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MD4001 > Infections of the Sensory System > Flashcards

Infections of the Sensory System Flashcards

1
Q

Identify the main sites of sensory infections.

A
  • Eyes
  • Oral cavity
  • “Upper” respiratory tract
  • Ears
  • Sinuses
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2
Q

Identify the main ocular defense mechanisms.

A
  • Eyelids
  • Lacrimal system
  • Conjunctiva
  • Cornea
  • Blood-ocular barrier
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3
Q

Identify examples of sensory system infections.

A
  • Bacterial Conjunctivitis
  • Adenovirus Infections
  • VZV Infections
  • Shingles
  • HSV Infections
  • Onchocerciasis
  • Trachomatis
  • AIDS (ocular manifestations)
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4
Q

Identify the main kinds of different bacterial conjunctivitis.

A

Common condition
Neonatal
HAI

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5
Q

Identify the main pathogens responsible for common bacterial conjuctivitis.

A

– Haemophilus influenzae

– Streptococcus pneumoniae – Moraxella spp.

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6
Q

Identify the main pathogens responsible for neonatal bacterial conjuctivitis.

A

– Neisseria gonorrhoeae
– Chlamydia trachomatis
– Escherichia coli

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7
Q

Identify the main pathogens responsible for hospital acquired bacterial conjuctivitis.

A

-Pseudomonas aeruginosa

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8
Q

Identify the main clinical features of bacterial conjunctivitis.

A

– Hyperaemic red conjunctivae

– Mucopurulent discharge

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9
Q

Identify the main investigations for bacterial conjunctivitis.

A 
1) Samples:
– Conjunctival swabs 
– Corneal scrapings
2) Lab diagnosis
– Culture and NAAT
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10
Q

Describe treatment for bacterial conjunctivitis.

A

• Treatment with local antibiotics:
– Fusidic acid
– Tetracycline
– Chloramphenicol

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11
Q

ADENOVIRUS INFECTIONS

  • Clinical features
  • Treatment
  • Serotypes
A

ADENOVIRUS INFECTIONS

  • Clinical features: purulent + enlargement of ispilateral periauricular lymph node + may have corneal involvement (incl. punctate keratitis, subepithelial inflammatory infiltration)
  • Treatment: Symptomatic treatment + avoid topical steroids
  • Serotypes: 3, 4, 7, 8, and 10
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12
Q

VZV INFECTIONS

-Clinical features

A 
VZV INFECTIONS (SHINGLES)
-Clinical features: 
Ophtalmic dermatome of 5th cranial nerve
Skin lesions
Anterior uveitis
Ocular perforation 
Retinal involvement
Very painful (post-herpetic neuralgia)
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13
Q

Describe treatment of shingles.

A
  • Antiviral treatment – aciclovir
  • Severe inflammation – topical steroids
  • Prevent primary infection – live attenuated vaccine
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14
Q

What proportion of shingles constitutes a chronic disease ?

A

25%

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15
Q

What is the most common infectious cause of blindness in the developed world ?

A

HSV infections

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16
Q

Identify the main clinical (ocular) features of HSV infections.

A 
– Ulcerative blepharitis
– Follicular conjunctivitis
– Regional lymphadenopathy
– Corneal involvement – not unusual (possible corneal oedema)
– Opacity 
– Dendritic ulcer (marker of infection) 
– Keratitis
– Opacity
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17
Q

Describe the timeline of HSV infections.

A

Relapses may occur ~4 years

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18
Q

Describe treatment for HSC infections.

A
  • Antiviral treatment – aciclovir
  • Avoid steroids
  • Repeated scarring – corneal grafting
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19
Q

ONCHOCERCIASIS

  • Disease caused
  • Causative pathogen
  • Transmission
  • Clinical features
  • Treatment
  • Where in the world ?
A

ONCHOCERCIASIS

  • Disease caused: River blindness
  • Causative pathogen: Onchocerca volvulus
  • Transmission: Blackfly
  • Clinical features: Lesions may lead to blindness
  • Treatment: Invermectin and doxycyline
  • Where in the world ? West Africa, S America, C America
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20
Q

TRACHOMATIS

  • Causative pathogen
  • Other names
  • Clinical features
  • Treatment
  • Where in the world ?
A

TRACHOMATIS
-Causative pathogen: Chlamydia trachomatis
-Other names: Chronic keratoconjunctivitis
-Treatment: Oral macrolides (azithromycin) + surgery for inturned eyelids
-Where in the world ? Largely confined to the tropics
-Clinical features:
Symptoms occur 3-10d post-infection:
Lacrimation
Mucopurulent discharge
Conjuntival involvement
Follicular hypertrophy

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21
Q

Identify preventive measures to eradicate trachomatis.

A

Surgery- inturned eyelids
Antibiotics (azithromycin)
Facial cleanliness to prevent disease transmission
Environmental change (to increase access to water and sanitation)

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22
Q

Identify ocular manifestations of AIDS.

A
  • “Cotton wool spots” (“caused by damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer”)
  • Infarction of retinal nerve fibre layer
  • CMV infection late in course of HIV disease (can eat the retina, and cause eue symptoms such as loss of vision)
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23
Q

Describe treatment of AIDS against its ocular manifestations.

A
  • Antiviral treatment – IV ganciclovir

* Maintain therapy to prevent relapse

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24
Q

How does endophthalmitis.

A 
• Develops after:
– Ocular operation
– Trauma
– Inoculation of foreign body
– Complication of systemic infection
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25
Q

Which class of pathogens cause endophthalmitis ?

A

Bacterial causes

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26
Q

How is endophthalmitis treated ?

A

Treated by systemic antibiotics and early vitrectomy

27
Q

Identify conditions arising from poor mouth hygiene.

A

– Oral Candiasis (thrush)
– Caries
– Gingivititis

28
Q

True or false: glycoproteins from biofilms are amazing at covering our teeth!

A

True

29
Q

Describe normal microbiota of the RT.

A

• COMMON (>50% normal people)

  • Bacteroides spp.
  • Candida albicans
  • Oral Streptococci
  • Haemophilus influenzae

• OCCASIONAL (<10% normal people)

  • Streptococcus pyogenes
  • Streptococcus pneumoniae
  • Neisseria meningitidis

• LATENT STATE IN TISSUES

  • Herpes simplex virus type I (HSV)
  • Epstein-Barr virus (EBV)
  • Cytomegalovirus (CMV)
30
Q

Identify examples of RT infections.

A 
Rhinitis (sinusitis...)
Pharyngitis
Laryngitis
Tracheitis
Bronchitis
Pnuemonia
31
Q

Identify the main host defences of the RT.

A
  • Saliva
  • Mucus
  • Cilia (muco-ciliary escalator/elevator)
  • Nasal secretions
  • Antimicrobial peptides
32
Q

Identify the main infections of the RT, affecting the sensory system.

A
  • Common Cold
  • Acute Pharyngitis and Tonsillitis
  • Cytomegalovirus (CMV)
  • Epstein-Barr Virus (EBV): Glandular Fever
  • Streptococcus pyogenes
  • Parotitis
  • Acute Epiglottitis
  • Diphtheria
  • Laryngitis and Tracheitis
  • Otitis and Sinusitis
33
Q

COMMON COLD

  • Transmission
  • Causative pathogens
  • Pattern of infection
  • Clinical features
  • Prevention
A

COMMON COLD
-Transmission: aerosol, virus-contaminated hands
-Causative pathogens: Rhinoviruses, Coronaviruses
-Pattern of infection: Seasonal: early autumn and mid / late spring (but generally mild and self-limiting)
-Clinical features:
• tiredness
• slight pyrexia
• malaise
• sore nose and pharynx
• profuse, watery nasal discharge becoming mucopurulent
• sneezing in early stages
• secondary bacterial infection occurs in minority
-Prevention: No vaccine

34
Q

Identify another term for common cold.

A

Acute coryza

35
Q

Identify causative agents of acute pharyngitis and tonsillitis.

A

– Viruses
• Epstein-Barr virus (EBV)
• Cytomegalovirus (CMV)

– Bacteria
• Streptococcus pyogenes (tonsilitis is mainly this)

36
Q

CMV (in acute pharyngitis and tonsilitis).

  • Transmission
  • Symptoms
  • Treatment
A

CMV (in acute pharyngitis and tonsilitis).

  • Transmission: Transmission in body secretions and organ transplants
  • Symptoms: usually asymptomatic or mild in healthy adults
  • Treatment: ganciclovir, foscarnet, cidofovir
37
Q

What condition is the Epstein-Barr virus mainly responsible for ?

A

Infectious mononucleosis (Glandular fever)

38
Q

What is the main histological effect of the EBV ?

A

Replicates B lymphocytes

39
Q

Identify the clinical features of EBV.

A 
– Fever
– Headache 
– Malaise
– Sore throat 
– Anorexia
– Palatal petechiae
– Cervical lymphadenopathy 
– Splenomegaly
– Mild hepatitis
- Swollen tonsils and uvula
- Petechiae on the soft palate 
- White exudate
40
Q

Describe treatment for glandular fever.

A

– Not to be treated with antibiotics (ampicillin and amoxycillin)!
– Contact sports or heavy lifting should be avoided durind the first month of illness and until any splenomegaly has resolved

41
Q

Identify possible complications of glandular fever.

A

– Burkitt’s lymphoma

– Nasopharyngeal carcinoma – Guillain-Barré syndrome

42
Q

Identify the main clinical features of Tonsilitis.

A

– Fever
– Pain in throat
– Enlargement of tonsils
– Tonsillar lymphadenopathy

43
Q

Describe treatment of Tonsilitis.

A
  • Susceptible to treatment with penicillin

* Increasing resistance to erythromycin and tetracycline

44
Q

Identify possible complications to Strep Pyogenes infections.

A 
Scarlet Fever
– Caused by erythrogenic
toxin from S. pyogenes
• Peritonsillar abscess
(“quinsy”)
• Otitis media / sinusitis
• Rheumatic heart disease
• Glomerulonephritis
45
Q

Which pathogen is responsible for Parotitis ?

A

Mumps virus

46
Q

Identify the main clinical features of Mumps.

A 
– Fever
– Malaise
– Headache
– Anorexia
– Trismus
– Severe pain and swelling of parotid gland(s)
47
Q

What are the primary sites of replications of the mumps virus in Parotitis ?

A

• Primary sites of replication: URT and eye

48
Q

Describe treatment, and prevention for parotitis.

A

TREATMENT
– Mouth care
– Nutritional
– Analgesia

PREVENTION
– Active immunisation
– Measles-Mumps-Rubella (MMR) vaccine

49
Q

Identify possible complications from parotitis.

A

– CNS involvement

– Epididymo-orchitis (~30% infected after puberty)

50
Q

Identify the main causative pathogen of Acute epiglottitis.

A

Haemophilus influenzae (normal microbiota of nasopharynx)

51
Q

Describe clinical features of acute epiglottitis.

A

– High fever
– Massive oedema of the epiglottis
– Severe airflow obstruction resulting in breathing difficulties
– Bacteraemia

52
Q

Describe treatment and prevention of acute epiglottitis.

A

TREATMENT
– Life-threatening emergency
– Requires urgent endotracheal intubation
– Intravenous antibiotics (ceftriaxone or chloramphenicol)

PREVENTION
Hib vaccine

53
Q

Describe diagnosis of acute epiglottitis.

A

– Do not examine throat or take throat swabs as this will precipitate complete obstruction of airway.
– Blood cultures to isolate H. influenzae

54
Q

Identify the causative pathogen for Diphtheria.

A

Corynebacterium diphtheriae

55
Q

Which parts of the body are colonised in diphteria ?

A

Colonises pharynx, larynx and nose (rarely skin and genital tract)

56
Q

DIPHTERIA

  • Transmission
  • Clinical features
  • Diagnosis
  • Treatment
  • Prevention
A

DIPHTERIA
• Transmission through aerosol
• Clinical features:
– Sore throat
– Fever
– Formation of pseudomembrane
– Lymphadenopathy
– Oedema of anterior cervical tissue (bull-neck)
• Diagnosis:
– Made on clinical grounds as therapy is usually urgently required
• Treatment:
– Prompt anti-toxin therapy administered intramuscularly – Concurrent antibiotics (penicillin or erythromycin)
– Strict isolation
• Prevention:
– Childhood immunisation with toxoid vaccine
– Booster doses given if travelling to endemic areas if >10 years have elapsed since primary vaccination

57
Q

LARYNGITIS AND TRACHEITIS

  • Causative pathogens
  • Clinical features
A

LARYNGITIS AND TRACHEITIS
• Infections may spread down from the URT

• Causative pathogens: Usually viral in origin
– Parainfluenza virus
– Respiratory Syncytial virus – Influenza vurus
– Adenovirus

• Clinical features:

  • In adults: hoarseness; retrosternal pain
  • In children: dry cough; inspiratory stridor (croup)
58
Q

Describe pathophysiology of otitis and sinusitis.

A

• Pathogen invasion of the air spaces associated with the URT
– Middle ear
– Outer ear
– Sinuses
• Blockage of the eustachian tube or sinuses
• Mucosal swelling prevents muco-ciliary clearance of infection
• Exacerbated by local accumulation of inflammatory bacterial products

59
Q

Identify the main causative agents for otitis and sinusitis.

A 
• Main causative agents:
– Respiratory syncytial virus (RSV) 
– Mumps virus
– Streptococcus pneumoniae
– Haemophilus influenzae
– Bacteroides fragilis
60
Q

OTITIS MEDIA

  • Epidemiology
  • Main pathogen
  • Clinical features
  • Complications
A

OTITIS MEDIA
-Epidemiology: most common in infants and small children
-Main pathogen: mainly Respiratory Syncytial Virus (RSV), but also S. pneumoniae and H. influenzae
-Clinical features:
Fever
Diarrhoea and vomiting
Bulging ear drum and dilated vessels
Fluid in middle ear (“glue ear”)
-Complications: May lead to chronic suppurative otitis media + May result in hearing difficulties and delayed learning development

61
Q

OTITIS EXTERNA

  • Main pathogens
  • Treatment
A

OTITIS EXTERNA

  • Main pathogens: Staph aureus, Candida albicans, Pseudomonas aeruginosa
  • Treatment: antibiotic ear drops containing polymyxin
62
Q

Does the middle ear have a similar microbiota to the skin ? the external ear ?

A

In contrast to the middle ear, the external ear has a similar microbiota to the skin

63
Q

ACUTE SINUSITIS

  • Clinical features
  • Treatment
A 
ACUTE SINUSITIS
• Clinical features:
 – Facial pain
– Localised tenderness
• Treatment:
– Ampicillin, amoxycillin, oral cephalosporins (especially to deal with β-lactamase-producing organisms)

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