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Ophthalmology SB > Microbiology + Immunology > Flashcards

Microbiology + Immunology Flashcards

1
Q

what infections can happen in the eye

A

Conjunctivitis
Cornea= keratitis
Entire globe= endophthalmitis
Cellulitis (skin around the eyes)

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2
Q

bacteria that causes neonates bacterial conjunctivitis

A

Staph aureus
Neisseria gonorrhoeae
Chlamydia trachomatis

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3
Q

what must happen in cases of neonate bacterial conjunctivitis

A

all cases must be referred to ophthalmology

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4
Q

bacteria that causes other ages bacterial conjunctivitis

A

Staph aureus
Strep pneumoniae
Haemophilus influenzae (especially in children)

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5
Q

Tx for bacterial conjunctivitis

A

Swab

Topical Chloramephenical

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6
Q

when should Chloramephenical not be used

A

history of aplastic anaemia or allergy

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7
Q

what are signs that the patient is allergic to Chloramephenical

A

worsening symptoms

skin becomes red and itchy

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8
Q

what are causes of viral conjunctivitis

A

Adenovirus
Herpes simplex
Herpes zoster

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9
Q

what is suggestive of chlamydial conjunctivitis

A

Often chronic history
Unresponsive to treatments
Suspect in bilateral conjunctivitis in young adults
May or may not have symptoms of urethritis, vaginitis

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10
Q

what is seen in chlamydial conjunctivitis

A 
follicles under upper eye lid 
intense erythema
subtarsal scarring (caused by follicles bursting)
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11
Q

what is seen in bacterial keratitis

A

hypopyon - leukocytic exudate, seen in the anterior chamber

appears as white mark in red eye

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12
Q

Mx of bacterial keratitis

A

Scrap hypopyon
Admission + Hourly drops
Associated w/ contact lens wearers

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13
Q

what viruses can cause keratitis

A

Herpes

Adenovirus

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14
Q

what is an indication of a herpetic keratitis

A

dendritic ulcer

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15
Q

Sx of herpetic keratitis

A

Very painful
Can be recurrent
recurrences eventually result in reduced corneal sensation

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16
Q

what is NOT given in the treatment of herpetic keratitis and why

A

Steroids

Can cause Corneal melt

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17
Q

what is seen in adenoviral keratitis

A

subepithelial infiltrates

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18
Q

features of adenoviral keratitis

A

Bilateral
Usually follows an URTI
Contagious
May affect vision

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19
Q

Mx of adenoviral keratitis

A

Can give topical AB to prevent secondary infection

Can give steroids to speed up recovery if becomes chronic

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20
Q

what are fungal causes of keratitis

A

Acanthamoeba

Pseudomonas aeruginosa

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21
Q

what can lead to fungal keratitis

A

contact lenses

trauma Hx of trauma from vegetation

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22
Q

features of orbital cellulitis

A 
Painful – especially on eye movements
Proptosis
Often associated with paranasal sinusitis
Pyrexial
Sight threatening
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23
Q

IX for orbital cellulitis

A

CT scan

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24
Q

what causes orbital cellulitis

A

spread via paranasal sinus infection

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25
Q

what organisms are seen in orbital cellulitis

A 
Staphylococci
Streptococci
Coliforms
Haemophilus influenzae
anaerobes
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26
Q

Tx of orbital cellulitis

A

Broad spectrum AB

Surgery

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27
Q

what is Endophthalmitis

A

infection is in the whole eye

28
Q

what causes Endophthalmitis

A

post-surgical infection
trauma
endogenous (low grade sepsis/endocarditis)

29
Q

Sx of Endophthalmitis

A

Painful +++, with decreasing vision
Very red eye
Sight threatening - lose vision very quickly

30
Q

what organisms cause endophthalmitis

A

Staph epidermidis most commonly

31
Q

Tx for endophthalmitis

A

Intravitreal amikacin and vancomycin and topical antibiotics

32
Q

what is choridoretinitis

A

inflammation of the choroid of the uvea

33
Q

what can cause choridoretinitis

A

CMV in AIDS
Toxoplasma gondii
Toxocara canis (worm)

34
Q

what is toxoplasmosis

A

Protozoan infection - toxoplasmosis gondii

Mild flu like illness
Get from cats and dogs

35
Q

what happens in immunocompetent patients with toxoplasmosis

A

it enters latent phase with cysts forming
Can reactivate
Requires systemic treatment if sight threatening

36
Q

what is toxocara

A

Parasitic nemotode (roundworm)
Affects cats or dogs
Unable to replicate in humans
Remains an immature form of the worm (larvae)

37
Q

features of toxocara

A

self limiting as they cannot replicate

However, can form granulomas which can cause irreversible visual loss

38
Q

when is ‘Swabs for Culture’ used to diagnose an eye infection

A

bacterial, chlamydial, viral

Corneal scrapes in bacterial keratitis

39
Q

what Ix is done in cases of endophthalmitis

A

Aqueous/vitreous for culture

40
Q

what is done in cases of acanthamoeba

A

Microscopy/culture

41
Q

what is done in cases of toxoplasma and toxocara

A

Serology

42
Q

what are Chloramphenicol side effects

A

Allergy
Irreversible aplastic anaemia
Grey baby syndrome

43
Q

what is dacryocystitis

A

infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac

44
Q

Tx for viral conditions

A

Aciclovir - used for dendritic ulcers of the cornea

45
Q

Tx for Bacterial conjunctivitis

A

chloramphenicol - (treats most bacteria except Pseudomonas aeruginosa)

fusidic acid - (treats Staph. aureus)

gentamicin- (treats most Gram negative bacteria including Pseudomonas aeruginosa)

46
Q

Tx for chlamydial conjunctivitis

A

topical oxytetracycline

47
Q

Tx for bacterial keratitis

A

A 4-quinolone (Ofloxacin)
OR
Gentamicin and cefuroxime

48
Q

what is part of the immediate, innate immune response

A

Complement proteins
Mast cells
Macrophages

49
Q

features of innate immune system

A

Rapid, general response (mins-hours)
Targets groups of pathogens
- Responds to only a limited number of microbial structures
No memory

50
Q

features of adaptive immune system

A

Gradual response (>days)
Targets specific pathogens
- Can responds to a huge array of different microbial structures
Memory

51
Q

what chemicals are contained in tears for immune protection

A

Lysozyme - works against gram –ve, fungi

Lactoferrin and transferrin - works against gram +ve

Complement

Tear lipids - antibacterial to cell membranes

Secretory IgA- prevents attachment

52
Q

what cells are contained in tears for immune protection and what are there function

A

Neutrophils

  • attracted by chemotaxis
  • Scavengers-release free radicals, enzymes

Macrophages

  • Phagocytosis of damaged cells
  • Help to trigger adaptive immune system

Conjunctival mast cells
- Vasoactive mediators

53
Q

what is immune privilege

A

parts of the body that able to tolerate the introduction of antigens without eliciting an inflammatory immune response

54
Q

why does the eye need immune privilege

A

eye is very small

immune response can cause damage

55
Q

what is the only part of the eye with lymphatic drainage

A

conjunctiva

56
Q

what cells act as APC in the conjunctiva

A

dendritic cells

57
Q

features of cornea and sclera

A

Avascularity
No lymphphatics/lymphoid tissue
Downregulated immune environment
Relative lack of antigen presenting cells

58
Q

what is the role of cornea and sclera

A

tough collagen coat

59
Q

role of vitreous, choroid and retina in immune system

A

Blood-ocular barrier
Relative lack of APCs
Downregulated immune environment

60
Q

what are the hypersensitivity classifications

A

Type I: Immediate hypersensitivity
Type II: Direct cell killing
Type III: Immune complex mediated
Type IV: Delayed type hypersensitivity

61
Q

what happens in type I hypersensitivity reaction

A
  • mast cells Express receptors for Fc region of IgE antibody on their surface
  • On encounter with allergen, B cells produce antigen-specific IgE antibody
  • allergen is cleared
  • Residual IgE antibodies bind to circulating mast cells via Fc receptors.
  • re-encounter with allergen
  • Allergen binds to IgE - coated mast cells & disrupts cell membrane
  • 
Release of vasoactive mediators – histamine, tryptase, also increased cytokines and leukotriene transcription
62
Q

what happens in Type II hypersensitivity

A

Cells killed either by:
Macrophages/natural killer cells
Complement (membrane attack complex)

63
Q

what is an example of type II hypersensitivity in the eye

A

Ocular cicatricial pemphigoid

64
Q

what is an example of type III hypersensitivity in the eye

A

Autoimmune corneal melting

65
Q

what happens in type IV hypersensitivity

A

T helper cells activated by intracellular pathogens
Clonal expansion
When re-exposed, macrophages attracted

66
Q

example of type IV hypersensitivity in the eye

A

corneal graft rejection

Ophthalmology SB (7 decks)

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