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ENT Medicine > Microbiology of ENT Infections > Flashcards

Microbiology of ENT Infections Flashcards

1
Q

What are some viral causes of oral ulceration?

A

Herpes simples virus, primary gingivostomatitis due to HSV1, cold sore, herpangina, hand/foot and moth disease, primary syphilis

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2
Q

What types of herpes simplex virus are usually associated with oral ulceration?

A

Types 1 and 2 = type 1 acquired in childhood and most commonly associated with oral ulceration

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3
Q

How does herpes simplex infection spread?

A

Through saliva contact

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4
Q

What age group is most at risk of developing primary gingivostomatitis due to HSV1?

A

Pre-school children (usually primary infection)

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5
Q

What do children with primary gingivostomatitis due to HSV1 present with?

A

Systemic upset, fever, local lymphadenopathy, vesicles of 1-2mm, ulcers

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6
Q

Where do the lesions from primary gingivostomatitis occur?

A

Lips, buccal mucosa, hard palate = may spread beyond mouth

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7
Q

How is primary gingivostomatitis due to HSV1 treated?

A

Aciclovir = may take up to 3 weeks to recover

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8
Q

What occurs in viral latency?

A

After primary infection inactive form of virus hides in sensory nerve cells = can reactivate to re-infect mucosal surfaces

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9
Q

What causes cold sores?

A

Reactivation of latent virus from nerves causes active infection (due to various stimuli)

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10
Q

Are all reactivations of cold sores symptomatic?

A

No = may be silent reactivation

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11
Q

How are cold sores treated?

A

Aciclovir or suppression = acyclovir doesn’t prevent latency

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12
Q

What is the natural history of cold sores?

A

Multiple cycles of latency and active infection are possible, decreasing frequency over time, only 50% of infected people get clinical recurrences

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13
Q

What virus is normally responsible for cold sores?

A

Oral herpetic lesions usually HSV1

Recurrent intra-oral lesions rarely HSV

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14
Q

How is HSV confirmed in the lab?

A

Swab of lesion in virus transport medium = detection of viral DNA by PCR

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15
Q

Where do lesions occur in herpangina?

A

Vesicles/ulcers on soft palate

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16
Q

What age group normally suffers form herpangina?

A

Pre-school children

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17
Q

What causes herpangina?

A

Coxsackie viruses = usually enterovirus

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18
Q

How are herpangina and hand, foot and mouth disease diagnosed?

A

Clinically or by PCR test of swab in viral transport medium

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19
Q

What causes hand, foot and mouth disease?

A

Coxsackie viruses = usually enterovirus

Family outbreaks common (child usually first infected)

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20
Q

What is the primary lesion of syphilis called?

A

Chancre = usually at site of entry of bacterium

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21
Q

How does primary syphilis present?

A

Painless indurated ulcer at site of entry = most common site is genitals, but may be oral lesion

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22
Q

What bacteria causes primary syphilis?

A

Treponema pallidum

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23
Q

What happens if syphilis is left untreated?

A

Can progress to secondary and tertiary syphilis

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24
Q

What are aphthous ulcers?

A

Non viral, self limiting but recurrent painful ulcers of mouth =round/ovoid, have inflammatory halo

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25
Q

What are some features of aphthous ulcers?

A

Confined to mouth and no systemic disease, each ulcer lasts about 3 weeks, begin in childhood and tend to ablate in 30s

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26
Q

What are some systemic diseases that cause oral ulcers?

A

Bechet’s disease, coeliac, IBD, Reiter’s disease, drug reactions, skin disease

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27
Q

How does Bechet’s disease present?

A

Recurrent oral ulcers, uveitis and genital ulcers

May involve visceral organs (i.e heart, lungs, MSK etc)

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28
Q

What additional symptoms has a patient with oral ulceration due to coeliac or IBD have?

A

Diarrhoea and weight loss

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29
Q

What normally accompanies the oral ulcers of Reiter’s disease?

A

Arthritis

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30
Q

What are some skin diseases that may cause oral ulceration?

A

Lichen planus, pemphigus, bullous pemphigoid

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31
Q

What age groups are mostly affected by acute throat infections?

A

Children aged 5-10 and young people aged 15-25

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32
Q

Inflammation of what structures usually causes pain at the back of the throat?

A

Acute pharyngitis = inflammation of part of throat behind soft palate
Tonsillitis = inflammation of tonsils

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33
Q

What age group is commonly affected by infectious mononucleosis?

A

Young people aged 15-25

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34
Q

What are some rarer causes of an acute sore throat that should always be considered?

A

HIV (especially seroconversion), gonococcal pharyngitis, diphtheria

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35
Q

What are some non-infectious causes of an acute sore throat?

A

Largely uncommon = GORD, irritation from smoking, alcohol or hay fever

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36
Q

Are throat swabs routinely done to investigate sore throats in primary care?

A

No

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37
Q

In what situation would a patient with a sore throat be admitted to hospital as an emergency?

A

Sore throat with stridor or respiratory distress = attempts to examine throat should be avoided

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38
Q

What is the natural history of most sore throats?

A

Self limiting regardless of cause = resolves in 3 days in 40%

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39
Q

What are some complications associated with an acute sore throat?

A

Otitis media (most common), peri-tonsillar abscess (quinsy), para-pharyngeal abscess, mastoiditis

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40
Q

How are sore throats managed?

A

Self-care advice, antibiotics if needed, identify those who are immunosuppressed or who need admission

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41
Q

When would a sore throat be suspected as being a sign of throat cancer?

A

If sore throat persistent, especially if there is a neck mass

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42
Q

When should patients with a sore throat be admitted to hospital or referred to a specialist?

A

Suspected throat cancer
Sore/painful throat for 3-4 weeks = pain on swallowing/dysphagia for >3 weeks
Red/red on white patches or ulceration/swelling of oral/pharyngeal mucosa for >3 weeks

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43
Q

What are some self-care treatments for patients with sore throats?

A

Analgesia = paracetamol, ibuprofen

Medicated lozenges, avoid hot drinks, adequate fluid intake, mouthwashes/sprays (less evidence)

44
Q

What is responsible for 2/3 of sore throats?

A

Viral infection = don’t need antibiotics

45
Q

What is the most common cause of a bacterial throat infection?

A

Strep pyogenes (group A strep)

46
Q

What does strep pyogenes infection of the throat cause?

A

Acute follicular tonsillitis = treated with penicillin

47
Q

What are some late complications of strep pyogenes infection of the throat?

A

Rheumatic fever and glomerulonephritis

48
Q

When does rheumatic fever present after a strep pyogenes infection of the throat?

A

3 weeks post sore throat = fever, arthritis, pancarditis

49
Q

When does glomerulonephritis present after a strep pyogenes throat infection?

A

1-3 weeks post sore throat = haematuria, albuminuria, oedema

50
Q

How is the CENTOR criteria for assessing the risk of strep pyogenes infection of the throat scored?

A

I point for each, out of 4, developed for adults but used widely = 0,1 or 2 has 3-17% risk, 3 or 4 has 32-56% risk

51
Q

What are the categories in the CENTOR criteria for assessing the risk of strep pyogenes infection of the throat?

A

Tonsillar exudate, tender anterior cervical lymph nodes, history or fever >38, absence of cough

52
Q

What age group is most at risk of strep pyogenes throat infections?

A

Children aged 5-15 years old (less likely outside this age range)

53
Q

How is the fever PAIN criteria scored for assessing the risk of strep pyogenes infection of the throat?

A

One point for each, not validated for use in children <3 = 0 or 1 has 13-18% risk, 2 or 3 has 34-40% risk, 4 or 5 has 62-65% risk

54
Q

What makes up the fever PAIN criteria for assessing the risk of strep pyogenes infection of the throat?

A

Fever (lasts 24hrs), purulence, attend rapidly (within 3 days), inflamed tonsils, no cough/coryza

55
Q

What must be done before prescribing a DMARD?

A

Take full blood count

56
Q

What should be done if a patient on a DMARD has a low white cell count or is deteriorating?

A

Seek specialist advice, stop DMARD, provide symptomatic relief, consider antibiotics

57
Q

What are some causes of neutropenia?

A

Carbimazole, chemotherapy, leukaemia, asplenia, aplastic anaemia, HIV with low CD4

58
Q

What should be done in patients with neutropenia?

A

Get urgent full blood count and withhold drug suspected of causing it

59
Q

When should phenoxymethlypenicllin be considered to treat strep pyogenes throat infections?

A

If fever PAIN score 4 or 5

If CENTOR criteria score 3 or 4

60
Q

What is the causative organism of diphtheria?

A

Corynebacterium diphtheriae = produces potent exotoxin which is cardio/neuro-toxic

61
Q

What does diphtheria present with?

A

Sore throat with grey/white membrane across pharynx

62
Q

Is there a vaccine for diphtheria?

A

Yes = cell-free purified toxin from Corynebacterium diphtheriae (toxoid vaccine)

63
Q

Is diphtheria common?

A

No = rare in UK (but higher incidence in Russia)

64
Q

How is diphtheria treated?

A

Antitoxin and supportive measures, penicillin/erythromycin

65
Q

What is the other name for infectious mononucleosis?

A

Glandular fever

66
Q

How does infectious mononucleosis present?

A

Fever, enlarged lymph nodes, sore throat, pharyngitis, tonsillitis, malaise, lethargy

67
Q

What is the prognosis of infectious mononucleosis?

A

Protracted but self-limiting disease

68
Q

What are some rarer signs and symptoms that can occur due to infectious mononucleosis?

A

Jaundice/hepatitis, rash, leucocytosis (lymphocytosis), atypical lymphocytes on blood film, splenomegaly, palatal petechiae

69
Q

What are some complications associated with infectious mononucleosis?

A

Anaemia, thrombocytopenia, splenic rupture, upper airway obstruction, increased risk of lymphoma (especially in immunosuppressed)

70
Q

What causes infectious mononucleosis?

A

Epstein Barr virus = establishes persistent infection in epithelial cells (notably in pharynx)

71
Q

What are the two phases of primary infection of infectious mononucleosis?

A

Early childhood = rarely causes infectious mononucleosis

Age >10 years = often causes infectious mononucleosis

72
Q

What is the therapy for infectious mononucleosis?

A

Bed rest, paracetamol, avoid sport, no antivirals, corticosteroids if complicated

73
Q

How can infectious mononucleosis be confirmed in the lab?

A

EB virus IgM, heterophile antibody (Paul-Bunnell test, monospot test), blood count and film, LFTs

74
Q

What are other infectious agents that may cause symptoms similar to those of infectious mononucleosis?

A

Cytomegalovirus, toxoplasmosis, primary HIV infection

75
Q

What causes candida/thrush?

A

Candida albicans is causative agent

Risk factors = post antibiotics, immunosuppression, smoking, inhaled steroids

76
Q

When should candida/thrush be investigated?

A

If recurrent

77
Q

How does candida/thrush present?

A

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

78
Q

How is candida/thrush treated?

A

Nystatin or fluconazole

79
Q

What is acute otitis media?

A

Upper respiratory infection involving middle ear by extension of infection up the Eustachian tube

80
Q

What age group is acute otitis media most common in?

A

Predominantly disease of infants and children

81
Q

What does acute otitis media present with?

A

Ear ache

82
Q

What is the most common cause of acute otitis media?

A

Often viral with secondary bacterial infection

83
Q

What are some bacteria commonly implicated in acute otitis media?

A

H. influenzae, strep, pneumoniae, strep, pyogenes

84
Q

When should a swab be taken to diagnose acute otitis media?

A

Only if the eardrum perforates (can’t gain access otherwise)

85
Q

How is acute otitis media treated?

A

80% resolve in 4 days without antibiotics
First line is amoxicillin
Second line in erythromycin

86
Q

What is malignant otitis externa?

A

Extension of the otitis externa into the bone surrounding the ear canal

87
Q

What is the prognosis of untreated malignant otitis externa?

A

Fatal if untreated = osteomyelitis will progressively involve skull and meninges

88
Q

What are the symptoms of malignant otitis externa?

A

Pain and headache, more sever than clinical signs would suggest

89
Q

What occurs in malignant otitis externa?

A

Granulation tissue at bone-cartilage junction of ear canal, exposed bone in ear canal, facial nerve palsy (drooping of face on side of lesion)

90
Q

What investigations are done for malignant otitis externa?

A

PV/CRP, imaging, biopsy, culture

91
Q

What organism causes malignant otitis externa?

A

Usually pseudomonas aeruginosa

92
Q

What are the risk factors of malignant otitis externa?

A

Diabetes, radiotherapy of head and neck

93
Q

What is otitis externa?

A

Inflammation of the outer ear canal

94
Q

How does otitis externa present?

A

Redness and swelling of skin of ear canal, sore and painful, discharge or increased ear wax, may be itchy in early stages

95
Q

How does hearing become impaired in otitis externa?

A

If canal becomes blocked by swelling or secretions

96
Q

What are some bacterial causes of otitis externa?

A

Staph. aureus, proteus spp, pseudomonas aeruginosa

97
Q

What are some fungal causes of otitis externa?

A

Aspergillus niger, candida albicans

98
Q

How is otitis externa managed?

A

Topical aural toilet and swab for microbiology

99
Q

When are antimicrobials used to treat otitis externa?

A

In unresponsive or severe cases

100
Q

What are some antimicrobials used to treat otitis externa?

A

Depends on culture result = topical clotrimazole (canestan) for aspergillus niger, gentamicin 0.3% drops

101
Q

How does acute sinusitis present?

A

Mild discomfort over frontal/maxillary sinuses due to congestion

102
Q

What group of patients normally suffer from acute sinusitis?

A

Seen in patients with URT viral infections

103
Q

What would indicate a secondary bacterial infection in acute sinusitis?

A

Severe pain and tenderness with purulent discharge

104
Q

What organisms cause acute sinusitis?

A

Similar to those that cause acute otitis media

105
Q

How long does acute sinusitis usually last?

A

Two and a half weeks

106
Q

When should antibiotics be given to treat acute sinusitis?

A

For severe or deteriorating cases of >10 days duration

107
Q

What antibiotics are used to treat acute sinusitis?

A

First line = phenoxymethlypenicllin

Second line = doxycycline (not in children)

ENT Medicine (22 decks)

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