Micro1650ex2.txt

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samraborjr
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Micro1650ex2.txt
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2010-09-21 00:48:17
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  1. Acute Bacterial Conjunctivitis
    • -Rapid onset of unilateral edema, contralateral w/in 1-2 days
    • - Big three: S aureus, S. pneumoniae, NTHi
    • - Mech: compromised epithelium
    • - SS: pus/crust along lid margin, no preauricular lymphadenopathy (viral), Pink eye (contagious)
    • -Tx: Rinse, topical ABX
  2. Acute Epidemic Hemmorhagic Conjuntivitis
    • et: enterovirus 70, Coxsackie A24, Adenovirus 11
    • Highly contagious
    • SS: bilateral follicular conjuntivitis, Pink sclera, excessive tearing, photophobia
    • TX: spontaneous, 4-5days
  3. Chlamydia trachomatis
    • ~gram (-)
    • Serovars A-C: cause IC. can lead to blindness (trachoma)
    • D-K: STD, conjunctivitis, pneumonitis
    • L1-L3: STD, Lymphogranuloma venereum
    • Cycle: Extracellular (EB) -> intracellular (RB) -> converts back to EB and lyses
  4. Chronic Bacterial Conjuntivitis
    • Et: Staphylococcus, Moraxella
    • - low virulence
    • -Mech: exotoxin
    • SS: minimal mucopurulent discharge, Sty
    • TX: ABX, hygeine
  5. Corneal Infection (keratitis)
    • an ophthalomologic emergency due to rapid risk of vision loss
    • Corneal ulceration is a major concern
    • Et: Staph, Stept, GNRs, Listeria, Neisseria,
    • P. aeruginosa is most common case (contact lense)
    • Herpes simplex keratitis (HSK), varicella
    • Host response plays role in pathology
    • SS: Unilateral red eye w/ corneal luster, ocular pain, photophobia, dendritic figures(HSK)
    • TX: empirical tx w/ ophtho referral
  6. Epidemic Keratoconjuntivitis "shipyard eye"
    • Et: adenovirus (8,19,37, sometimes 11)
    • -highly contagious
    • SS: central corneal ulcer, pseudomembrane, photophobia. 10-14days
    • TX: supportive/palliative, removal of pseudomembrane
  7. Hand Foot Mouth Disease
    • Group A coxsackie A16, Enterovirus 71
    • -POE is RT
    • - milder than herpangina
    • - Enanthem (anterior), Examthem (hand, foot)
    • - ruptured ulcers do not crust over
    • - Tx: Pleconaril
  8. Herpangina
    • Group A coxsackieviruses (A21, A24)
    • -POE is RT
    • -Sore throat w/ dysphagia
    • - prominent in posterior of throat
    • -vesicular
  9. Hyperacute Mucopurulent Conjunctivitis in the Newborn
    • IC in newborn: Ophthalmia neonatorum (ON)
    • Et: N. gonorrheae (crede procedure), Chlamydiae (D-K), HSV-1,2
    • SS-Gonoccocal: (medical emergency), 2-5days of life, very purulent, frequently bilateral, corneal ulceration
    • SS-Chlamydiae: more delayed (5-10days), less purulent, more serous
    • DX/TX: empiric TX immediately w/ ABX, saline eyewashes for GC
  10. Inclusion Conjuntivitis
    • Et: viruses and Chlamydiae
    • all chlamydiae serotypes
    • Viruses: adenoviruses, entero, HSV-1, HSV-2, Measles
    • transmission: eye -> hand -> eye
    • SS: Follicular, inflammation
    • TX: ABX, antivirals
  11. Mumps Virus
    • (-)ssRNA
    • - forms syncytia
    • - acute contagious disease
    • - Winter/spring
    • - contact, resp drop, fomites
    • - S/S: flu-like, parotid swelling/pain, Epididymo-orchitis (brucella)
  12. Non-polio Enteroviruses: Epidemiology
    • - one of the most common
    • - june-oct (temperate climate)
    • - young children more common (- ATM route
  13. Non-polio Enteroviruses: Examples
    • * Coxsackie A and B (~30 serotypes)
    • * ECHO (~40 serotypes)
    • * Enterovirus 68-71
  14. Non-polio Enteroviruses: Manifestations
    • - multiplies in mucosa and nodes of pharynx
    • - immunity is serotype specific
    • - fever w/ or w/o rash, MFH, pharyngitis, Herpangina
  15. Pharyngeal Conjunctival Fever
    • Et: adenovirus (serotype 3,4,7)
    • -Highly infectious (summer mths)
    • -transient (2-4wks)
    • -SS: Pharyngitis + Fever + conjunctivitis (triad), preauric adenopathy common
    • TX: spontaneous ~2wks
  16. Retinitis
    • Et: CMV, HSV, VZV...typically on second exposure or time of immuno-supression
    • Mech: Infxn via vessel/nerve thus no kerititis or conjunctivitis.
    • SS: uni->bi, patches or white and red
    • Tx: reverse immune defect if possible, antivirals
  17. Trachoma
    • C. trachomatis serovar A-C
    • -begins as a inclusion conjunctivitis
    • -prominent in underdeveloped countries and poor areas.
    • leading cause of infectious blindness
    • -end-state disease
    • mech: slow, many reinfections, necrosis, fibrosis, corneal abrasion -> blindness (opacity)
    • TX: S.A.F.E.
  18. Rhinitis "common cold"
    • Et: Rhinovirus and Coronaviruses
    • trans: direct, fomite, inhalation (only way for corona)
    • POE: nasal, conjuntiva, oropharynx
    • Peaks in late fall, winter, early spring
    • -Incubation period 2-4 days
    • -attach via ICAM-1 (CD54) (blocked by IgA2)
  19. Rhinovirus
    • Picornaviridae (enterovirus family)
    • (+) ssRNA virus, non-enveloped
    • ideal temp is 33-35*C. Just below NBT
  20. Coronavirus
    • Enveloped (+) ssRNA
    • 2 major strains
  21. Complications to Rhinitis
    • Otitis media
    • Sinusitis
    • asthma attack
    • LRT infection
    • Acute exacerbation of chronic bronchitis (AE-CB)
  22. Sinusitis
    • Et. bacterial-S pneumoniea, NTHi, Moraxella
    • viral (less common)-Rhino, Influenza virus, Parainfluenza
    • -Normal flora is predominant cause
    • -peak during late fall to winter
    • Risk factors: IgG, IgA deficient; cystic fibrosis
    • -Maxilla is most common site
  23. Types of Sinusitis
    • Acute (ACABS) - <1mnth
    • Subacute - 4-8wks
    • Chronic>8wks
    • Recurrent 3+ acute episodes/yr
  24. Otitis Externa "Swimmer's Ear"
    • Et: Pseudomonas aureginosa (60%), Staph, fungi
    • 50/50 between peds and adults
    • -most often due to trapped water in canal
    • -outer canal acutely inflammed
    • hearing loss possible
    • no fluid behind TM
    • TX: topical ABX w/ w/o cortisone
  25. Acute Otitis Media
    • all bacteria: S pneumoniae, NTHi, Moraxella
    • most common ailment in the youth (6m-3y)
    • Winter/spring
    • rapid onset of symptoms
    • -pyogenic, TM bulging/full, opaque/yellow/erythmatous/gray, immobile
    • TX: Amoxicillin
  26. Otitis Media with Effusion
    • Serous fluid (not pus) in middle ear
    • Slow onset (chronic/insidious)
    • -can be resolution of AOM or not
    • -Persistant: chronic bact infxn of mid ear w/biofilm
    • -air bubble or air/fluid line behind drum
    • -hearing impairment
    • Fall/spring
  27. Treatment of OM
    • Watchful waiting and SNAP; WASP
    • Amoxicillin for AOM
    • Augmentin if chronic or persistent
    • Tympanostomy tube
  28. Pharyngitis
    • inflammation of pharynx
    • Et. infection of pharynx or inflammatory mediators for other site
    • -rhinitis, adenovirus
  29. Adenovirus (Ad)
    • non-enveloped dsDNA, linear
    • -penton fibers
    • -most common pharyngitis agent
    • -causes many differing diseases are various sites
  30. Adenovirus Pharyngitis
    • clinically indistinguishable from GABHS, S. pyrogenes
    • -SS last 3-7 days
    • - +coryza w/ cough, -n/v, -abd pain

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