Week 1 Flashcards
Signs and symptoms of AOM
- Neonates: Irritability or feeding difficulties may be the only indication of a septic focus
- Older children: This age group begins to demonstrate a consistent presence of fever and otalgia, or ear tugging
- Older children and adults: Hearing loss becomes a constant feature of AOM and otitis media with effusion (OME); ear stuffiness is noted before the detection of middle ear fluid
Risk factors of AOM
- Prematurity and low birth weight
- Family history
- Allergy
- Day care
- Tobacco and pollutant exposure
- Use of pacifier
- Absence of breastfeeding, prolonged bottle use
Anatomy of middle ear
part of the ear between the eardrum and the oval window. The middle ear transmits sound from the outer ear to the inner ear. The middle ear consists of three bones: the hammer (malleus), the anvil (incus) and the stirrup (stapes), the oval window, the round window and the Eustrachian tube.
Identify the indications for myringotomy and tympanoplasty
• Neonates who are younger than 6 weeks (and therefore are more likely to have an unusual or more invasive pathogen)
• Patients who are immunosuppressed or immunocompromised
• Patients in whom adequate antimicrobial treatment has failed and who continue to show signs of local or systemic sepsis
-Patients who have a complication that requires a culture for adequate therapy
Identify the most common bacterial pathogens
S pneumoniae, H influenzae, Moraxella catarrhalis,Streptococcus pyogenes
class, mechanism of action, and antimicrobial spectrum of amoxicillin/clavulanate
- Class: B-lactamantibiotic
- MOA: Amoxicillin binds to penicillin-binding protein 1A (PBP-1A) located inside the bacterial cell well. Penicillins acylate the penicillin-sensitive transpeptidase C-terminal domain by opening the lactam ring. This inactivation of the enzyme prevents the formation of a cross-link of two linear peptidoglycan strands, inhibiting the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that amoxicllin interferes with an autolysin inhibitor.
- Spectrum: Active against gram positive bacteria and gram negative bacteria
class, mechanism of action, and antimicrobial spectrum of levofloxacin
- Class: Fluoroquinolone
- MOA: Levofloxacin inhibits bacterial type II topoisomerases, topoisomerase IV and DNA gyrase. Levofloxacin, like other fluoroquinolones, inhibits the A subunits of DNA gyrase, two subunits encoded by the gyrA gene. This results in strand breakage on a bacterial chromosome, supercoiling, and resealing; DNA replication and transcription is inhibited.
- Spectrum: Gram positive and Gram negative bacteria
antimicrobial resistance of the most common bacterial causes of otitis media
-Streptococcus pneumoniae:
Alteration of the cell wall’s penicillin-binding protein (the antimicrobial target) has led to the appearance of multidrug-resistantS pneumoniae
-Haemophilus influenzae
formation of a single enzyme, triethylenemelamine 1 lactamase; resistance is overcome relatively easily by using blocking agents, extended-coverage cephalosporins, broad-spectrum macrolides, or sulfonamides.
-Moraxella catarrhalis:
secretion of multiple isoenzymes of lactamase,
Pathogenesis of M. catarrhalis
- have LPS
- pili or fimbriae, which may facilitate adherence to the respiratory epithelium
- produce a protein that confers resistance to complement by interfering with the formation of the membrane attack complex
- commensal status ofM catarrhalisin the nasopharynx
how OMT can be used as adjunct treatment for otitis media.
-OMT naturally enhances the body’s ability to drain the middle ear
early signs and symptoms of primary Lyme Disease
- erythema migrans
- fever, headache, malaise, fatigue, arthralgias or myalgias
- regional lymphadenopathy
risk factors for lyme disease
- Age: Highest rates are in children aged 5 to 15 years and in persons older than 50 years7
- Sex: In the United States, more common in males; in Europe, more common in females,
- Genetics: HLA-DRB1*0401 is associated with persistent posttreatment arthritis1
- Other risk factors: Exposure to tick habitat in an endemic area
how Borrelia burgdorferi is transmitted
- transmission ofB. burgdorferito humans through the bite of an infected tick of theIxodesgenus
- tick can become infected at any stage of its life cycle by feeding on a host, usually a small mammal such as the white-footed mouse (Peromyscus leucopus), which is a natural reservoir forB. burgdorferi.
- Most commonly transmitted during the tick’s nymph stage but can be transmitted by adult ticks as well
- A tick must attach and feed for more than 36 hours to cause infection in the host
preventative measures for lyme disease
- Use personal protection and avoid exposure to ticks
- If exposure cannot be avoided wear long-sleeved shirts tucked into long pants with pant legs tucked into socks and use Tick repellents
- Reduce favorable tick habitat around homes; remove leaf litter and brush
- Inspect for and promptly remove ticks
- In endemic areas, use prophylactic antibiotic treatment afterIxodestick bite
proper procedure for removing ticks
- use forceps or tweezers to grasp tick as close to skin surface as possible and pull upward with steady pressure
- disinfect bite site and save tick for identification
- avoid use of physical substances (such as petroleum jelly) or heat which appear ineffective for tick removal
