3 days of delivery while Chlamydia causes present within 4-10 days. Chlamydia is a more common cause.

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65
Q

Untreated Neisserial keratoconjunctivitis in newborns can progress to what?

A

Ulceration or perforation of the cornea in as little as 24 hours.

66
Q

What is the treatment for Ophthalmia neonatorum?

A

Cetriaxone for Neisserial infections and erythromycin ointment is used for prophylaxis right after birth.

67
Q

What is Trachoma?

A

An eye infection caused by Chlamydia trachomatis. It is often found in third world countries and is a disease of poverty and unsanitary living conditions.

68
Q

How does Trachoma present?

A

A mucopurulent keratoconjunctivits. Often with purulent discharge, swollen eyelids, trichiasis, fever, pre- auricular LAD, photophobia and follicular response on the conjunctival surface of the upper eyelid (formation of follicles in lymph tissues).

69
Q

What is trichiasis and what can it cause?

A

Trichiasis is when the eyelashes turn into the eye. With blinking, this can cause scratching of the cornea which leads to cicatricial or corneal scarring which in turn can lead to blindness.

70
Q

Most cases of keratitis also involve…?

A

The conjunctiva - leads to keratoconjunctivitis.

71
Q

Microbial keratitis is considered to be what?

A

A potentially vision-threatening condition that can be caused by many different viruses, bacteria, fungi, or parasites.

72
Q

What is the most common risk factor for microbial keratitis in the US?

A

The use of contact lenses.

73
Q

What are the most common causes of viral keratitis?

A
  1. HSV -1 in adults
  2. HSV-2 in neonates
  3. varicella zoster
  4. adenoviruses
74
Q

What are the most common causes of bacterial keratitis?

A
  1. Staph aureus
  2. Strep pneumo
  3. Strep pyogenes
  4. H. flu
75
Q

What are some other less common causes of keratitis?

A
  1. Aspergillus
  2. Fusarium
  3. Candida
  4. Acanthamoeba species - in contact lens wearers
  5. Pseudomonas aeurginosa - in contact lens wearers
76
Q

What is the most common corneal infection in the US?

A

HSV keratitis.

77
Q

HSV keratitis is the leading cause of what in the US?

A

Infectious blindness and the need for corneal transplantation.

78
Q

Most cases of keratitis are…?

A

Unilateral - greater than 90% are unilateral.

79
Q

What are some ways for HSV to spread to the eye?

A
  1. transferred from oral or genital herpes

2. spread via the trigeminal ganglion

80
Q

Pathology in HSV keratitis is caused by what?

A

HSV cytotoxicity and damage from inflammation. Often corticosteroids are used to dampen inflammation and prevent scarring.

81
Q

What is the treatment of HSV keratitis?

A
  1. Trifluridine drops for 3 weeks

2. Acyclovir if infection persists

82
Q

What is Uveitis?

A

Inflammation of the uvea which is the pigmented, vascular middle layer of the eye between the cornea-sclera outer layer and the retina.

83
Q

What causes Uveitis?

A
  1. autoimmune conditions like lupus
  2. infections - cause about 20% of cases
  3. trauma
  4. 50% of cases are idiopathic
84
Q

What are the most common infectious causes of uveitis?

A

HSV and toxoplasma gondii infections.

85
Q

How does anterior uveitis present? posterior uveitis?

A

Anterior uveitis effects the anterior chamber. Presents with eye pain, decreased vision, ciliary flush, and cells in the anterior chamber (hypopyon). The vitreous has few cells and the retina is normal. Posterior uveitis presents with painless loss of vision, few cells in the anterior chamber, many cells in the vitreous, and lesions in the retina, choroid, or both.

86
Q

What is endophthalmitis?

A

Refers to bacterial or fungal infection of the vitreous or aqueous humor or both. Most cases are exogenous; organisms are introduced from an external source (e.g. cataract surgery).

87
Q

Anterior Uveitis is also called what?

A

Iritis, cyclitis, iridocyclitis.

88
Q

What is the most common cause of anterior uveitis?

A

HSV

89
Q

Posterior uveitis is also called what?

A

Choroditis, chorioretinitis, retinitis.

90
Q

What are the most common causes of posterior uveitis?

A
  1. Toxoplasma gondii
  2. CMV
  3. Toxocara canis
91
Q

What is Panuveitis?

A

Infection of all uveal structures. Most often caused by Treponema pallidum.

92
Q

What are the most common causes of endopthalmitis?

A
  1. Staph aureus
  2. Streptococci
  3. gram-negative bacilli
93
Q

What is the most common form of posterior uveitis in otherwise healthy individuals?

A

Toxoplasma chorioretinitis.

94
Q

What is a highly suggestive finding for toxoplasma chorioretinitis?

A

An active, uniforcal area of acute chorioretinal inflammation adjacent to an old chorioretinal scar

95
Q

Describe some characteristics of toxoplasma chorioretinitis.

A
  1. vitreous inflammation can be severe
  2. some damage is due to T cell mediated immunopathology
  3. dormant bradyzoites can reactivate in the eye
  4. vision can be impaired when lesions form in critical locations such as the macula
96
Q

What is the concern with women who are infected for the first time with toxoplasma gondii during the first trimester?

A

About 1/3 of infections will have transplacental transmission. Many cases of toxoplasma chorioretinitis originate as congenital infections.

97
Q

90% of colds are caused by what?

A

Viruses.

  1. rhinoviruses
  2. coronavirues
  3. adenoviruses
  4. myxoviruses
  5. enteroviruses
98
Q

Describe the pathogenesis of the common cold.

A
  1. rhinoviruses (most commonly) enters nasal passages
  2. virus infects ciliated columnar epithelial cells by binding to ICAM-2
  3. host cells killed causing inflammation including hyperemia and edema
  4. usually occurs in the winter
99
Q

What is rhinorrhea?

A

Secretion of clear, mucoid nasal fluids. Occurs in the common cold initially and may become mucopurulent with secondary bacterial infection.

100
Q

What can happen if rhinorrhea is severe?

A

Blockage of the sinus ostia or the eustachian tubes leading to paranasal sinusitis or otitis media.

101
Q

URI’s such as the common cold can extend where?

A

To the lower respiratory tract to cause bronchitis.

102
Q

What is the treatment for the common cold?

A

Supportive therapy to ease discomfort. Includes:

  1. oral hydration - nasal saline and steam to promote drainage
  2. antipyretics, and analgesics such as acetaminophen
  3. decongestants such as oxymetazoline
  4. mucolytics such as guaifensesin to thin nasal secretions and reduce postnasal drip
103
Q

What is acute rhinosinusitis?

A

Inflammation or infection of the nasal passage mucosa and at least one of the paranasal sinuses that lasts no longer than 4 weeks.

104
Q

Most cases of rhinosinusitis are caused by….?

A

Respiratory viruses such as rhinovirus, parainfluenza virus, respiratory syncytial virus and adenovirus. Most cases occur in the winter months.

105
Q

Infections of the sinuses often follow…?

A
  1. the common cold
  2. dental extractions
  3. rhinitis due to allergies
106
Q

acute viral rhino sinusitis can be complicated by…?

A

Bacterial infection - leads to acute bacterial rhinosinusitis. More likely diagnosis if high fever (> 39 C) and purulent discharge are present. Often preceded by viral URI.

107
Q

What are the most common causes of acute bacterial rhinosinusitis?

A
  1. Strep pneumo
  2. nontypeable H. flu
  3. Moraxella catarrhalis
108
Q

Rhinosinusitis in immune compromised patients can be caused by what?

A

Fungal rhinosinusitis - Mucor, Rhizopus and Aspergillus.

109
Q

What are the symptoms of rhinosinusitis?

A

Sneezing, rhinorrhea, nasal congestion, postnasal drip, aural fullness, facial pressure, headache, sore throat, cough, fever and myalgia.

110
Q

How is acute bacterial rhinosinusitis treated?

A
  1. initial antibiotic therapy with amoxicillin or cefdinir
  2. trimethoprim-sulfamethoxazole or azithromycin in B-lactam allergic patients
  3. removal of septal deviations, large nasal polyps or foreign bodies
  4. practice of proper dental management
111
Q

What is acute rhino cerebral mucormycosis?

A

Fungal rhinosinusitis - can be caused by mucor or rhizomes in immune compromised patients such as those with uncontrolled diabetes.

112
Q

What is the most common presentation of rhino cerebral mucormycosis?

A

Includes headache, facial pain, lethargy, visual loss, proptosis, and/or palatal ulcer or eschar.

113
Q

How is rhino-cerebral mucormycosis diagnosed?

A
  1. fine needle aspiration - silver stain will show nonseptate hyphae and right angle branching
  2. imaging studies such as CT are helpful
114
Q

What is a dangerous complication of rhino-cerebral mucormycosis?

A

CNS involvement such as in cavernous venous thrombosis. Can also lead to death.

115
Q

What is the treatment of rhino-cerebral mucormycosis?

A
  1. start systemic antifungals immediately - such as liposomal Amphoterecin B
  2. surgical consult for extensive debridement of all infected and necrotic tissue with drainage of all sinus and abscess fluid collections
116
Q

What is pharyngitis?

A

Infection of the pharynx. Most common in winter and early spring. Usually benign and self-limiting (except Diphtheria). Can be acquired via contaminated fomites or person to person contact.

117
Q

What is the most common cause of pharyngitis?

A

Viruses - rhinovirus, adenovirus, EBV, CMV, HSV, influenza, parainfluenza, coronavirus, enterovirus and HIV.

118
Q

Bacterial pharyngitis is most commonly caused by what?

A

Streptococcus pyogenes or Group A strep. Called Strep throat. Usually a disorder of children ages 5-15.

119
Q

What are two other causes of pharyngitis?

A
  1. Corynebacterium diphtheria - causes a serious pharyngitis with systemic complications
  2. candida albicans - can cause a fungal oropharyngitis called thrush - most commonly seen in immune compromised patients.
120
Q

Describe the pathogenesis of pharyngitis.

A
  1. viruses may gain access to mucosal cells lining the nasopharynx and replicate and damage them
  2. bacteria may gain access and attach to mucosal epithelial cells using M protein
  3. If is Strep throat - Strep pyogenes produces proteases and hyaluronidases that assist the bacteria in invading mucosa
121
Q

What are possible complications of an untreated episode of bacterial pharyngitis?

A
  1. Post -streptococcal rheumatic fever.
  2. peritonsillar abscess
  3. cervical lymphadenitis
  4. mastoiditis
122
Q

What is a common presentation for Strep throat?

A
  1. fever, severe pain upon swallowing - usual sudden onset
  2. headache, nausea, abdominal pain and vomiting may occur - especially in children
  3. tonsillopharyngeal erythema with or without exudate
  4. LAD in the cervical lymph nodes
123
Q

Describe the diagnosis of bacterial pharyngitis.

A
  1. culture of throat swabs on blood agar plates - are beta hemolytic, catalase negative, bacitracin sensitive gram positive cocci
  2. rapid antigen detection tests for S. pyogenes - not as sensitive as culture
124
Q

How is pharyngitis treated?

A
  1. test for S. pyogenes because antimicrobial therapy is needed to prevent rheumatic fever
  2. if rapid Strep A test is positive then antibiotics are prescribed (usually oral penicillin V for ten days), if negative then wait for culture to start antibiotics
125
Q

A type of pharyngitis caused by candida albicans is called what?

A

Thrush or oropharyngeal candidiasis. Most often is painless but may present with burning sensation. May occasionally present with dysphagia (difficulty swallowing). Most often occurs in the immune compromised.

126
Q

How is thrush treated?

A
  1. topical nystatin or chlortrimazole

2. manage cause of immunosuppression

127
Q

Cornybacterium diphtheriae is a bacteria that can infect….?

A

Can colonize the oropharynx and skin. Humans are the only known reservoir. Rarely seen in US due to vaccination.

128
Q

Describe the Cornybacterium diphtheriae bacteria.

A

Irregularly staining gram positive, club shaped bacteria.

129
Q

Describe the pathogenesis of diphtheria.

A
  1. Only C. diphtheriae lysogenic for the bacteriiophage carrying toxin gene cause diphtheria
  2. damage to the pharynx is caused by diphtheria toxin
  3. diptheria toxin kills mucosal cells by ADP-ribosylation of elongation factor II which terminates protein synthesis
  4. inflammatory response to cell death form the pharyngeal pseudomembrane.
130
Q

Diptheria toxin can also bind to heart and nerve cells causing what complications?

A
  1. myocarditis - associated with high mortality rate

2. Cranial nerves are most sensitive resulting in difficulty swallowing and nasal regurgitation of liquids

131
Q

Describe some common clinical findings of diphtheria.

A
  1. pharyngeal pain and pseudomembrane on tonsils and back of oropharynx
  2. regional lymphadenopathy or Bull neck
  3. edema of surrounding tissue, fetid breath, low-grade fever, cough
  4. may present with airway obstruction leading to tachypnea, stridor, cyanosis
132
Q

How is diphtheria diagnosed?

A

I clinical signs are present ororpharynx should be swabbed and cultured - often assay for toxin or PCR

133
Q

Describe the treatment of diphtheria.

A
  1. patient should be hospitalized and placed in isolation
  2. immediately give antiserum to neutralize toxin
  3. give antimicrobials such as erythromycin or clindamycin
  4. give diphtheria vaccine - DTaP for children and DT vaccine for adults
134
Q

What are croup, laryngitis and epiglottitis?

A

Acute inflammatory diseases of the upper airways.

135
Q

What is the most serious risk involved with the acute inflammatory diseases of the upper airways?

A

Risk of airway obstruction - particularly in young children because their airways are narrower than older children and adults.

136
Q

What are the most common causes of croup?

A

Viruses - especially parainfluenza virus.

137
Q

What microorganisms are associated with acute laryngitis?

A
  1. rhinovirus
  2. adenovirus
  3. coronavirus
  4. metapneumovirus
  5. influenza virus
  6. mycoplasma pneumoniae
  7. chlamydophila pneumoniae
138
Q

What is the most common cause of epiglottitis?

A

Many organisms cause it but predominately H. flu type b.

139
Q

Describe the pathogenesis of the upper airway infections.

A
  1. viral infection of upper airway causes inflammation and edema of the larynx leading to acute laryngitis
  2. viral infection of the larynx, trachea and bronchi causes viral croup
140
Q

What causes the partial obstruction of the airway in both acute laryngitis and viral croup?

A

Mucus

141
Q

How does acute laryngitis present?

A

Swelling of the vocal cords that results in dysphonia (hoarseness), odynophonia (pain with speaking) and dysphagia (difficulty swallowing).

142
Q

How does viral croup present?

A
  1. narrowing of the subglottic trachea leads to audible inspiratory stridor
  2. laryngotracheal inflammation leads to barking cough
143
Q

Describe epiglottitis.

A
  1. a cellulitis of the epiglottis and surrounding tissues
  2. organisms cause inflammation leading to erythema and edema
  3. sore throat rapidly progresses to difficulty breathing, stridor and obstruction of the airways that may lead to respiratory arrest
144
Q

Croup begins with….?

A

A prodromal mild URI with coryza, nasal congestion, sore throat and cough that lasts 2-3 days.

145
Q

How is croup diagnosed?

A
  1. clinical diagnosis based on fever, stridor and characteristic barking cough
  2. Steeple sign on X-ray
  3. rule out other rare but significant causes of acute upper airway obstruction such as epiglottitis or soft tissue infection
146
Q

What is the most common cause of epiglottitis?

A

H. flu type b. Incidence of epiglottitis has decreased due to Hib vaccine. Prevalence in adults now surpasses kids due to success of vaccine. Mortality and morbidity of epiglottitis can be very high

147
Q

What is the overriding priority in epiglottitis?

A

Securing and maintaining the airway. Children should be put in ICU.

148
Q

What is usually the first symptom of epiglottitis?

A

Fever - often reaching 40 C. Classic presentation includes drooling, dysphagia and distress.

149
Q

What is a characteristics X-ray sign for epiglottitis?

A

Thumbprint sign - shows a swollen epiglottis.

150
Q

How is epiglottitis treated?

A
  1. ceftriaxone or cefotaxime for 7-10 days

2. corticosteroids used to decrease inflammation

151
Q

Infection by Bordetella pertussis causes what?

A

Pertussis or whooping cough.

152
Q

Is Bordetella pertussis a gram-negative coccobacillus?

A

Yes.

153
Q

Describe some characteristics of pertussis.

A
  1. can be fatal
  2. DTaP has lowered incidence in US
  3. humans are only natural host
  4. infection via aerosolized droplets - highly infectious
  5. most serious in children younger than 12 months
  6. up to 50% of cases in children can be traced to adults with a chronic cough (carriers)
154
Q

Describe the pathogenesis of pertussis.

A
  1. B. pertussis is inhaled and it attaches to ciliated epithelium in trachea
  2. pertussis toxin, tracheal cytotoxin and filamentous hemagglutinin cause tissue damage in trachea
  3. large amounts of mucus are produced in response to infection and this leads to cough
  4. neurologic effects are associated with hypoxia and intracerebral hemorrhage
155
Q

Pertussis may begin with….?

A

Catarrhal phase - this phase is indistinguishable from an URI.

156
Q

What is the paroxysmal phase of pertussis?

A

Begins with sudden episodic coughing that generally lasts 2-4 weeks - about 15 attacks per day

157
Q

What is it about the cough of a person with pertussis that is pathognomonic?

A

The cough begins with an inspiratory ‘whoop’.

158
Q

Severe cases of pertussis result in?

A

Hemoptysis, subonjunctival hemorrhages, hernias, seizures and even death.

159
Q

How is pertussis diagnosed?

A

Clinical picture plus culture of aspirates on a Bordet-Gengou medium and serology

160
Q

What is a common lab finding for pertussis?

A

Elevated WBC count with lymphocytosis.

161
Q

How is pertussis treated?

A

Erythromycin is drug of choice but it does little during paroxysmal phase.

Block 9 week 3 (5 decks)

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