Microbiology of ENT Infections Flashcards
what is an absolute indication for hospital admission
sore throat with stridor/respiratory difficulty, attempts to examine the throat should be avoided
what are some non-infectious causes of pain at the back of the mouth (pharyngitis, tonsillitis etc)
physical irritation from GORD, smoking, alcohol or hay fever
Lemierre’s syndrome
a complication of pharygotonsillitis
infection of the posterior compartment of the lateral pharyngeal space, complicated by jugular vein thrombophlebitis which causes septic emboli. these can travel to lungs, bone, kidney, muscle etc
what is the most common complication of URTI
otitis media
prognosis of URTI
tend to be self-limiting, msot will resolve in a week (irrespective o Streptococcal infection)
what should be considered if sore throat and lethargy persist into 2nd week
infectious mononucleosis
especially if the person is between 15 and 25
diagnosis
throat swabs should not be carried out routinely in primary care
list 4 indications for referral of sore throat
- Suspected throat cancer – persistent sore throat ± neck lump
- Sore/painful throat that lasts for 3/4 weeks with no pain on swallowing or dysphagia for more than 3 weeks
- Red ± white patches, ulceration/swelling or oral/pharyngeal mucosa persists for more than 3 weeks
- Stridor/respiratory difficulty is a medical emergency
simple treatment advice for sore throat
analgesia - paracetamol/ibuprofen
avoid hot drinks
adequate fluid intake
simple mouthwashes eg salty water
what is the most common bacterial cause of sore throat
Strep Pyogenes (Group A Beta Haemolytic)
how does S Pyogenes present in the throat
and treatment
acute follicular tonsillitis
penicillin
late complication: rheumatic fever
presentation
3 weeks post sore throat
presents with fever, arthritis, pancarditis (can cause SOB and chest pain)
late complications: glomerulonephritis
1-3 weeks post sore throat
presents with haematuria, albuminuria and oedema
diphtheria
URT characterised by sore throat, low-grade fever and an adherent pseudomembrane that can cover the tonsils and mucosa of the pharynx, larynx and nose
characteristic appearance of diphtheria
bulls neck appearance - combination of cervical adenopathy and swollen mucosa
diphtheria exotoxin
- The toxin causes tissue necrosis and formation of the pseudomembrane (composed of a mixture of dead cells etc.). Removal of the membrane reveals a bleeding, oedematous mucosa.
where does neuritis in diphtheria often start
with the cranial nerves
complications in diphtheria
- pseudomembrane can become very large and obstruct the airway
- myocarditis (can cause shock) and neuritis (often starting with CN)
what is the most common cause of death due to diphtheria
- The pseudomembrane may become very large and obstruct the airway, this is the most frequent cause of death, along with suffocation following aspiration of the pseudomembrane
epidemiology
rarely seen in the UK anymore as it is covered by the 5 in 1 vaccine
given at 2, 3, 4 months of age
diagnosis of diphtheria
swab culture of material below pseudomembrane
treatment of diphtheria
antitoxin and supportive penicillin/erythromycin
main organism in oral thrush
candida albicans
how does oral thrush normally occur
- Carried in mouths of around half of world population as a commensal organism
- Oral thrush occurs when it becomes pathogenic and invades host tissues, tends to constitute an opportunistic infection
clinical appearance of oral thrush
white patches on red, raw mucous membranes in throat and mouth
treatment of oral thrush
Nystatin
an anti-fungal available as mouthwash
