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Session 2 Microbio21

Microbio -21- Ear, Nose, Throat hartley

What is the cause of epidemic keratoconjunctivitis (EKC) adenovirus strains 8,19 or 37. infection Usually last 2-4 weeks but keratitis may linger for months
What is the cause of Pharyngoconjunctival fever Adenovirus
what disease is associated with "OUTBREAKS" at summer camps, marked by bilateral conjunctivitis, low grade fever, rhinitis, sore throat, cervical lymphadenopathy pharyngoconjuctival fever
what is the cause of follicular conjunctivitis adenovirus more common or HSV
What three syndromes does adenovirus cause epidemic keratoconjunctivitis (EKC) PHaryngoconjuctival fever follicular conjunctivitis
what are the common sources of infection with adenovirus contaminated towels, or other daily use items in kindergarten, school, clinic or swimming pools
what is the most common cause of conjunctivitis adenovirus- more than any other virus or bacteria
what type of infection does adenovirus have and where can it become latent usually a lytic infection but can become latent in lymphocytes
what virus that can infect the eye can establish life long latency and life long persistence in sensory neurons herpesvirus (HSV-herpes simplex, ZVZ-varicella zoster, CMV-cytomegalovirus)
how are herpesviruses spread spread by contaminated secretions, mucous membranes, incubation 2-11 days most infectous during early days of a primary infection
viral Causes blepharoconjunctivitis most commonly HSV but may be VZV
what is blepharoconjunctivitis infections of the eyelid that spread to mucus membranes that line the eyelid or eyeball
viral cause of follicular conjunctivitis Herpesviruses less common but similar in appearance to adenovirus caused follicular conjunctivitis
viral cause of keratoconjunctivitis may be caused by HSV, VZV can cause permanent visual loss can also be caused by adenovirus
viral cause of retinitis CMV in HIV patients
viral cause of opthalmia neonatorum herpes virsuses
how can you differentiate between an HSV blepharoconjunctivitis infection and impetigo caused by group a strep or staph aureus lesions in HSV mature at same rate.
what can happen if HSV blepharoconjunctivitis spreads to cornea can cause scarring and permanent vision loss
how do you dx herpes keratitis use fluorescein staining will see a dendritic pattern. Can be distinguished from corneal abrasion by the sheet like pattern of corneal abrasions in fluorescein staining.
what is the severe conjunctivitis of newborns acquired infection at birth genearlly from sexually transmitted microorganisms getting into the eyes during delivery opthalmia neonatorum- gen cuased by neisseria gonorrhoeae, chlamydia trachomatis, and HSV
dsDNA virus that replicates in cytoplasm not nucleus poxvirus (molluscum contagiosum virus)
infection syndrome has pearly flesh colored skin lesions 2-5mm in diameter and is more common in HIV patients molluscum contagiosum virus (poxvirus)
virus cause of acute hemorrhagic conjunctivitis enterovirus (picornavirus)
eye infection marked by acute onset of severe eye pain, blurred vision, photophobia, and watery discharge. P/E will have edema, chemosis, subconjunctival hemorrhage w/ headache and fever. Acute hemorrhagic conjunctivitis short duration and sudden onset differentiate between enterovirus and adenovriral or chalmydia infections
virus that selectively infects epithelial cells of skin and mucous membranes w/ some oncogenic strains. Usually only cuases a single lesion papilloma virus strains 6,11 or 16
what is the tx for eye infections caused by herpesviruses acyclovir and antibiotics to avoid super infection by bacteria
What is the tx for eye infections caused by adenovirus symptomatic only
what is the tx for eye infections caused by poxvirus removal of large lesions from eyelids
what is the tx for eye infections cuased by enterovirus symptomatic only
what is the tx for papillomaviruses symptomatic only vaccine does not protect against strains causing ocular infection
how are bacterial eye infections characterized may be superinfections to viral disease and typically show more purulent discharge less frequently preauricular lymphadenopathy
what are the 4 gram negative bacteria that gen cause eye infections H. Influenza, Chlamydia Trachomatis, Neisseria Gonorrhea, Bartonella henselea.
bacterial cause of keratoconjunctivitis H. Flu, Strep Pneumoniae
44-68% non typable cause of keratoconjunctivitis that often is concomitant with otitis media H. Flu
causes trachoma (D-K) chlamydia trachomatis
eye infection that starts as follicular conjunctivitis, then you get leukocyte infilltration of cornea scarring of conjunctiva causes eyelid to turn inward trachoma D-K
starts as unilateral follicular conjunctivitis, w/ preauricular adenopathy, untreated may resolve in 6weeks to 2 years. May have foreign body sensation w/ minimal itichin adult inclusion conjunctivitis caused by chlamydia trachomatis
what is the cause of adult inclusion conjunctivitis chalmydia trachomatis
bacteria that causes adult follicular conjunctivitis like chlamydia trachomatis neisseria gonorrhea
bacteria that causes cat scratch disease, where you get a pimple at site of infection w/ local lymph node enlargement (nodes may soften and drain pus) Bartonella henselea
what are the gram positive bacteria that commonly cause eye infections strep. pneumonea, Staph aureus, staph epidermidis
bacterial cause of keratoconjunctivits like H. Flu but grows in chains and is catalase negative and alpha hemolytic strep pneumonea
Bacteria cause conjunctivitis that is coagulase positive staph aureus
what is the tx for opthalmia neonatorum antibiotic eye drops or silver nitrate drops in infants eyes
What bacterial eye infection is least likely to clear with penicillin treatment Neisseria Gonorrhea
what type of eye infection do the following likely describe? unilateral onset red eye minor pain or foreign body sensation mucoid or mucopurulent discharge usually in children acute bacterial conjunctivitis
what type of eye infection do the following likely describe? usually bilateral onset follicular rxn preauricular lymphadenopathy watery discharge usually in children acute viral conjunctivitis
what type of eye infection do the following likely describe? Often Bilateral onset profuse discharge and tearing tarsal plate papillae neonates and young adults most common chlamydial conjunictivitis
3 common causes of fungal eye infections candida sp. Fusarium Sp. Aspergillus Sp.
yeast fungi that can cause opportunistic infections especially in immune suppressed individuals. can grow on or in any eye structure candida sp.
is candida normally found on the skin and mucous membranes yes is normal flora of skin and mucous membranes but fulminanat infections are not normal
What are candida infections associated with when infecting the eye injection through eye surgery, hematogenous spread from other area of body, and low birth weight
What eye infection does candida typically cuase endophthalmitis
patient has white cotton ball lesions in vitreous that can often lead to permanent damage what are they likely infected with candida sp. caused endophthalmitis
what two fungi are histologically indistinguishable from each other and cause keratitis and less commonly endophthalmitis fusarium sp. and aspergillus sp.
patient has been doing a lot a yard work digging in the soil and working to build a new compost grove box. While shoveling they accidently flung some dirt into their eyes and now have keratitis what is the likely pathogen causing the infection. fusarium sp.- soil saprophyte feeds on dead organic matter. histologically would look just like aspergillus but history points to fusarium sp.
hyaline mold that is an opportunistic pathogen that can cause keratitis or endophthalmitis aspergillus sp.
what state do most pts have to be in to have a fungal eye infection fungal eye infections are rare and opportunistic infection patient is generally immunocompromised or been exoposed to conatminated equipment or solutions
what amoeba can cause eye infection acanthameoba
what eye infection can acanthamoeba cause keratitis in contact lens wearers
how does acanthamoeba typically get in to infect the eye introduced via contaminated contact lens solution or home made saline solutions.
what s/sx does acanthamoeba keratitis have severe ocular pain, photophobia, stromal ring infiltrate
how can you distinguish infection from allergy allergy will itch but infections will typically be scratchy, burning, pain or foreign body sensation
why do you need to recognize and treat eye infections in neonates quickly to keep eye infection from spreading to brain meninges
which is more common duct obstruction or conjunctival infections in neonates most of the time eye discharge is from duct obstruction not infection. obstruction will be watery discharge with a white eye (not a red eye) and eyelid skin redness.
what adult group is at high risk for microbial corneal infection contact lens wearers
what is the most common complication of contact lens wearers microbial corneal infection
if patient has pathogen causing a corneal ulcer where could they likely have been exposed to the pathogen contact lens complication
name pathogens from the following groups that cause belpharitis bacteria viruses fungi parasites bacteria-staph aureus virus- fungi- parasites-
name pathogens from the following groups that cause Dacryocystitis bacteria viruses fungi parasites Bacteria-strep pneumoniat, staph aureus, S. Pneumoniae, H. Influenze virus- Fungi- Parasite-
name pathogens from the following groups that cause conjunctivitis, keratitis, keratoconjunctivitis bacteria viruses fungi parasites Bacteria-strep pyogenes, S. aureus, Chlamydia, N. Gonorrhoeae, N. Meningitidis virus- Adenovirus, HSV, VZV, measles Fungi- Aspergillus, Eusarium Parasite- Acanthamoba (keratitis)
name pathogens from the following groups that cause ophthalmia neonatorum bacteria viruses fungi parasites Bacteria-N. Gonorrhoeae, Chlamydia Trachomatis Viruses- HSV fungi- parasites-
name pathogens from the following groups that cause Endophthalmitis bacteria viruses fungi parasites Bacteria- S. Aureus, Pseudomonas aeruginosa, gram - bacteria virus- fungi- candida, aspergillus
name pathogens from the following groups that cause iridocyclitis bacteria viruses fungi parasites Bacteria- Treponema Pallidum Virus- HSV, VZV fungi- parasite-
name pathogens from the following groups that cause chorioretinitis bacteria viruses fungi parasites bacteria- mycobacterium tb viruses- Cytomegalovirus, HSV, VZV fungi- histoplasma capsulatum, coccidioides immitis, candida species parasites- toxoplasma gondii, toxocara canis
infections that effect the nasal passages rhinitis/common cold
infections that effect the sinus sinusitis
How do most nose infections start most start as common cold (viral URT infection)
what is the most common viral cause of rhinitis/common cold rhinovirus
what are the s/sx of rhinitis/common cold headache nasal congestion (post nasal drainage) WATERY rhinorrhea sneezing scratchy throat (pharyngotonsilar irriation from drainage) General Malaise
what is an effective tx for rhinits but should be used with caution nasal sprays caution can cause rebound hyperemia (also known as rhinitis medicamentosa)
What are the estimates on number of URT infections that adults have and children have each year adults 2-3 viraul URTs a year child 3-8
how does a sinus infection progress typically URT infection block sinuses which allows bacteria in sinuses to grow and cause an infection rather than being cleared out by normal ciliary mucus clearance
How can one tell when a sinus infection has started on top of the rhinitis the mucus will generally change from clear and watery to mucoid (yellow/green)
What type of bacteria typically cause acute sinusitis and what bacteria take over in chronic sinusitis acute sinusitis started by aerobic bacteria if infection last >3 months it is chronic and you see more anaerobic bacteria
what fraction of sinusitis is actually polymicrobial 1/3
what are the most common causes of bacterial sinusitis in kids strep pneumoniae, H. Flu, Moraxella cararrhalis
what are the risk factors for getting rhinitis and sinusitis allergic rhinitis nasal trauma immune compromised/diabetic smoking (especially H. Flu) swimming/barotrauma nasal polyps cocaine abuse pseudomonas aeruginosa from nosocomial infection from nasal tubes and catheters
What is nasal vestibulitis bacterial infection of nasal passage hair follicle most likely staph aureus
what are nasal polyps yellowish boggy masses of hypertrophic mucosa (benign) can be caused by recurrent allergic rhinitis attacks and can cause blockage of ostia leading to bacterial sinusitis
how are fungal nasal infections divided invasive and noninvasive invasive will spread to CNS (rhizopus, mucor, absidia)
What is the most common complication from bacterial sinusitis preorbital swelling
what do you want to look at to help determine if nasal infection is viral or bacterial and fungal time of symptoms purulent discharge maxillary tenderness worsening of symptoms after 5-10 days (fungal infections may affect only one sinus) abnormal transillumination
what are the two main sites of ear infections otitis externa otitis media
what is the most common cause of external ear infections otitis externa 98% of cases are bacterial pseudomonas aeruginosa (20-60%) Staph Aureus (10-70%)
What type of infection is likely if you have a painful or itchy ear with purulent discharge, with a cellulitis of the ear canal skin and subdermis. the inflammation in the ear canal can involve the pinna or tympanic membrane. Acute Otitis Externa (swimmers ear or tropical ear)
what are the classic s/sx of otitis externa otalgia, itching, fullness, hearing loss tenderness of the tragus, pinna or both. on otoscopy will see diffuse ear canal edema, erythema or both without otorrhea or material in ear canal.
What syndrome do you have if you have an infected hair follicle in the outer third of the ear canal causing otalgia, otorrhea, localized tenderness, furunculosis most likely caused by staph aureus
What ear infection do you have likely caused by fungus in tropical environments. Risk factors include long term antibiotic use, diabetic, HIV or immune compromised. will present with pruritis and thickened otorrhea (black, green, white) Otomycosis (tropical ear) aspergillus 60-90% candida spp. 10-40%
What is the likely tx for otitis externa ten day course of gentamicin and hydrocortisone drops
how can you tell otitis externa from otitis media pneumatic otoscopy should show good tympanic membrane motion in AOE and absent or limited mobility in AOM
what ear infection does your patient likely have if their Acute Otitis Externa has spread to posterior cranial bone, soft tissue middle ear, inner ear and potentially the brain Malignant otitis externa
what is an early symptom of malignant otitis externa facial nerve paralysis with raised ESR and abnormal CT/MRI
What is diagnostic of Malginant Otitis Externa raised ESR and abnormal CT/MRI
What is the most likely cause of Malignant otitis Externa Pseudomonas Areuginosa
How does a middle ear infection typically progress infection may spread from pharynx to middle ear abrupt onset of otalgia, irritablility, otorrhea, or fever infection is treated or pressure builds until it ruptures TM infection is cleared
What are the most probable organism to cause middle ear infection Strep Pneumoniae non typable H. FLu Moraxella Catarrhalis
what will you see on otoscopy of acute otitis media TM will have limited or absent moblility.
what are some risk factors for acute otitis media bottle feeding smoking parents attending daycare male
what are the AAFP guidelines for dx acute otitis media rapid onset 48hrs presence of middle ear effusion signs and symptoms of middle ear inflammation
What is Otitis media with effusion non infectious condition of unknown casue clear middle ear effusions with no other symptoms
what is the condition that can arise from ineffective or lack of treatment for AOM chronic suppurative otitis media- marked by chronic inflamattion of middle ear and mastoid mucosa. TM is NOT intact and discharge (otorrhea) is present
This ear syndrome can be caused by proloned eustachian tube dysfunction causing a negative prssure to draw the flaccid protion of TM inward. Creates a sac that can lead to chronic infection and can typically lead to bone erosion cholesteatoma
What will you see on PE with cholesteatoma epitympanic retraction pocket or perforation that exudes keratin debris
patient come in complaining of acute onset of continuous severe vertigo lasting several days with hearing loss and tinnitus. they recently had a upper respiratory tract infection what do they likely have labyrinthitis
Patient has episodic vertigo and chronic imbalance, unilateral hearing loss with rapid onset and spontaneous abatment of s/sx what do they likely have causing there vertigo multiple sclerosis
what is the most likely cause of eye infection, bacterial, viral, fungal or parasite viral
what is the most likely cause of ear infection, bacterial, viral, fungal or parasite bacterial secondary to viral URI
what is the most likely cause of sinus infection, bacterial, viral, fungal or parasite viral initially followed by bacterial infection from complications
what are the most common risk factors shared by ear eyes and nose infections smoking, immune compromised and diabetic
what are the main pathogens of eye infections adenovirus, or STDs in neonates
what are the main pathogens of ear infections externa: P. Aeruginosa, S. Aureus Media: S. Pneumoniae, H. Flu, M. Cararrhalis
What are the main pathogens of nose infections and sinus nose: rhinovirus sinus: S. Pneumoniae
Created by: smaxsmith