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IBI Test 4 > B3.054 Ear Infections > Flashcards

B3.054 Ear Infections Flashcards

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1
Q

how does primary otalgia present in an ear exam?

A

abnormal

discharge, tinnitus, hearing loss, vertigo

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2
Q

what structures of the ear have no pain fibers?

A

inner ear structures (cochlea, semicircular canals) cranial enervation

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3
Q

how does secondary otalgia present in an ear exam?

A

normal

referred pain due to sensation fibers from cranial and cervical nerves

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4
Q

common causes of primary otalgia

A

otitis media
otitis externa
foreign bodies
barotrauma (diving, air travel)

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5
Q

common causes of secondary otalgia

A 
dental caries, periodontal abcesses
pharyngitis, tonsillitis
TMJ syndrome
cervical spine arthritis
idiopathic
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6
Q

less common causes of primary otalgia

A

malignant (necrotizing) otitis externa
Ramsay Hunt syndrome
viral myringitis
cellulitis/chondritis/pericondritis, polychondritis, trauma, mastoiditis

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7
Q

signs of otitis media

A

recent URTI

red/cloudy and immobile tympanic membrane

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8
Q

signs of otitis externa

A

swimmers ear
ear phone use
white discharge

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9
Q

signs of malignant (necrotizing) otitis externa

A

diabetes, elderly immunocompromised

painful, granulation tissue

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10
Q

signs of Ramsay Hunt syndrome

A

vesicular rash

vertigo, hearing loss, tinnitus

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11
Q

what is Ramsay Hunt syndrome

A

reactivated VZV spreading to facial nerves

paralysis and rash affecting ear and mouth

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12
Q

4 primary acute otitis media pathogens

A

S. pneumo
H. influenzae
M. catarrhalis
S. pyogenes

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13
Q

3 primary acute otitis externa pathogens

A

s. epidermidis
p. aeruginosa
s. aureus

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14
Q

classify the Haemophilus species

A

small, gram - rods/coccobacilli
non-motile, non-sporulating
aerobic or facultative anaerobes
colonize mucosal surfaces of humans and animals

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15
Q

Haemophilus nutrition requirements

A 
complex
X factor (hematin)
V factor (NAD)
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16
Q

discuss the strains of H.influenzae

A

most commonly associated w human disease
6 capsular antigenic serotypes (a-f)
non-encapsulated (nontypeable) strains rarely cause invasive disease

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17
Q

most virulent strain of H. influenzae

A 
Type b (Hib)
>95% of invasive infections
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18
Q

how does Hib colonize the oropharynx?

A 
fimbrae (adhesins)
IgA protease (breaks down mucosal IgA)
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19
Q

what is the function of Hib LPS

A

impairment of ciliary function

damage to respiratory epithelium

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20
Q

how does Hib invade bloodstream?

A 
polyribitol capsule (PRP)
anti-PRP antibodies are protective
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21
Q

what other sites can Hib invade? how?

A 
hematogenous spread:
joints
meninges
CNS
all using PRP
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22
Q

what is the Hib virulence factor for disseminated disease?

A

LPS (endotoxin)

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23
Q

discuss the Hib epidemiology

A

humans only host
transmission via resp droplets
mainly pediatric disease

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24
Q

what is the Hib 2nd gen conjugate vaccine made up of?

A

purified PRP conjugated to carrier proteins

combo vaccines: DTaP-Hib and Hep B-Hib

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25
what type of cells mediate the immune response to the vaccine?
T cell dependent antigens protective antibody response in infants >2 months of age prior protection through maternal antibodies
26
who can get the Hib vaccine?
infants >6 weeks | not >5 years unless immunocompromised
27
how to identify Hib through lab tests
``` gram stain of CSF or synovial fluid antigen (PRP) detection in CSF or urine culture -requires media containing factors V and X -chocolate agar -SBA w/ s. aureus (hemolytic) ```
28
what is NTHi?
nontypable H.influenzae
29
where is NTHi located?
colonize nasopharynx of most individuals during the first few months of life, remain throughout life localized spread can lead to disease
30
common illnesses caused by NTHi
otitis media sinusitis pneumonia
31
treatment oh H. influenzae
penicillin resistance common in US (30%) for invasive: 3rd gen ceph for otitis media/sinusitis: ampicillin, ceph, fluoroquinolone
32
characterize pseudomonas
``` gram -, motive bacilli obligate aerobes ubiquitous in environment opportunistic pathogen common nosocomial ```
33
discuss the overarching properties of p. aeruginosa
most common human pathogenic pseudomonad opportunistic common nosocomial
34
what types of infections does p. aeruginosa primarily cause?
skin pulm outer ear eye
35
what are the virulent properties of the P.aeruginosa capsule
antiphagocytic contributes to antibiotic resistance adhesin polymer of mannuronic and glucuronic acid
36
what is another name for the p.aeruginosa capsule
alginate
37
discuss the regulation of capsule production in p.aeruginosa
environmental (osmoregularity, nitrogen) and quorum sensing produced at high levels in lungs (particularly in CF of immunocompromised patients) production ceases in vitro BASICALLY, can sense conditions, when conditions are appropriate, capsules grow
38
what is the difference between in vitro p.aeruginosa and p.aeruginosa cultures from CF lung?
in vitro: no capsule, smooth and pigmented flagella+, pili+, alginate- CF lung: mucoid colonies of highly encapsulated bacilli, shiny flagella-,pili-,alginate+
39
what appearance can a capsule give on biofilm?
halo
40
p.aeruginosa exotoxin A
A-B toxin: A subunit ADP ribosylates elongation factor EF-2 | affects protein synthesis
41
p.aeruginosa Exotoxin S
major virulence factor injected T3SS effector protein disrupts signal transduction and blocks phagocytosis
42
p.aeruginosa exotoxin U
cytotoxic for macrophages
43
p.aeruginosa elastase
``` degrades elastin (protein in pulmonary and endothelial tissues) production regulated by quorum sensing ```
44
what types of infections does p.aeruginosa cause in healthy people?
``` folliculitis "hot tub rash" otitis externa "swimmers ear" eye infections (trauma) ```
45
describe acute otitis externa
edema and desquamating epithelium, soft cerumen, purulent discharge (has to be removed prior to treatment of the infection)
46
default treatment of otitis externa
eardrops -mild: acetic acid + propylene glycol + hydrocortisone -moderate to severe: ciprofloxacin + hydrocortisone no neomycin drops if TM is ruptured
47
otisis externa prevention
alcohol eardrops
48
what types of infections does p.aeruginosa in immunocompromised people?
bacteremia burn wound infections malignant otitis externa pulmonary infections
49
when do burn wounds become infected with p.aeruginosa?
>2 weeks
50
pathogenesis of malignant otitis externa
spreads from ear to nearby tissues, bone, cranial nerves, brain 95% p.aeruginosa DOC: IV ciprofloxacin early diabetics, AIDS, chemo
51
conditions that are susceptible to pulmonary infections caused by p.aeruginosa
COPD CF neutropenia
52
discuss the presence of p.aeruginosa in CF patients
80-90% of patients are colonized lungs colonize by age 3 biofilm formation
53
what does p.aeruginosa cause in CF patients
recurrent episodes of pneumonia with increasing frequency | antibiotics select for highly resistant strains
54
pathogenesis of pneumonia due to p.aeruginosa
aspiration of upper respiratory tract secretions | can lead to bacteremia, shock, alveolar hemorrhage, and lung necrosis
55
risk factors for p.aeruginosa pneumonia
``` neutropenia chronic lung disease CHF mechanical ventilation lung burns most common in ICU and nursing homes ```
56
identification of p.aeruginosa on culture
``` obligate anaerobe catalase + oxidase + green pigmented, often fluorescent (mix of blue pyocyanin and yellow fluorescin) siderophores fruity smell ```
57
what is pyocyanin
toxin found in patients' airway secretions | affects multiple cellular functions
58
what are the effects of pyocanin
``` intracellular oxidative stress low ATP (cilia, CFTR) low NADPH (antibacterial) gene expression -down: catalase -up: oxidative stress response, mucins, cytokines, chemokines innate immune mechanisms: neutrophils ```
59
treatment of systemic p.aeruginosa
multidrug resistance common initial empiric combination treatment with antipseudomonal B-lactam + B-lactamase inhibitor + aminoglycosides monotherapy chosen on basis of local susceptibility patterns
60
last resort treatment of p.aeruginosa
polymyxin E | solubilizes bacterial membranes

IBI Test 4 (21 decks)

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