Microbiology of ENT infections Flashcards

Question

What is the diagnosis of acute otitis media?

Answer 1

• swab of pus if eardrum perforates – otherwise samples cant be obtained

Answer 2

¥ 80% resolve in 4 days without antibiotics. Antibiotics for AOM < 2yrs or AOM with otorrhoea: - amoxicillin 5 days - clarithromycin 5 days if penicillin allergic

Answer 3

3 or more episodes in 6mths 5 or more episodes in 12months • The infection may spread to the mastoid area and if there is tenderness and swelling around this area then an urgent ENT opinion should be obtained.

Answer 4

¥ Mild discomfort over frontal or maxillary sinuses due to congestion often seen in patients with upper respiratory viral infections. ¥ However, severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection

Answer 5

¥ In uncomplicated avoid antibiotics as 80% resolve in 14 days without antibiotics. ¥ Where indicated ¥ 1ST LINE penicillin V ¥ 2ND LINE doxycycline –NOT IN CHILDREN!!!

Answer 6

¥ Inflammation of the outer ear canal

Answer 7

Ð Redness and swelling of the skin of the ear canal. Ð It may be itchy (especially in the early stages). Ð Can become sore and painful. Ð There may be a discharge, or increased amounts of ear wax. Ð If the canal becomes blocked by swelling or secretions, hearing can be affected. Ð Common in swimmers that don’t dry their ears * Debris may be in the canal which needs to be removed by gentle mopping or preferably by suction viewed directly under microscope * In severe cases the canal may be swollen and a view of the tympanic membrane may be impossible * Any foreign body seen should be removed by trained personnel.

Answer 8

``` Bacterial causes Ð Staphylococcus aureus Ð Proteus spp Ð Pseudomonas aeruginosa Fungal causes Ð Aspergillus niger (black heads of the funghi) Ð Candida albicans ```

Answer 9

Mild (mild discomfort and/or pruritus; no deafness or discharge): - do not swab - acetic acid 2% (earcalm) for 7 days - if doesn't improve after 3 days = moderate Moderate: - do not swab - gentisone HC, locortem vioform, otomize or sofradex - if unresponsive then swab and treat according to sensitivities considering topical gentamicin or cipro (as 0.3% eye drops 3 drops BD) - include topical corticosteroid for ear canal oedema If cellulitis/disease extends out of ear canal: -oral or IV abiotics REFER ENT If fungal cause: -clotrimazole solution 1% 2-3times daily until 14 days after cure ``` Moderate if: a red, oedematous ear canal which is narrowed and obscured by debris conductive hearing loss discharge regional lymphadenopathy cellulitis spreading beyond the ear fever ```

Answer 10

Herpes simplex 1 virus

Answer 11

``` ¥ Disease of pre-school children ¥ primary infection ¥ systemic upset ¥ lips, buccal mucosa, hard palate ¥ vesicles 1-2mm ¥ ulcers ¥ Fever, local lymphadenopathy ¥ May take up to 3 weeks to recover ¥ spread beyond mouth ¥ aciclovir treatment ```

Answer 12

After primary infection an inactive form of the virus resides in sensory nerve cells which can reactivate to re-infect mucosal surfaces

Answer 13

``` ¥ Reactivation from nerves causes active infection ¥ various stimuli ¥ aciclovir therapy or suppression ¥ not all reactivations are symptomatic ¥ Aciclovir does not prevent latency ```

Answer 14

Although multiple cycles of latency and active infection possible and natural history is for decreasing frequency Only half of infected people get clinical recurrences ¥ recurrent intra-oral lesions are rarely HSV Herpetic whitlow is the infection around finger nail – wear gloves!

Answer 15

¥ Swab of lesion in virus transport medium | Ð detection of viral DNA by PCR

Answer 16

¥ Vesicles/ulcers on soft palate

Answer 17

¥ coxsackie viruses (not HSV) Ð enterovirus ¥ similar patient age range to 1ry HSV gingivostomatitis ¥ diagnosis clinically or by PCR test of swab in viral transport medium

Answer 18

¥ coxsackie viruses (enteroviruses)

Answer 19

¥ family outbreaks common | ¥ diagnosis clinically or by PCR test of swab in viral transport medium

Answer 20

Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

Answer 21

auricular pain is often the first feature facial nerve palsy vesicular rash around the ear other features include vertigo and tinnitus

Answer 22

oral aciclovir and corticosteroids are usually given

Microbiology of ENT infections Flashcards

(46 cards)