Eye and Ears Flashcards

Question

EYE SPECIMEN PROCESSING Culture: what do we get at michener

Answer 1

Non-sterile specimens plated to BA & CHOC rein for 48 -NYC or TM (350C CO2) 72hrs if GNDC seen or if dr wants or neonate <1 wk old Sterile specimens plated to BA, CHOC, CNA, MAC, BRUC & THIO (add NYC or TM if required) we just conjunctival swab direct report with quantitation the presence of pus cells, epithelial cells and organisms

Answer 2

S. aureus H. influenzae BHS Moraxella Neisseria gonorrhoeae Streptococcus pneumoniae Pseudomonas aeruginosa Enterobacterales Are pathogens only if growing in pure/predominant #’s: Enterococcus spp. S. lugdunensis

Answer 3

AST not usually done as most treatment is topical set up an OX screen for any S. aureus & a VANC screen for any Enterococcus to rule out MRSA/VRE AST will be performed & reported if specimens received were more invasively collected, i.e., tissue or fluids, because treatment will be intravenous instead of topical.

Answer 4

non sterile -Viridans strep, Diphtheroid, Micrococcus CoNs or non- pathogenic Neisseria do minimal testing and report as normal flora sterile - do full work up DO NOT REPORT AT NF

Answer 5

-Perform oxidase on any colonies growing on either CHOC or TM to rule out GC. -If oxidase neg, is not GC, re-incubate both CHOC & TM for up to 72 hours. -If oxidase positive, perform Gram stain. If GNDC then perform ID tests. ID of this organism must be by 2 different principles i.e., Biochemical + mass spectrometry or biochemical + serological. At Michener we will be using MALDI & Bacticard. -MALDI done first - If ID is not GC, stop there & re-incubate CHOC & TM for up to 72 hours -If pos for GC, then set up Bacticard (can only be done from selective media TM/NYC). -Requires a 2mcFld - if colonies too small, or growth too scant D2, subculture from TM to chocolate agar. -If both MALDI & Bacticard indicate a GC: perform a Beta lactamase test. -If no GC by D3, write you would re-incubate CHOC & TM for another day.

Answer 6

Superficial infection of skin of outer ear & outer ear canal (also called “Swimmer’s ear”). cause trapped moisture causes bacteria to grow -using a q tip too hard that it causes trauma to ear canal symp Red, weepy, sensitive skin; bleeds easily. Itchy & painful ear canal. Sometimes fluid drainage

Answer 7

complication of OE - rare -bacteria from external ear infection gets to temporal bone of skull -causes nerve damage/paralysis and sigmoid sinus clots. -50% mortality rate -in immunocomps and old ppl with diabetes P. aeruginosa is most common cause followed secondly by S. aureus. Aspergillus spp & Candida are most common fungus.

Answer 8

-related to Candida albicans - GT neg -Nosocomial pathogen – causes outbreaks in healthcare settings. -Causes wound, ear & severe invasive infections with high mortality (57%). -becoming multidrug resistant - problem -need Infection control to stop transmission at risk -ppl after surgery or with central venous catheter -ppl with diabetes or those treated with ABtic or Antifungal

Answer 9

-hard to ID -very drug resistant compared to Candida -molecular is only reliable but not all hospitals have -need to do susceptibility against antifungals -once isolated we need to tell Infection control

Answer 10

-Superficial fungal infection of external ear canal with Aspergillus -in ppl who swim, use oil in ear, ABtic ear drop, steroids or immunocomp -itchy, pain, feeling of blockage -green or black fuzzy growth in ear -Can also cause necrotizing or malignant otitis externa with local spread to bone & cartilage. front - color and texture back - color

Answer 11

infection of air-filled space behind eardrum -caused by virus/bacteria, cold, allergies -happens at any age but most from 3 mot- 3 years because eustachian tube is immature and not functioning symptoms pain, red bulging ear drum , fever, hearing loss -once the ear drum ruptures pus can drain from ear but the infection can spread to outer layer of CSF = meningitis

Answer 12

Tympanocentesis fluid - sterile -Special needle with tube attached used to collect fluid from behind eardrum. -sterile not NF -cant use ear swabs looking for any specimen

Answer 13

Outer ear swab in transport media– not sterile -Direct specimen gram: Quantitate and report: pus, epithelial cells, organisms -culture BA, CHOC, CNA, MAC all 48hrs -report and phone everyday

Answer 14

Pseudomonas aeruginosa (may cause malignant OE) Staphylococcus aureus (may cause malignant OE) Yeast BHS Enterobacteralis Enterococcus & S. lugdunensis if in pure or predominant #s Other pathogens more common in children Streptococcus pneumoniae Haemophilus influenzae

Answer 15

not usually done as most treatment is topical You must still set up an OX screen for any S. aureus & a VANC screen for any Enterococcus to rule out MRSA/VRE.

Answer 16

Specimen: Tympanocentesis fluid/aspirate–sterile Direct specimen gram: Quantitate and report: pus, & organisms (not epithelial) Culture BA, CHOC, CNA MAC, BRUC, THIO REINCUBATE ALL BUT MAC

Answer 17

Sterile specimen so any growth followed up. Perform testing until can determine whether organism is pathogen or not. -AST (if applicable)- see common -Send report & phone physician with results each day until specimen is complete. You may also have to phone ICP or MOH depending on organism.