Week 3 - A. Prunuske (Ear Infections) Flashcards
What are common symptoms of bacterial/viral Acute otitis media?
- Ear pain
- Red ear drum
- Pus
- Fever
What are common symptoms of Otitis media with effusion?
- Build up of fluid in Eustachian tube
- No infection
- Associated URI
- Cigarette smoke
- Allergies
- Self-resolving
Describe the pathogensis of Acute Otitis Media (AOM).
- URI/Allergic condition –> congestion of mucosa
- Narrowing/obstruction of Eustachian tube –> prevention of ventilation/drainage
- Adenoids –> possible blockage
- Accumulatio of secretions + pathogen ==> AOM!
Why do ~70% of children experience at least one episode of otitis media during childhood?
- Eustachina tubes are more narrow & horizontal
- Immune system is not well developed
What are the three most common bacterial etiologic agents of acute otitis media?
- Strep pneumoniae (25-50%)
- Haemophilus influenzae (15-30%)
- Moraxella catarrhalis (3-20%)
What are the two most common viral etiologic agents of acute otitis media?
RSV & rhinovirus
Streptococcus pneumonia
Gram +/-
Shape
Mode of transmission
- Gram positive
- Diplococcus
- Contact with secretions (normal flora)
What are the five main virulence factors for Streptococcus pneumoniae?
- Resistance - change in penicillin binding protein
- Capsule - blocks phagocytosis
- Choline-binding proteins - binds to carbs on epithelial cell surface
- Neuraminidases - cleave host mucins
- Pneumolysin - pore forming toxin disrupts cilia
Haemophilus influenzae
Gram +/-
Shape
Mode of Transmission
- Gram negative
- coccobacillus
- Not sure… part of normal flora?
What are the three main virulence factors for Haemophilus influenzae?
- Nontypeable-nonencapsulated
- Small, pleomorphic
- Express Beta-lactamases
Moraxella catarrhalis
Gram +/-
Shape
Mode of Transmission
- Gram negative
- Diplococcus
- Respiratory droplet
What are the two main virulence factors for Moraxella catarrhalis?
- Pili
- Produce Beta-lactamases
What two common pathogens of otitis media require chocolate agar to grow?
H. Influenzae & Moraxella catarrhalis
What are the recommended prevention strategies for Acute Otitis Media?
- Avoid exposing sick children to cigarette smoke
- Avoiding bottles before bed
- Stay up to date on vaccines (influenza & pneumococcal conjugate)
- WASH YO DAMN HANDS!
What age range do you always start empiric treatment for Acute Otitis Media with Amoxicillin?
6-24 months
If there is no improvement of acute otitis media symptoms within 48hrs on Amoxicillin, what do you switch to?
Amoxicillin + Clavulanate
How do you treat acute otitis media if there is a penicillin allergy?
Azithromycin
What are potential complications of otitis media?
- Conductive hearing loss
- Delayed speech due to perforation of TM/erosion of ossicles
- Cholesteatoma (epithelial cell cyst in middle ear)
- Infection can spread to:
- Mastoid
- Inner ear
- Temporal bone
- Meninges
- Brain
What is the most common pathogen in acute localized Otitis Externa?
Staphylococcus
(associated with hair follicle)
What is the most common pathogen associated with Acute Diffuse Otitis Externa?
Pseudomonas aeruginosa
What is the most common pathogen associated with Malignant Otitis Externa?
Pseudomonas aeruginosa
What are the most common fungal pathogens associated with Otitis Externa?
Aspergillus & Candida albicans
How do you manage/treat Otitis Externa?
- Topical antibiotics
- Neomycin + polymyxin + hydrocortisone
- Analgesics
- Cleansing with low pH topical solution
- acetic acid
- Flushing ONLY if TM is intact
