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EYE infections Flashcards

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1
Q

conjuntiva NF orgs

A

Staph epidermis, diphtheroids, Propionibacterium acnes

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2
Q

cause of conj. inflamm

A

chem irritants, allergies, inf. agents, diminution of tears, (keratoconj. sicca)

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3
Q

host defense mechs against conjunct.

A

mech. action of blinking
tears: lysozyme, sec. IgA, host-der. antimicrobial peps, etc
conj. : lympos, plasma cells, neutros, mast cells
int. eye protected by eyelids, conj., sclera, cornea (sterol and imm. privileged)

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4
Q

trauma or disease cause inflammation

A

(papillae, follicles present)

extravasation of neutros, macros, lymphos from conj. vasc into tears

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5
Q

follicles are..

A

focal lymp. aggr. assoc. w. viral/chlamydial infection (1-2mm) translucent elevations on lower conjunctiva

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6
Q

papillae are..

A

mult. minute, opaque elevations on conjunctiva, non-specific but typ. assoc w/ EC bac disease

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7
Q

conjun. (bac and viral) s/s

A

itching, burning, discharge, preauricular lymphaden. +/-, typ. unilat, most cases benign, self-limiting

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8
Q

conj. discharge

A

serour fluid OR purulent (PMN or moncytic) OR mucopuruleng (exc. PMN) (PMS: bac, Monocytes: viral/fungal)
-if discharge, clears w/ blinking

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9
Q

conj. complications

A

medical emergency req. imm. tx bc indicated inf. has spread to cornea (keratitis): vision impairment has begun

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10
Q

symp. of keratitis

A

eye pain, photophobia, vis. impairment

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11
Q

ddx conjunc.

A

conjunctivokeratitis, blepharitis, corneal abrasion, FB, other cause of subconjunc hemorrhage (cough/V), iritis, glaucoma, chem burn, scleritis

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12
Q 
bac conjunc (acute purulent/mucopurulent) conj. 
most common orgs
A

*Staphylococcus aureus (G+ cocci)
*Streptococci (G+cocci) S. pneumoniae, S. pyogenes (Staph & Strep most common in adults/ww)
H. flu (giogroup aegyptius (G- rod)
Moraxella catarrhalis (G- cocci)
Neisseria gonorrhoeae and Chlamydia spp.

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13
Q

bac conj. common orgs for age group

A

neonates: GC, chlamydia
up to school age: 2x more likely bac>virus
>=school age: viral/allergic (20%: adenovirus) epidemic keratoconjunc. more common in adolescents, adults

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14
Q

pink eye

A

acute contagious conjunct. w/ sub conj. hemorrhage (pink sclera)
most common: NTHi (aegyptius), Streptococcus pneumoniae (less moraxella spp., Pseudomonas aeruginosa)
*most common form of conj. in children
symps: gen conj. s/s, rapid, unilat lid edema, poss. contralat inv. 1-2 days, purulent neutro discharge, lid margin crusting, subconj hemorrhage (pink sclera), abs. of pre auricular lymphaden.

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15
Q

conjunc.-OM syndrome

A

orgs: NTHi, S. pneumo, Moraxella catarrhalis

infants, young kids (spreads btw siblings)

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16
Q

conjunc-OM dx

A

clin. obsv. lab confim: conjunc swab–>smear–>Gs, Cx, Abx sens. testing

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17
Q

conjunc-OM tx

A

benign and self-lim: 10-14 d, *EXCEPT S. aureus origin
topical abx w/ br-spec abx for 7-10 days: trimethoprim-polymixin, fluoroquinolone
*milder inf. will resolve w/out tx

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18
Q

Infectious Hyperacute Mucopurulent Conjunctivitis is called this in the neonate

A

Ophthalmia neonatorum (1st 28 days) contam of eyes thru birth canal

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19
Q

IHM conjun org: Neisseria gonorrhoeae

A

(G- cocci), major cause of STD, affects 50% of all infants born to gon-inf. moms, earlier (d 2-5 of life) than C. trachomatis
rapid, fulminante progression w. copious mucopurulent exudate, erythema, eyelid/conjunc edema, freq. bilat
rapidly destr. inf–>ulc, perf, blindness even in abs. of any corneal trauma/abrasio

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20
Q

inf. hyperacute mucopur. conjunc. (N. gon) tx

A
  • Medical emergency!* imm. tx and consult w. ophthalmologist (unlike Chlamydial ophthalmia neonatorum: tx but not emerg.)
  • tx imm. s. syst. abx (ceftriaxone or other 3rd gen cephs/fluoroquinolones (ciprofloxacin), freq. saline eyewash w/ abx, delayed tx (even1-2 d) can result in blindness!
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21
Q

inf. hypacute mucpur conjunc (Chlamydia trachomatis) (serotypes D-K)

A

Inclusion conjunct of newborn, G- cell wall architecture (can’t see w. Gs), an obli. IC pathogen

  • affects many infants born to moms inf. w/ chlamydial cervicitis
  • appears later: day 5-10 of life
  • less purulent, more serous discharge, less progressive
  • sight not threatened and dis. is self-limiting
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22
Q

IHM conjunc (C. trachomatis) tx

A

oral and topical erythromycin

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23
Q

Herpes classic triad (conjunc)

A

skin, eye, mouth (SEM): inclusion keratoconjunctivitis of newborn
obl. IC pathogen: HHV-2, affects some infants born to inf./shedding moms
appears even later! 9-10d of life) than N. ton and C. trach ocular disease
tx: acyclovir or other antiviral

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24
Q

other causes of inf hypacute mucpur conjunc

A

vag flora: Staph, Strep, some G- rods

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25
symptoms of bacterial inf. IHM conjunc
unilat or bilate erythema, sev. eyelid edema, conjunc. edema, profuse exudate w. marked purulence
26
Inf. hypacute mucopurulent conjunc dx
s/s, start emp. tx imm, Gs, Giemsa stain, DFA stain, Cx from conjunctival scrapings or swabs (also from mom)
27
Gs and Cx + for N. gonorrhoeae reveal
G- diplococci w/in cytoplasm of PMNs on Gs of conjunct. on smears and scrapings from symp. child *if negative, may indicate chlamydial etiol. (not routinely Cs in labs, not vis. on Gs)
28
Giemsa or DFA stain of conjunc material that reveal intracytoplasmic inclusions is positive for
chlamydia (also if chlamydia Ag present)
29
IHM conjunc. can have coinfection w/
N. gon and C. trach (50% of inf. women)
30
prev. of ophthalmia neonatorum
Crede procedure: silver nitrate (1%) for N. gon + abx eye drops (eryth, doxy, tetra for both G/C) -->causes chem conjunct. 24-48 hrs, prev. blindness
31
Inclusion conjunctivitis (IC)
any conjunct. caused by ob IC pathogen | -presence of IC (cyto or nuc) inclusions which is a cytopathic effect induced by the pathogen
32
IC etiol.
ob IC pathogen: Chlamydia trachomatitis or any viral conjunc. agent
33
IC patho
lysis and/or necrosis of epi cells-->inflamm resp. (symptoms) typ. follicular-->cause irritation and FB sensation dx: (cytoplasmic inclusions obs. on microscopic findings. of conjunct scrapings, or on Giemsa stains, DFA/FAT for chlamydia if viral: IN inclusions on Tzanck stained scrapings/smears for herpes virus)
34
Chlamydia trachomatis(G-) conjunctivitis
causes IC at any age-->end stage in adult is trachoma (*leading cause of prev. inf. blindness ww)
35
trachoma
keratoconjunctivitis which may result in partial/total vision loss
36
trachoma org.
C. trachomatis (serovars A thru C)
37
trachoma incidence
poverty/unsanitary: underdev. nations: Mid East, SE Asia, Africa, SW US (immig. pops and indian reserv) not transmissible h to h, but by low sanitation (lack of clean H2O); via flies, fomites, finger-eye inoculation *inf. kids are source/reservoir incidence of active dis. dec w/ age
38
trachoma immunology
"double-edged sword" limits replication of pathogen & induces patho changes to eye some protect. immun. (dis. of childhood, only adults have scarring)
39
trachoma disease course
slowww (years); begins as acute inclusion conjunct., rep. exposure to Chlamydial Ags-->intense chr. inflamm. resp-->scarring of inner eyelid-->retraction of tarsal plate-->inverting the eyelid: entropion-->inverted eyelashes (trichaisis) constantly abrade cornea-->corneal opacity/scarring
40
trachoma dx
clin. obs in endemic area Giemsa, FAT: IC inclusions, low sens. PCR is most sens., rarely done
41
trachoma tx/pxx
``` no vaccine! WHO imp. SAFE strategy: Surgery Abx Face/hand washing Environ. change (inc. clean water, better sanitation, education) ```
42
viral conjunctivitis (epidemic, inclusion conjunc)
adenovirus coxsackie virus/ enterovirus HSV 1, VZV, measles virus
43
viral conjunc. incidence
more common than bac! highly inf.-->via ocular sec. eye-hand-eye * adenovirus most common * prim. HSV-1 most common viral IC in kids
44
viral IC patho/s/s
transient, self-lim gen symps of conjunct. w/ mild tearing/itching thin watery discharge/exudate bearing monocytes (NOT purulent), + follicles, pre auricular lymphaden.
45
viral IC: pharyngeal conjunctival fever
transient, self-lim (2-4 wks) adenovirus (3,4,7) *contam. swimming pools!* so kids, y. aduls in summer (or lakes/ponds) -kids contagious 1st 2 w
46
pharyngeal conjunctival fever triad
fever, pharyngitis, IC symps
47
pharyngeal conj. fever dx, tx, ppx
clin obs. epid. consider no tx, resolves about 2 wks ppx: contagious 1st 2 wks so keep out of school
48
epidemic Keratoconjunctivitis ("shipyard eye")
adenovirus (8,19,37,11) | highly contagious, spread by close contact, sec. fomites
49
epidemic Keratoconjunctivitis symps
PCF + mild irritaiton and sev. photophob. (10-14 d post onset), painful cent. located corneal ulcer (keratoconj. from imm. resp. to inf.) may persist for mos.
50
epidemic Keratoconjunctivitis dx tx ppx
dx: clin obs, contact w/ case tx: supportive/palliative, rem. of membranes and pseudo mem along w/ top steroids (imp. comfort) ppx: isolate inf. pt (10-14 d) educate
51
acute epidemic hemorrhagic conjunctivitis (AEHC)
highly contagious, self-lim, | crowding, poor hygiene
52
acute epidemic hemorrhagic conjunctivitis viruses
Coxsackie virus (A24) enterovirus 70 adenovirus (11)
53
symps of AEHC
bilat, sudden, photophob, exc. tearing (epiphora), eye irritiation/FB sens, eyelid edema, erythema, conj. hem, pink sclera, sm. superfic. corneal ulcers, superfic. punctate keratitis short (4-5d) duration, spont. resolution
54
tx, ppx of viral IC (all)
tx symptomatically, topical corticosteriods, NO topical abx unless discharge becomes purulent/mucopurulent (second. bac inf) ppx: know infectious period, keep home, approp. personal hygiene
55
Keratitis (corneal inflammation)
corneal inflammation-->corneal ulceration w/in 24 hours! *eye emergency*-->risk of rapid vision loss
56
keratitis bac
Staph (G+coc) Strep (G+coc) Listeria (G+rod) Neisseria (G-coc) anaerobes, GNRs, Pseudomonas aeruginosa (causes corneal inf. w/ soft contact lens use
57
fungal etiol. of keratitis
less common, but happens w/ eye trauma
58
protozoan etiol of keratitis
Amoeba: Acanthamoeba sp. (rare: tap water use for contacts)
59
viral etiol. of keratitis
typ. adults immune suppression is key prec. factor, recur. common -HSV-1: leading cause blindness in dev./industr. countries (vs C. trach in underdev. countries) -50-500k cases in US/yr, 1000s corneal trans. -VZV keratitis involves a periorbital lesion tx (both HSV-1 and VZV keratitis) w/ prol. combo topical acyclovir and corticosteroids
60
keratitis path for non-viral agents
brkdwn in corneal epi-->invasion of corneal stroma by WBC (immpath) and bac (toxin-prod, i.e. proteases)-->some corneal scarring/opacification from inflamm. (even if tx)
61
keratitis path for viruses
viral repl-->cytolysis of corneal cells (dendritic figures: clinical sign) -inf. is reactiv. of latent inf. so no breach in corneal epi layer req (virus inf. acq. early in life, remains latent in trigeminal/cervical ganglia-->triggered by environ. or sec. imm supprs-->migrates to cornea, can be shed (even when no symps)
62
symps of keratitis
unilat red eye, mod-sec ocular pain, photophob, serous discharge, dec. vision, loss of corneal luster/appearance, viral agents cause dendritic bodies/lesions (fluorescein dye, slit lamp) VZV keratitis: if involves periorbital skin, many dev. ocular complications
63
keratitis dx
clin. findings, labs: NV: Gs, Cx, sens viral: DFA, Cx, PCR ophthalmology consult for HSV Ker. and VAV ker. to ID virus and det. epi or stromal forms (dendritic figures)
64
keratitis tx
non-viral agents: antimicr. tx to avoid perf, ulc, blindness: FQ eye drops (Ciloxan, Ocuflox) HSV K: depends on K form VZV keratitis: oral acyclovir (3 days)
65
retinitis
CMV retinitis HHV 5
66
retinitis most common viral sight/life threatening opp. inf. in
AIDS pts; poor px
67
retinitis path
recrudescence of latent CMV inv (waning CMI)
68
retinitis symps
unilateral-->bilat vision loss due to eye lesions-->visual field loss and dec. visual acuity
69
retinitis dx
``` red patches (hemorrhage) and white (necrosis, edema) over lg portions of retina vitreous clear and inflamm-free ```
70
retinitis tx
ganciclovier, foscarnet, cidofovir (IV, intravitreally, both)
71
this org. causes retinitis (not as common as viral CMV cause)
``` Tosoplasma gondii (protozoan, EUK) path: recrudescence of latent T. gondii inv (waning CMI) ```
72
other causes of retinitis
"salt and pepper lesions" of congenital rubella (German measles) *HSV (prim and rec) *VZV (prim and rec**) *dis. in bot immcomp and CMI comp, poor ps despite high does IV acyclovir Roth spots of infectious endocarditis
73
River blindness org
(Onchocerciasis) | parasitic worm: Onchocerca volvulus (helminth, tissue round worm, filarial nematode)
74
River blindness cycle
transmit. thru bites- blackflies (Simulium) * *2nd leading cause of blindness ww! (after trachoma) - microfilariae found in peripheral blood, urine, sputum, mostly skins and lymph. of CT (2y lifespan)
75
River blindness path
systemic, derm, ocular inf symps caused by body's resp to dead/dying larvae (rel. Wobachia bac) -skin inflammation: itchy and damaging -eye inflammation: rev. lesions on cornea-->if no tx, perm. clouding-->blindness also optic nerve inflamm.-->vision loss (perish)-->blindness
76
River blindness s/s
itchy skin rashes: "leopard skin", thinning: "cigarette-paper" "hanging groin" nodules under skin vision changes: loss of peri vision/blindness occ. non painful swelling of lymph glands
77
River blindness tx
IVERMECTIN (ev. 6 mos as long as eye/skin inf) | **but make sure not Loa loa!!: sev. SEs (encephalopathy) to ivermectin*

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