Lecture 13- Eyes, Ear, Nose and Throat Infections Flashcards
W7
Conjunctivitis
Infection/inflammation of the conjunctiva; commonly referred to as “pink eye”
What is the conjunctiva ?
Mucuous membrane than covers to outside of the eyes and under the eyelids which lubricate the eyes and prevent pathogen entry
Risk factors for pink eye?
Exposure to someone, contact lenses, allergies, trauma, immunocompromised, prior ocular infections
List the most common causes of bacterial conjunctivitis
Streptococcus pneumonia, haemophilia influenzae, stap aureus, pseudomonas aeruginosa
Which infectious entities with pink eye are most common in neonates?
Chlamydia trach, neisseria gonorrhea
What are the most common causes of viral conjunctivitis ?
Adenovirus
Enterovirus
VSZ
Herpes simplex (neonates)
When diagnosing conjunctivitis, what do we need to determine?
If this is bacterial or viral done with gram stain and culture
How do we treat bacterial conjunctivitis ?
Antibiotics unless HSV
How do we treat viral conjunctivitis?
Supportive care
What is otitis external?
Swimmers ear
What causes swimmers ear?
Pseudomonas spp
HOw do we treat otitis external?
Aimed at drying the area with alcohol
Can swimmers ear be caused by fungus or anything else?
Yes. Some fungi, prolonged antibiotic use, and dermatophytes
Otitis media- describe the structure implicated
The tubs that link nasopharynx to the middle ear; draining normal secretions from the middle ear which regulate pressure in the middle ear to equalize it with the outside
What happens when the eustasian tubes become blocked
Pathogensis of otitis media
Which bacteria can lead to otitis media?
streptococcus pneumonia, haemophilia influenzar, others in the upper resp tract
What viral infections can lead to otitis media?
RSV, influenza, adenovirus
How do we diagnose otitis media ?
Otoscope for inflammation and this is followed up with microbiology
How do we trat otitis media?
Acute and prophylactic treatment with recurrent infections
MOst episoes of pharyngitis are…
Viral
List some viruses that can cause pahryngitis
mono, adenovirus, influenza, common cold, RSV, HSV, acute HIV
List some bacterial species that can lead to pharyngitis
Streptococcus pyogenes, acranobacterium hemolyticum, chlamyda trach, neisseria gono, corynebacterium diphtheria
What test is used for mono
rapid monospot test which has 90% sensitivity when tested in the first 2-3 weeks in the blood
How do you test for bacterial pharyngitis?
Throat swab for group A strep to be treated with penicillin
When someone has croup, laryngitis, or bronchitis- what is it really?
Tracheobronchitis which may be bacterial or viral
Viral tracehobronchitis infections?
RSV, influenza, parainfluenza
Bacterial aetiologies of tracheobronchitis ?
Bordetella pertussis (whooping cough)
Why is the influenza virus so virulent?
Paralyze cilia, antigenic drift, antigenic shift
Describe the parainfluenza virus?
Croup in children- inflammation of the larynx but will lead to bronchitis in older children/adults
How do you detect parainfluenza virus?
Typically clinical, should confirm if being hospitalized
RSV- respiratory syncytial virus
RSV leads to bronchitis (inflammation of the bronchus); can be severe in young and old which can lead to pneumonia and can require hospitalization
How do you diagnose or detect RSV
Nasopharyngeal swab or wash, rapid antigen detection (good for RSV only), virus culture, PCR, combination of several tests
Bordertella pertussis
Whooping cough, transmitted by droplets, gram negative organisms that infect respiratory epithelial cells
Clinical manifestations of whooping cough
Mild upper respiratory tract infection, cough, leads to uncontrolled cough and whoop and vomiting
Vaccine for whooping cough
DTap: aP- acellular pertussis vaccine, recent evidence suggests aP vaccine immunity wanes
How do you detect bordetella pertussis ?
Culture not done as it needs specialized media, PCR testing of NPG swab - can lead to kennel cough
What are the two types of pneumonia
CAP and HAP
What is pneumonia
Inflammation and infection of the lungs that may be caused by bacteria, viruses, and fungi
Pneumonia
Acute onset: classic symptoms, fever, SOB, and productive cough
More serious in older people and infants
What can cause CAP (community acquired pneumonia)?
Streptococcus pneumonia, haemophilia influenza, legionella pneumophila, chlaymydia pneumonia, mycoplasma pneumonia, staph aureus
What sample do you need to submit to a lab for CAP
SPUTUM, NOT SALIVA as well as blood cultures- we worry about bacteremia
What are some things to look out for that show atypical CAP
Protracted illness, less sputum production (dry cough), age, travel, animal exposure, typically harder to diagnose because organisms not in lab algorithm
Mycoplasma pneumonia
Common in school aged kids, spreads via resp droplets, no cell wall, hard to culture, 100 day cough, detected with PCR and serology
Chlamydia pneumonia
Common cause of illness with most cases being mild or asymptomatic, persistent cough, malaise, bad if immunocompromised, detected with PCR
Do people still use cell lines?
NO
Legionella pneumophila
Gram negative bacili
Where can you find legionella pneumophila?
Water- cooling towers, air conditioners, hot tubs
Who is at high risk with legionella pneumophila infection?
older, smoker, COPD- under diagnosed alot
Urinary antigen and PCR
Ventilator associate pneumonia- VAP
Dx with blood culture, suctioning, bronchial washing causative agents change with onset
Causative agents: Early onset VAP
Hemophilus influenza
Streptococcus pneumoniae
Staph aureus
E. coli
Klebsilla
(antibiotic sensitive)
Late onset causative agents of VAP
Pseudomonas aeruginosa
MRSA
Acinetobacter
Strains are multiple antibiotic resistant
What causes tuberculosis ?
Mycobacterium tuberculosis (MTB)
Most TB infections are ___________ with 10% progressing to __________
Latent, disease
Are there specific host factors which can predispose you to TB disease?
No
How is TB spread?
Droplets
Very _______ doses of tb are required for infection
small
How do we detect TB?
culture, this can take 6 weeks and look for antibodies with a skin test or direct smears leading to PCR
How do you control TB infection?
Isolation, negative pressure room- report to PHU, prolonged treatment of 6-9 months
