Microbiology of ENT Infections

Question 1

what is an absolute indication for hospital admission

Answer 1

sore throat with stridor/respiratory difficulty, attempts to examine the throat should be avoided

Question 2

what are some non-infectious causes of pain at the back of the mouth (pharyngitis, tonsillitis etc)

Answer 2

physical irritation from GORD, smoking, alcohol or hay fever

Question 3

Lemierre’s syndrome

Answer 3

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

Question 4

what is the most common complication of URTI

Answer 4

otitis media

Question 5

prognosis of URTI

Answer 5

tend to be self-limiting, msot will resolve in a week (irrespective o Streptococcal infection)

Question 6

what should be considered if sore throat and lethargy persist into 2nd week

Answer 6

infectious mononucleosis

especially if the person is between 15 and 25

Question 7

diagnosis

Answer 7

throat swabs should not be carried out routinely in primary care

Question 8

list 4 indications for referral of sore throat

Answer 8

• 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

Question 9

simple treatment advice for sore throat

Answer 9

analgesia - paracetamol/ibuprofen

avoid hot drinks

adequate fluid intake

simple mouthwashes eg salty water

Question 10

what is the most common bacterial cause of sore throat

Answer 10

Strep Pyogenes (Group A Beta Haemolytic)

Question 11

how does S Pyogenes present in the throat

and treatment

Answer 11

acute follicular tonsillitis

penicillin

Question 12

late complication: rheumatic fever

presentation

Answer 12

3 weeks post sore throat

presents with fever, arthritis, pancarditis (can cause SOB and chest pain)

Question 13

late complications: glomerulonephritis

Answer 13

1-3 weeks post sore throat

presents with haematuria, albuminuria and oedema

Question 14

diphtheria

Answer 14

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

Question 15

characteristic appearance of diphtheria

Answer 15

bulls neck appearance - combination of cervical adenopathy and swollen mucosa

Question 16

diphtheria exotoxin

Answer 16

• 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.

Question 17

where does neuritis in diphtheria often start

Answer 17

with the cranial nerves

Question 18

complications in diphtheria

Answer 18

• pseudomembrane can become very large and obstruct the airway
• myocarditis (can cause shock) and neuritis (often starting with CN)

Question 19

what is the most common cause of death due to diphtheria

Answer 19

• 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

Question 20

epidemiology

Answer 20

rarely seen in the UK anymore as it is covered by the 5 in 1 vaccine

given at 2, 3, 4 months of age

Question 21

diagnosis of diphtheria

Answer 21

swab culture of material below pseudomembrane

Question 22

treatment of diphtheria

Answer 22

antitoxin and supportive penicillin/erythromycin

Question 23

main organism in oral thrush

Answer 23

candida albicans

Question 24

how does oral thrush normally occur

Answer 24

• 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

Question 25

clinical appearance of oral thrush

Answer 25

white patches on red, raw mucous membranes in throat and mouth

Question 26

treatment of oral thrush

Answer 26

Nystatin

an anti-fungal available as mouthwash