Microbio -21- Ear, Nose, Throat hartley
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| 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
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| What is the cause of Pharyngoconjunctival fever | Adenovirus
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| what disease is associated with "OUTBREAKS" at summer camps, marked by bilateral conjunctivitis, low grade fever, rhinitis, sore throat, cervical lymphadenopathy | pharyngoconjuctival fever
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| what is the cause of follicular conjunctivitis | adenovirus more common or HSV
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| What three syndromes does adenovirus cause | epidemic keratoconjunctivitis (EKC)
PHaryngoconjuctival fever
follicular conjunctivitis
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| what are the common sources of infection with adenovirus | contaminated towels, or other daily use items in kindergarten, school, clinic or swimming pools
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| what is the most common cause of conjunctivitis | adenovirus- more than any other virus or bacteria
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| what type of infection does adenovirus have and where can it become latent | usually a lytic infection but can become latent in lymphocytes
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| 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)
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| how are herpesviruses spread | spread by contaminated secretions, mucous membranes, incubation 2-11 days most infectous during early days of a primary infection
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| viral Causes blepharoconjunctivitis | most commonly HSV but may be VZV
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| what is blepharoconjunctivitis | infections of the eyelid that spread to mucus membranes that line the eyelid or eyeball
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| viral cause of follicular conjunctivitis | Herpesviruses less common but similar in appearance to adenovirus caused follicular conjunctivitis
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| viral cause of keratoconjunctivitis | may be caused by HSV, VZV can cause permanent visual loss can also be caused by adenovirus
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| viral cause of retinitis | CMV in HIV patients
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| viral cause of opthalmia neonatorum | herpes virsuses
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| 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.
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| what can happen if HSV blepharoconjunctivitis spreads to cornea | can cause scarring and permanent vision loss
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| 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.
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| 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
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| dsDNA virus that replicates in cytoplasm not nucleus | poxvirus (molluscum contagiosum virus)
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| infection syndrome has pearly flesh colored skin lesions 2-5mm in diameter and is more common in HIV patients | molluscum contagiosum virus (poxvirus)
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| virus cause of acute hemorrhagic conjunctivitis | enterovirus (picornavirus)
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| 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
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| 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
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| what is the tx for eye infections caused by herpesviruses | acyclovir and antibiotics to avoid super infection by bacteria
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| What is the tx for eye infections caused by adenovirus | symptomatic only
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| what is the tx for eye infections caused by poxvirus | removal of large lesions from eyelids
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| what is the tx for eye infections cuased by enterovirus | symptomatic only
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| what is the tx for papillomaviruses | symptomatic only vaccine does not protect against strains causing ocular infection
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| how are bacterial eye infections characterized | may be superinfections to viral disease and typically show more purulent discharge less frequently preauricular lymphadenopathy
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| what are the 4 gram negative bacteria that gen cause eye infections | H. Influenza, Chlamydia Trachomatis, Neisseria Gonorrhea, Bartonella henselea.
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| bacterial cause of keratoconjunctivitis | H. Flu, Strep Pneumoniae
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| 44-68% non typable cause of keratoconjunctivitis that often is concomitant with otitis media | H. Flu
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| causes trachoma (D-K) | chlamydia trachomatis
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| 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
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| 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
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| what is the cause of adult inclusion conjunctivitis | chalmydia trachomatis
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| bacteria that causes adult follicular conjunctivitis like chlamydia trachomatis | neisseria gonorrhea
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| 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
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| what are the gram positive bacteria that commonly cause eye infections | strep. pneumonea, Staph aureus, staph epidermidis
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| bacterial cause of keratoconjunctivits like H. Flu but grows in chains and is catalase negative and alpha hemolytic | strep pneumonea
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| Bacteria cause conjunctivitis that is coagulase positive | staph aureus
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| what is the tx for opthalmia neonatorum | antibiotic eye drops or silver nitrate drops in infants eyes
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| What bacterial eye infection is least likely to clear with penicillin treatment | Neisseria Gonorrhea
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| 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
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| 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
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| 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
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| 3 common causes of fungal eye infections | candida sp.
Fusarium Sp.
Aspergillus Sp.
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| yeast fungi that can cause opportunistic infections especially in immune suppressed individuals. can grow on or in any eye structure | candida sp.
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| 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
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| 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
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| What eye infection does candida typically cuase | endophthalmitis
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| 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
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| what two fungi are histologically indistinguishable from each other and cause keratitis and less commonly endophthalmitis | fusarium sp. and aspergillus sp.
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| 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.
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| hyaline mold that is an opportunistic pathogen that can cause keratitis or endophthalmitis | aspergillus sp.
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| 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
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| what amoeba can cause eye infection | acanthameoba
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| what eye infection can acanthamoeba cause | keratitis in contact lens wearers
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| how does acanthamoeba typically get in to infect the eye | introduced via contaminated contact lens solution or home made saline solutions.
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| what s/sx does acanthamoeba keratitis have | severe ocular pain, photophobia, stromal ring infiltrate
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| how can you distinguish infection from allergy | allergy will itch but infections will typically be scratchy, burning, pain or foreign body sensation
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| why do you need to recognize and treat eye infections in neonates quickly | to keep eye infection from spreading to brain meninges
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| 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.
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| what adult group is at high risk for microbial corneal infection | contact lens wearers
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| what is the most common complication of contact lens wearers | microbial corneal infection
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| if patient has pathogen causing a corneal ulcer where could they likely have been exposed to the pathogen | contact lens complication
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| name pathogens from the following groups that cause belpharitis bacteria viruses fungi parasites | bacteria-staph aureus
virus-
fungi-
parasites-
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| 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-
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| 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)
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| name pathogens from the following groups that cause ophthalmia neonatorum bacteria viruses fungi parasites | Bacteria-N. Gonorrhoeae, Chlamydia Trachomatis
Viruses- HSV
fungi-
parasites-
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| name pathogens from the following groups that cause Endophthalmitis bacteria viruses fungi parasites | Bacteria- S. Aureus, Pseudomonas aeruginosa, gram - bacteria
virus-
fungi- candida, aspergillus
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| name pathogens from the following groups that cause iridocyclitis bacteria viruses fungi parasites | Bacteria- Treponema Pallidum
Virus- HSV, VZV
fungi-
parasite-
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| 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
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| infections that effect the nasal passages | rhinitis/common cold
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| infections that effect the sinus | sinusitis
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| How do most nose infections start | most start as common cold (viral URT infection)
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| what is the most common viral cause of rhinitis/common cold | rhinovirus
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| 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
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| 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)
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| 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
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| 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
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| 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)
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| 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
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| what fraction of sinusitis is actually polymicrobial | 1/3
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| what are the most common causes of bacterial sinusitis in kids | strep pneumoniae, H. Flu, Moraxella cararrhalis
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| 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
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| What is nasal vestibulitis | bacterial infection of nasal passage hair follicle most likely staph aureus
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| 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
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| how are fungal nasal infections divided | invasive and noninvasive
invasive will spread to CNS (rhizopus, mucor, absidia)
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| What is the most common complication from bacterial sinusitis | preorbital swelling
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| 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
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| what are the two main sites of ear infections | otitis externa
otitis media
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| 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%)
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| 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)
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| 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.
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| 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
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| 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%
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| What is the likely tx for otitis externa | ten day course of gentamicin and hydrocortisone drops
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| 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
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| 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
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| what is an early symptom of malignant otitis externa | facial nerve paralysis with raised ESR and abnormal CT/MRI
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| What is diagnostic of Malginant Otitis Externa | raised ESR and abnormal CT/MRI
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| What is the most likely cause of Malignant otitis Externa | Pseudomonas Areuginosa
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| 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
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| What are the most probable organism to cause middle ear infection | Strep Pneumoniae
non typable H. FLu
Moraxella Catarrhalis
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| what will you see on otoscopy of acute otitis media | TM will have limited or absent moblility.
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| what are some risk factors for acute otitis media | bottle feeding
smoking parents
attending daycare
male
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| 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
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| What is Otitis media with effusion | non infectious condition of unknown casue clear middle ear effusions with no other symptoms
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| 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
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| 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
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| What will you see on PE with cholesteatoma | epitympanic retraction pocket or perforation that exudes keratin debris
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| 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
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| 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
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| what is the most likely cause of eye infection, bacterial, viral, fungal or parasite | viral
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| what is the most likely cause of ear infection, bacterial, viral, fungal or parasite | bacterial secondary to viral URI
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| what is the most likely cause of sinus infection, bacterial, viral, fungal or parasite | viral initially followed by bacterial infection from complications
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| what are the most common risk factors shared by ear eyes and nose infections | smoking, immune compromised and diabetic
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| what are the main pathogens of eye infections | adenovirus, or STDs in neonates
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| what are the main pathogens of ear infections | externa: P. Aeruginosa, S. Aureus
Media: S. Pneumoniae, H. Flu, M. Cararrhalis
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| What are the main pathogens of nose infections and sinus | nose: rhinovirus
sinus: S. Pneumoniae
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