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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
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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
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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
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Chronic Bacterial Conjuntivitis
- Et: Staphylococcus, Moraxella
- - low virulence
- -Mech: exotoxin
- SS: minimal mucopurulent discharge, Sty
- TX: ABX, hygeine
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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
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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
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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
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Herpangina
- Group A coxsackieviruses (A21, A24)
- -POE is RT
- -Sore throat w/ dysphagia
- - prominent in posterior of throat
- -vesicular
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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
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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
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Mumps Virus
- (-)ssRNA
- - forms syncytia
- - acute contagious disease
- - Winter/spring
- - contact, resp drop, fomites
- - S/S: flu-like, parotid swelling/pain, Epididymo-orchitis (brucella)
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Non-polio Enteroviruses: Epidemiology
- - one of the most common
- - june-oct (temperate climate)
- - young children more common (- ATM route
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Non-polio Enteroviruses: Examples
- * Coxsackie A and B (~30 serotypes)
- * ECHO (~40 serotypes)
- * Enterovirus 68-71
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Non-polio Enteroviruses: Manifestations
- - multiplies in mucosa and nodes of pharynx
- - immunity is serotype specific
- - fever w/ or w/o rash, MFH, pharyngitis, Herpangina
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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
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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
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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.
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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)
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Rhinovirus
- Picornaviridae (enterovirus family)
- (+) ssRNA virus, non-enveloped
- ideal temp is 33-35*C. Just below NBT
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Coronavirus
- Enveloped (+) ssRNA
- 2 major strains
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Complications to Rhinitis
- Otitis media
- Sinusitis
- asthma attack
- LRT infection
- Acute exacerbation of chronic bronchitis (AE-CB)
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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
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Types of Sinusitis
- Acute (ACABS) - <1mnth
- Subacute - 4-8wks
- Chronic>8wks
- Recurrent 3+ acute episodes/yr
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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
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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
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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
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Treatment of OM
- Watchful waiting and SNAP; WASP
- Amoxicillin for AOM
- Augmentin if chronic or persistent
- Tympanostomy tube
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Pharyngitis
- inflammation of pharynx
- Et. infection of pharynx or inflammatory mediators for other site
- -rhinitis, adenovirus
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Adenovirus (Ad)
- non-enveloped dsDNA, linear
- -penton fibers
- -most common pharyngitis agent
- -causes many differing diseases are various sites
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Adenovirus Pharyngitis
- clinically indistinguishable from GABHS, S. pyrogenes
- -SS last 3-7 days
- - +coryza w/ cough, -n/v, -abd pain
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