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ENT > Microbiology of ENT Infections > Flashcards

Microbiology of ENT Infections Flashcards

1
Q

which type of herpes simplex virus causes oral lesions?

A

type 1

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2
Q

how is herpes simplex virus acquired and which type is usually acquired in childhood?

A

through saliva contact

type 1 acquired in childhood

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3
Q

describe the features of primary HSV1 infection?

A 
pre-school children
systemic upset
lips,buccal mucosa, hard palate affected
vesicle 1-2mm
ulcers
fever
local lymphadenopathy
3 weeks recovery
spread beyond mouth
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4
Q

how is HSV1 managed?

A

aciclovir

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5
Q

what happens after primary HSV1 infection?

A

latency
inactive for of virus in sensory nerve cells
can reactivate to re-infect mucosal surface

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6
Q

what causes a cold sore?

A

reactivation of HSV1 from nerves which causes active infection

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7
Q

how are cold sores managed?

A

aciclovir

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8
Q

does HSV1 always reactivate after primary infection?

A

no

only half

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9
Q

intra oral vs oral herpetic lesions?

A 
oral = HSV1
intra-oral = HSV
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10
Q

what coloured tube is use for viral PCR?

A

red

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11
Q

what causes herpangina?

A

coxackie virus (not HSV)

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12
Q

how does herpangina present?

A

vesicles/ulcers on soft palate

similar age range to primary HSV gingivostomatitis

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13
Q

how is herpangina diagnosed?

A

clinically or viral PCR

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14
Q

what causes hand foot and mouth disease?

A

coxackie viruses (enteroviruses)

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15
Q

features of hand foot and mouth?

A

sore throat
mouth ulcers
rash
blisters on hands and feet

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16
Q

diagnosis of hand foot and mouth?

A

clinically or viral PCR

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17
Q

main feature of primary syphilis?

A

chancre (painless ulcer at site of entry of the bacterium)
most common site = genital
oral lesions are possible

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18
Q

what bacteria causes syphilis?

A

treponema pallidum

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19
Q

what are apthous ulcers?

A

non-viral, self limiting recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halos
in the absence of systemic disease
confined to mouth
begin in childhood and tend to abate in 3rd decade
each ulcer lasts less than 3 weeks

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20
Q

5 causes of recurrent ulcers associated with systemic disease (non-viral)?

A 
behcets disease
gluten sensitive enteropathy or inflammatory bowel disease
reiter's disease
drug reactions
skin diseases
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21
Q

clinical presentation of acute pharyngitis?

A

inflammation of the part of the throat behind the soft palate (oropharynx)

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22
Q

clinical presentation of tonsillitis?

A

inflammation of the tonsils

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23
Q

when may mononucleosis/Epstein barre virus (glandular fever) be suspected?

A

if sore throat and lethargy persist into 2nd weeks, especially if person is 15-25 yrs old

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24
Q

non-infectious causes of sore throat?

A 
GORD
chronic irritation from smoking
alcohol
hay fever
(look for red flags)
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25
Q

primary care management of sore throat?

A

history and clinical exam

throat swabs not routinely carried out in primary care

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26
Q

how is sore throat managed generally?

A

usually self limiting

- usually within 3 days - 1 week

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27
Q

4 common secondary causes of sore throat?

A

otitis media (most common)
peri-tonsillar abscess
para-pharyngeal abscess
mastoiditis

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28
Q

which cases of sore throat may need referral/admission?

A

suspicion of throat cancer (persistent with neck mass)
sore throat lasting over 3-4 weeks with pain on swallowing or dysphagia for more than 3 weeks
red or red/white patches or ulceration or swelling of the oral/pharyngeal mucosa for >3 weeks
stridor/respiratory difficulty is an emergency

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29
Q

what does penicillin treat?

A

strep pyogenes

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30
Q

self care for sore throat?

A 
regular analgesia
medicated lozenges
avoid hot drinks
fluid intake
mouthwash/spray
31
Q

do most sore throats needs antibiotics?

A

no

2/3rds are viral

32
Q

most common bacterial cause of sore throat?

A

strep pyogenes (group A beta haemolytic strep)

33
Q

clinical presentation of strep pyogenes sore throat?

A

acute follicular tonsilitis

34
Q

management of strep pyogenes sore throat?

A

penicillin

35
Q

describe strep pyogenes?

A

gram +ve cocci chains

beta haemolysis

36
Q

name 2 late complications of strep pyogenes infection

A 
rheumatic fever (fever, arthritis and pancarditis)
glomerulonephritis (haematuria, albuminuria and oedema)
37
Q

what is CENTOR criteria?

A

scoring system for likelihood of group A beta haemolytic strep cause of sore throat

38
Q

what are the components of CENTOR criteria?

A 
tonsillar exudate
tender anterior cervical lymph nodes
history of fever (>38)
absence of cough
one point each (out of 4 points)
- 0, 1 or 2 = 3-17% risk
- 3 or 4 = 32-56% risk
39
Q

management of sore throat for people who are taking DMARDs?

A

FBC (withhold DMARD while awaiting result)
seek urgent specialist advice/referral if patient has low WCC or deteriorates
- give symptomatic relief and consider an antibiotic (take into account DMARD interactions)

40
Q

what can cause neutropaenia?

A

drugs like carbimazole
chemotherapy
known/suspected leukaemia
immunosuppression of any kind

41
Q

management of sore throat in co-existent neutropenia?

A

urgent FBC
withhold causative drug until result is back
consider antibiotic

42
Q

when may phenoxymethylpenicillin be considered?

A

fever PAIN score 4 or 5

CENTOR 3 or 4

43
Q

what bacteria causes diptheria?

A

Corynebacterium diptheriae

44
Q

clinical presentation of diptheria?

A

severe sore throat with grey-white membrane across the pharynx
- bacteria produces exotoxin which is cardiotoxic and neurotoxic

45
Q

can diptheria be prevented?

A

yes

vaccine

46
Q

how is diptheria managed?

A

antitoxin and supportive

penicillin/erythromycin

47
Q

presentation of infectious mononucleitis (glandular fever)?

A 
fever
enlarged lymph nodes
sore throat, pharyngitis, tonsillitis
malaise
lethargy
jaundice/hepatitis
rash
splenomegaly
palatal petechiae (non blanching palatal rash)
48
Q

cause of infectious mononucleosis?

A

Epstein barre virus

part of the herpes family

49
Q

haematology of mononucleosis?

A

leucocytosis (lymphocytosis)

presence of atypical lymphocytes in blood film

50
Q

possible complications of mononucleosis?

A

anaemia, thrombocytopaenia
splenic rupture
upper airway obstruction
increased lymphoma risk

51
Q

are steroids given for viruses?

A

no

generally steroids make viruses worse

52
Q

what are the 2 phases of primary infection with Epstein barr virus?

A

primary infection in childhood rarely results in symptoms

primary infection in those >10 often causes infectious mononucleosis

53
Q

management of mononucleosis?

A 
bed rest
paracetamol
avoid sport (spleen rupture)
antivirals not effective
steroids used very rarely
54
Q

lab confirmation of EBV?

A 
EBV IgM
heterophile antibody
- paul bunnel test
- monospot test
blood count and film
LFTs
55
Q

what 3 illness can cause similar illness to EBV?

A

cytomegalovirus
toxoplasmosis
primary HIV

56
Q

clinical presentation of candida?

A

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

57
Q

what can cause candida in the mouth?

A 
endogenous
post antibiotics
immunosuppression 
smokers
inhaled steroids
58
Q

treatment of candida?

A

nystatin or fluconazole

59
Q

what is acute ottis media?

A

URTI involving middle ear by extension of infection up the eustachian tube
usually in infants and children
presents with earache

60
Q

most common causes of middle ear infection?

A

usually viral with secondary bacterial infection

most common bacteria = haemophilus, strep pneumoniae and strep pyogenes

61
Q

diagnosis of middle ear infection?

A

swab of pus if eardrum perforates

otherwise samples cant be obtained

62
Q

how is middle ear infection managed?

A

80% resolve within 4 days without antibiotics
1st line = amoxicillin
2nd line = erythromycin

63
Q

what is malignant otitis?

A

extension of otiyis externa into the bone surrounding the ear canal
fatal without treatment

64
Q

how does malignant otitis present?

A

pain and headache (more severe than clinical signs would suggest)
granulation tissue at the bone -cartilage junction of the ear canal
exposed bone in the ear canal
facial nerve palsy (drooping face on side of lesion)

65
Q

how is malignant otitis investigated?

A 
PV raised
CRP raised
imaging
biopsy
culture (usually shows pseudomonas aeriginosa)
66
Q

risk factors for malignant otitis?

A

diabetes

radiotherapy to head and neck

67
Q

what is otitis externa and how does it present?

A 
inflammation of outer ear canal
redness and swelling of skin of ear canal
may be itchy
can be sore and painful
can have discharge or increased ear wax
- hearing can be affected if blocked
68
Q

bacterial causes of otitis externa?

A

staph aureus
proteus spp
pseudomonas aerginosa

69
Q

fungal causes of otitis externa?

A

aspergillus niger

candida albicans

70
Q

management of otitis externa?

A

topical aural toilet
swab to microbiology and antimicrobial prescription only for severe cases
- clotrimazole for aspergillus niger
- gentamicin drops

71
Q

how does acute sinusitis present?

A

mild discomfort over frontal or maxillary sinuses due to congestion
severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection
seen in patients with viral URTIs

72
Q

management of acuet sinusitis?

A

illness usually lasts 2.5 weeks
antibiotics if severe/deteriorating cases lasting over 10 days
1st line = phenoxymethylpenicillin
2nd line = doxycycline (not in children)

73
Q

Fever PAIN criteria?

A

likelihood of group B strep

74
Q

what are the components of fever PAIN criteria?

A 
Fever (last 24 hrs)
Purulence
Attend rapidly (within 3 days)
v. Inflammed tonsils
No cough/coryza
one point each
- 0 or 1 = 13-18% risk
- 2 or 3 = 34-40% risk
- 4 or 5 = 62-65% risk

ENT (21 decks)

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