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Microbiology of ENT infections Flashcards

1
Q

What HSV causes oral ulcers?

A

Types 1 and 2
Type 1 acquired in childhood
HSV1 = oral lesions
Infections through saliva contact

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2
Q

What is primary gingivostomatitis?

A

Disease of pre-school children with a primary infection of HSV1
Systemic upset, lips, buccal mucosa, hard palate affected
Vesicles 1-2 mm
Ulcers

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3
Q

What will HSV2 commonly cause?

A

Genital ulcers

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4
Q

How is primary gingivostomatitis due to HSV1 treated?

A

Aciclovir - used for all herpes simplex infections

May take 3 weeks to recover

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5
Q

Where will HSV remain latent?

A

In the trigeminal ganglia

Will reactivate to re-infect mucosal surfaces

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6
Q

Will aciclovir prevent latency?

A

No

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7
Q

How many people with HSV will get clinical recurrences?

A

Half

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8
Q

How is HSV confirmed in the lab?

A

Swab lesion in virus transport medium to detect the viral DNA via PCR
Red cap

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9
Q

What is a dangerous complication of HSV infection?

A

Herpes simplex encephalitis

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10
Q

What is herpangina?

A

Vesicle/ ulcers on the soft palate

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11
Q

What causes herpangina?

A

Coxsackie enterovirus

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12
Q

What causes hand foot and mouth disease?

A

Coxsackie enterovirus

Diagnose by PCR test of swab in viral transport medium

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13
Q

What is a chancre?

A

Painless indurated ulcer at the site of entry of bacterium treponema pallidum (syphilis)
Most commonly genital but can be oral

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14
Q

What is an aphthous ulcer?

A

Non-viral
Self limiting
Painful ulcer on the mouth that are round or ovoid and have inflammatory halos

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15
Q

How long will an aphthous ulcer last?

A

3 weeks

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16
Q

What recurrent ulcers are associated with systemic disease (non-viral)?

A

Behcet’s disease: recurrent oral and genital ulcers, uveitis, GI, pulmonary, MSK, CV and neurological system involvement
Gluten-sensitive enteropathy or IBD: diarrhoea, wt loss
Reiter’s disease: arthritis
Drug reactions
Skin diseases: lichen planus, pemphigus vulgaris

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17
Q

What are the common age groups for an acute throat infection?

A

Children - 5-10

YA - 15-25

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18
Q

What is acute pharyngitis?

A

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

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19
Q

What commonly causes a sore throat?

A

Common cold
Influenza
Streptococcal infection

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20
Q

What should you think about is there is ore throat and lethargy into the 2nd week in a patient aged 15-25?

A

Infectious mononucleosis via EBV

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21
Q

What are uncommon causes of acute pharyngitis/tonsillitis?

A

HIV
Gonococcal pharyngitis
Diphtheria

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22
Q

What are non-infectious causes of acute pharyngitis/tonsillitis?

A

Physical irritation - reflux, smoking, alcohol, hay-fever

LOOK FOR RED FLAGS

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23
Q

When should someone with a sore throat be admitted to hospital straight away?

A

Stridor
Resp difficulty
DO NOT attempt to examine the throat - leave to ENT surgeon

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24
Q

What is the natural history of a sore throat?

A

Self-limiting condition that will resolve within 1 week for 85% of people

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25
What are complications of a streptococcal infection?
Otitis media (eustachian tube) Peritonsillar abscess (quinsy) Para-pharyngeal abscess Mastoiditis
26
When should throat cancer be suspected?
Persistent sore throat for more than 3 weeks with a neck mass Pain on swallowing or dysphagia Red or white patches, or ulceration of the oral/pharyngeal mucosa for more than 3 weeks Stridor
27
What is the recommended self care of a sore throat?
``` Regular analgesia - paracetamol or ibuprofen to relieve pain and fever Medicated lozenges (local anaesthetic, analgesia or antiseptic) ```
28
What can cause a bacterial sore throat?
``` Streptococcus pyogenes (group A beta haemolytic streptococcus) Acute follicular tonsillitis ```
29
How is streptococcus pyogenes acute follicular tonsillitis treated?
Phenoxymethylpenicillin
30
What are complications of streptococcus pyogenes?
Rheumatic fever - 3 weeks post sore throat; fever, arthritis and pancarditis Glomerulonephritis - 1-3 weeks post sore throat; haematuria, albuminuria and oedema
31
What is the CENTOR criteria?
Tonsillar exudate Tender anterior cervical lymph nodes History of fever above 38 Absence of cough
32
What does a CENTOR score of 3 or 4 signify?
Should prescribe antibiotics
33
What is the Fever PAIN criteria?
``` Fever (last 24 hrs) Purulence Attend rapidly (w/in 3/7) v. Inflamed tonsils No cough/ coryza ```
34
What does a score of 4-5 in Fever PAIN signify?
65% risk of strep | Prescribe antibiotics
35
What should you do if someone on a DMARD presents with a sore throat?
FBC - neutropenia | Withhold DMARD until result is known
36
What can cause neutropenia?
``` DMARD Carbimazole - agranulocytosis Chemo Leukaemia Asplenia Aplastic anaemia HIV with a low CD4 Patient taking azathioprine post transplant ```
37
What bacterium causes diphtheria?
Corynebacterium diphtheriae (gram negative bacillus)
38
What is the clinical presentation of diphtheria?
Severe sore throat with a grey white membrane across the pharynx Organism produces an exotoxin which is cardiotoxic and neurotoxic
39
What type of vaccine id diphtheria?
Toxoid vaccine
40
What is the treatment of diphtheria?
Antitoxin and supportive | Penicillin/ erythromycin (pregnant)
41
What is the presentation of infectious mononucleosis?
``` Fever Enlarged lymph nodes Sore throat, pharyngitis, tonsillitis Malaise, lethargy Jaundice/ hepatitis Rash Haematology - lymphocytosis, atypical lymphocytes in blood film Splenomegaly Palatal petechiae ```
42
What other tests should be run in someone presenting with symptoms of EBV?
HIV and CMV - very similar presentation
43
What are potential complications of EBV?
``` Anaemia Thrombocytopenia Splenic rupture - avoid contact sports Upper airway obstruction Increased risk of lymphoma ```
44
Where will the EBV remain latent?
Epithelial cells in the pharynx
45
What is the treatment for EBV?
Bed rest Paracetamol for fever Avoid contact sport for 6 weeks
46
Should steroids be used for viruses?
No - they make it worse
47
How is EBV confirmed in the lab?
``` EBV IgM for acute infection IgG for chronic infection Heterophile antibody - paul bunnell test, monospot test Blood count and film - lymphocytosis LFTs ```
48
What is the presentation of candida?
White patches on red, raw mucous membranes in throat/ mouth
49
What can cause candida?
Endogenous - post antibiotics, immunosuppressed, smokers, inhaled steroids
50
What is the treatment of candida?
Nystatin or fluconazole
51
What is acute otitis media?
An URTI involving the middle ear by extension of infection by the eustation tube
52
What can cause acute otitis media?
Commonly caused by a virus with a secondary bacterial infection: haemophilus influenzae, streptococcus pneumoniae, streptococcus pyogenes
53
When should you swab an ear?
If the ear drum perforates and thereis pus
54
How should middle ear infections be treated?
80% resolve in 4 days without antibiotics 1st line: amoxicillin 2nd line: erythomycin
55
What is malignant otitis externa?
Extension of otitis externa into the bone surrounding the ear canal (mastoid and temporal) Without treatment is fatal as the osteomyelitis will involve the skull and meninges
56
What are the symptoms of malignant otitis?
Pain Headache More severe than clinical signs
57
What are the signs of malignant otitis?
Granulation tissue at bone-cartilage junction of ear canal, exposed bone in the ear canal Facial nerve palsy
58
How should malignant otitis be investigated?
PV CRP Radiological imagine Biopsy and culture
59
What are risk factors for malignant otitis?
Diabetes | Radiotherapy to head and neck
60
What is otitis externa?
``` Inflammation of outer ear canal: Redness and swelling of ear canal Itchy Sore and painful Discharge or increased ear wax Affected hearing ```
61
What bacteria can cause otitis externa?
Staph aureus Proteus Pseudomonas aeruginosa - swimming pools
62
What bacteria causes malignant otitis externa?
Pseudomonas aeruginosa
63
What fungus can cause otitis externa?
Aspergillus niger Candida albicans Culture and biopsy
64
What is the management of otitis externa?
Topical aural toilet Swab to microbiology Topical clotrimazole for aspergillus niger Gentamicin 0.3% drops for pseudomonas
65
What is acute sinusitis?
Mild discomfort over frontal and maxillary sinuses due to congestion Seen in patients with URTI Severe pain and tenderness with purulent discharge = bacterial infection
66
What is the management of acute sinusitis?
Average length is 2.5 weeks Antibiotics for severe cases over 10 days 1st line: phenoxymethylpenicillin 2nd line is doxycycline
67
Why should doxycycline not be prescribed in children?
Yellow tooth discolouration and dental enamel hypoplasia
68
What are the issues with PO ciprofloxacin?
``` Ruptured achilles tendon Generalised tendonitis Psychiatric symptoms Lower threshold for seizures Pseudomembranous colitis (c.diff) ```

ENT (20 decks)

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