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CONJUNCTIVA ANOMALIES > BACTERIAL CONJUNCTIVITIS > Flashcards

BACTERIAL CONJUNCTIVITIS Flashcards

1
Q

what are the general bacterial conjunctivitis symptoms?

A
  1. unilateral –> bilateral
  2. redness
  3. pain
  4. photophobia
  5. Mucopurulent discharge
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2
Q

what are the general bacterial conjunctivitis signs?

A
  1. unilateral first, possibility to be bilateral.
  2. papillae
  3. purulent/mucopurulent discharge
  4. bulbar and palpebral conjunctiva injection
  5. chemosis
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3
Q

tx for acute bacterial conjunctivitis?

A
  • Topical Abx –> trimethoprim/polymyxin B or fluoroquinolone qid x 5-7 days.
  • F/U –> every 2-3 days initially –> then every 5-7 days when stable until resolved.
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4
Q

what is acute bacterial conjunctivitis? what species(s) is involved?

A

Bacterial infection most commonly due to:
In neonates:
* Chlamydia Trachomatis
* Neisseria gonorrhoeae
In children:
 H. influenza
 Strep pneumonia
In adults:
 Staph aureus
 S. epidermis

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5
Q

acute bacterial conjunctivitis is the most common cause of conjunctivitis in ____?

A

children <3 yrs old

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6
Q

symptoms of acute bacterial conjunctivitis?

A
  1. general bacterial conjunctivitis symptoms
  2. acute onset (24hrs)
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7
Q

signs of acute bacterial conjunctivitis?

A
  • general bacterial conjunctivis signs
  • acute onset (24hrs)
  • no cornea involvment + preauricular lymphadenopathy
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8
Q

what is (hyper-acute) gonococcal conjunctivitis? what species is involved?

A

Rare bacterial infection that is due to:
* Neisseria gonorrhoeae
* Neisseria meningitidis

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9
Q

who gets gonococcal conjunctivitis?

A
  • Sexually transmitted ocular disease (STD) that is most common in young adults’ w/ history of multiple sexual partners.
  • May also be transmitted to infants thru vaginal birth canal in infected mothers.
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10
Q

why is gonococcal conjunctivitis improtant to catch early and treat agressively?

A
  • organism involved is neisseria gonorrhoeae - which can invade an intact cornea!
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11
Q

symptoms of gonococcal conjunctivitis?

A
  • general bacterial conjunctivitis symptoms
  • hyper-acute onset (12-24hrs)
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12
Q

signs of gonococcal conjunctivitis?

A
  • general bacterial conjunctivits signs
  • hyperacute onset
  • pseudomembrane
  • postive preauricular lymphadenopathy – usually only in viral infx.
  • corneal ulceration –> can progress to perforation.
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13
Q

w/u for gonococcal conjunctivitis?

A
  • Thayer-Martin agar (chocolate agar) – used to culture both Neisseria gonorrhoeae & Haemophilus influenzae.
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14
Q

what is the pneumonic to remember types of organisms culture in a thayer-martin chocolate agar?

A

Hershey’s & Nestle Chocolate:
* Haemophilus influenzae
* Neisseria gonorrhoeae

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15
Q

tx for gonococcal conjunctivitis?

A
  • If no cornea involvement – tx with ceftriaxone 1g IM plus azithromycin 1g po in single dose.
  • If Cornea involvement – tx with ceftriaxone 1g IV + hospitalized
  • If pt is allergic to penicillin or cephalosporin – use fluoroquinolones.
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16
Q

what is neonatal conjunctivitis (ohpthalmia neonatorum)?

A
  • It is any conjunctival inflammation within the first month of life that can be from any source, non-infectious or infectious.
17
Q

how do you get neonatal conjunctivitis?

A
  • Usually due to transmitted infection from mother during delivery.
18
Q

how to determine bacterial etiology for neonatal conjunctivitis?

A

“Rule of 5s” to predict the most likely bacterial etiology.
* Neisseria gonorrhoeae - 0-5 days
* Chlamydial Trachomatis - 5 days to 5 weeks
* Strep or H. influenzae - 5 weeks to 5 years

19
Q

the most common infection source in neonatal conjunctivitis?

A

chlamydia

20
Q

what is used as a prophylactic tx for neonatal conjunctivitis?

A

erthromycin oinment

21
Q

tx for neonatal conjunctivitis?

A
  • Suspected chemical toxicity –> d/c offending agent + ATs qid + reassess in 24 hrs.
  • Suspected chlamydial infx –> azithromycin 20mg/kg po for 3 days
  • Suspected gonorrhoeae –> ceftriaxone 25-50 mg/kg IM or IV as a single dose. Also tx for possible chlamydia coinfection –> azithromycin po for 3 days
  • F/U –> daily
22
Q

what are the 2 types of conjunctivitis caused by chlamydia? what serotype causes each?

A
  1. adult inclusion conjunctivis - caused by serotypes D-K
  2. trachoma - caused by serotypes A-C
23
Q

who gets adult inclusion conjunctivitis? how does someone get adult inclusion conjunctivitis?

A
  • occurs in sexually active adults.
  • Most common via direct inoculation (hand-eye, genital-eye, etc.).
  • Rare - via contaminated swimming pool water, or shared cosmetic.
24
Q

signs for both chlamydial conjunctivitis?

A
  • Unilateral - then bilateral
  • Mucopurulent discharge (can be stringy)
  • HUGE Follicles (limbal & palpebral) – inferiorly = for adult inclusion & supeior = trachoma.
  • LIL Papillae – mainly in the inferior palpebral conj & fornices.
  • Can involve cornea - SEI
25
Q

only bacterial infection that causes follicles on palpebral and bulbar conj?

A

chlamydial bacterial infx

26
Q

what are specific signs of late-stage trachoma?

A
  • Arlts lines - linear white scarring of the superior tarsal conjunctiva.
  • Herbert’s Pits - depression on the superior limbal conjunctiva after resolution of limbal follicles.
  • Trichiasis, entropion
  • Corneal neovas
  • Severe corneal opacification
27
Q

tx for both chlamydial conjunctivitis?

A
  • single dose of oral azithromycin (1g) –> then daily use of oral doxycycline, tetracycline, or erythromycin for 1-2 wks.
  • F/u shoud be every 2-3 wks until resolution.
  • refer to specialist to r/o other STDs.
  • tx all pt’s sexual partners.

CONJUNCTIVA ANOMALIES (4 decks)

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