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64 Cards in this Set
- Front
- Back
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what are sinuses
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we have cavities in the front of our face, like maxillary, ethmoid, frontal, sphenoid
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what are s n s of sinusitis
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-thick colored post nasal drainage
-headache -fever -congested nasal passages -facial pain, tenderness,swelling -cough -loss of breath -halitosis -ear stuffiness |
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what are the s n s of otitis media
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-fever
-irritanility -""otalgia"" -anorexia -vomitting -bulging tympanic membrane -middle ear effusion |
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what do sinusitis and otitis media uaually follow
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Upper respiratory infections
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what is the general cause of both sinusitis and otitis media
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PMN infiltrate the sinuses and ear canal
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what is the epidemiology of Otitis media
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-most common infection in kids
-50% will have it by their by 1sr bday and 80% before 3rd -most common reason to prescribe antibacs |
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what is the clinical disease seen with Otitis media
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-constant complain about an ear ache
-nausea -hearing loss -accompanied by URIm the congestion spreads to eustahsisn tube leading to ""Stasis"", effusion and multiplication of bacteria -spontaneous resolution with drainage or perforation of tymapnic membrane -tympanic membrane may be erythmatous and bulge |
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what are the most common pathogens associated with sinusitis and Otitis media
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-haemophillus influenza
-strp pneumoniae -moraxella catarrhalis |
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w/c species out of the 3 listed has been controlled by HIB virus
-haemophillus influenza -strp pneumoniae -moraxella catarrhalis |
haemophillus
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what are signs symptoms associated with haemophillus influenza
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-sinusitis
-otitis media -epiglottitis -bronchitis -pneumonia |
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what are the characteristics of haemophillus influenza
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-g-
-coccobacilli -facultative anaerobe -blood loving so it require hematin to grow -requires hematin x and nad+ V growth factor -part of the normal flora and is found in the human repiratory tract -requires chocolate agar |
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chocolate agar
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haemophillus influenza
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otalgia and stasis
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otitis media
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are there multiple serotypes to haemophillus influenza and what does the HIB protect against
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there are multiple strains and the HIB vaccine protects only against type B strain
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what is the most virulent strain haemophillus influenza
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type B strain
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what determines if the bacteria is serotypeable or not
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whether its pathogenic or not and only time it's pathogenic is when it has the capsule, non capsulated strains are part of the normal flora
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what are the virulence factors associated with haemophillus influenza
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-PRP capsule renders the influenza resistant to phagocytosis by PMN
-IgA protease -pili -beta lactamase |
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w/c strain of haemophillus influenza causes meningitis and epiglottitis
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strain B
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what else does strain B of haemophillus influenza causes
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-primary case of meningits
-otitis media -LRT, seen in CF patients and pneumonia in older patients -epiglottitis |
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what is epiglottitis and what causes it
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it is a medical emergency and it causes the obstruction of airways post infection with haemophillus influenza type b
-children b/t 2-4 yrs -adults 20-40 yrs -fever -drooling -""dysphagia"" -""stridor"" respiratory distress |
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dysphagia
stridor drool medical emergency begining w/inflammation and ending with complete obstruction of airways |
epiglottitis caused by haemophillus influenza
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what are some of the lab tests associated with haemophillus influenza
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- culture on the chocolate agar
-g strain to make sure -""rapid PRP antigen for haemophillus influenza" |
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what are some of the treatments associated with haemophillus influenza
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-amox/calvlinic acid combo
-sulfa (antimetbolite) -broad spectrum cephalosporin |
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what are the preventions and controls against haemophillus influenza
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-HIB vaccine
-rifampin as a chemproflaxis to high risk groups (inhibits Nucleic Acid synthesis) |
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what do we congugate the Hib vaccine with
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usually an immunogenic protein in the case of PRP-d vaccine it was congugated with bacterial toxoid
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what is caused by moraxella catarrhalis
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otitis media, sinusitis
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how do you know that the infection is causes by the moraxella
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usually g- cocci would be attaching to or releasing within PMN in sputum specimen
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what are some of the virulence factors of moraxella catarrhalis
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-oxidase positive
-DNASE -beta lactamase + -penicillin resistant |
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moraxella catarrhalis
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- g-
-obligate parasite of the mucosal mebranes -3rd most common cause of otitis media -beta lactamase + -penicillin resistant -normal pharyngeal flora in kids |
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what happens with patients that are immunocompromied and are infected with moraxella catarrhalis
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-brinchitis
-pneumonia -meningitis -bacterimia -endocarditis |
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what is the treatment and prevention for moraxella catarrhalis
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-pencillin resistant
-SMX/TMP (antimetbolites) -amp/calvulanate |
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what are the treatments for
1)otitis media w/bulging tympanic membrane 2)otitis media w/out bulging tympanic membrabe |
1)immediately treat w/high dose of amoxicllin 80-100 mg
2)delayed antibiotic strategy, start with tylenol and prescribe amox w/instructions to take it if fever or otalgia (ear pain) |
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what is caused by corynebacterium diptheriae
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diptheria
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what is significant about diptheria
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it is the most serious obstruction of airways after pharyngitis
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what is characteristic presentation of corynebacterium diptheriae
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it is called Chinese alphabets but mostly looks like snapping characters
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what are some of the characteristics of corynebacterium diptheriae
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-g+
-coryneform (irregular shaped or club shaped) -normal flora residing in the naso pharynx of humans -usually asymptomatic |
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what are the virulence factors of corynebacterium diptheriae
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-diptheria toxin
-AB toxin inhibits prtoein synthesis by ADP ribosyltaion of EF-2 transcription factor -lysogenized corynebacteriophage B -regulation via DTxR (iron dependent repressor protein) |
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what do we launch an immune response/antibiotic against in AB toxins
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B, b/c the goal should be to inhibit the binding of the bacterium
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as far as the iron is concerned, what is required to + the repressor of of the corynebacterium diptheriae phage
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high leve of iron is needed to repress the toxin gene but if iron is low then repressor is inhibited and the toxin gene is activated
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what does diptheria toxin require to be effective
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it requires a diptheria receptor, once bound it releases a unit called furin, w/c with the help of V-atpase cause acidification and that would lead to the inhibition of E2F factor via ribosylation
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how is diptheria spread
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person -person
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what do asymptomatic carriers carry
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they are the carriers of the lysogenized phage
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what is DRAP 27
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it is diptheria toxin receptor associated protein
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what is clinical respiratory diptheria
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-2-6 day incubation
-clolonize in the epthelial cells of the pharynx -will lead to formation of ""pseudomembrane"" or ""pathgnomonic"" -exudate filled with neutrophills, necrotic epithelial cells, erythrocytes and bacteria in fibrous mesh covers tonsils and uvula -difficult to detach wothout damaging underlying skin |
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what is nasal diptheria
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mild w/one sided nasal discharge
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what id cutaneous diptheria
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-skin contact acquisition
-more common than resp form -chronic non healing ulcer |
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what are some of the complications with all of diptheria associated diseases
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breathing obstruction
-myocrditis -cardia arrythmias -neuritis, peripheral neuropathy -coma -death |
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what are some of diptheria signs
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gross swelling and congestion of the whole pharyngeal and tonsillar area, with dirty white exudate that covers the area
-bull neck or periglandular edema -perforation of the soft palate as a late effect of the disease |
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how is lab diagnosis made against corynebacterium diptheriae
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-microscopy = yields false results
-must see club shaped g+ -also metallic shiny grnuales that are filled with inorganic polyphosphates -potassium tellurite will inhibts normal growth flora and only pathogenic diptheriae will grow aqnd for black colonies w/in 24-48 hours - |
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what kind of testing is performed against toxin
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elek test, immunodiffusion assay
- 3 streaks if toxin present you'll see streaks or spurs, if not no streaks |
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what is the treatment against corynebacterium diptheriae
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-early administration of diptheria antitoxin
-penicillin or erythromycin -respiratory support |
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how can an infection w/corynebacterium diptheriae be prevented
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-DPT toxoid vaccine series followed by boosters
-any contact to known case should receive a booster |
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what is the main symptom caused by bordetella pertussis
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-whooping cough
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what are some of the characteristics of bordetella pertussis
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- G -
-coccabacillus -reservoir human only -sensitive to drying -aerosol transmission /direct contact -endemic even though there is a vaccine for it -immunity in adults is waning |
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what are the virulence factors associated with bordetella pertussis
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-filamentuous hemaglutinin
-peractin -pertussis toxin |
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what do FHA and pertacin have that allows bordetella pertussis to bind
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they a RGd sequence that binds to integrins
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what are some of the toxins associated with bordetella pertussis
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AB type = pertussis toxin type x S1 or A subunit is ADP ribosyl transferase
-lethal or dermonecrotic toxin= heat labile -tracheal cytotoxin = PG subunit, interferes w/DNA synthesis, kills ciliated respiratory cells, increase IL-1, + fever |
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what are pertussis AB toxin properties
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1 A subunit
5 B subunti S2 attaches to the host by binding to lactisylceramide SI (enz )contains disulfide bonds, and are reduced to release active enzymes -reductions occurs inside the host cell membrane |
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what is the overall effect of pertussis toxin
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it increases the cAMP levels b/c the ribosyl transferase transfers to the G regulatory subunit and that causs it to be inhibited and the adenylate cyclase cannot be inhibited and you have continuous production of cAMP
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what are the clinical symptoms associated with bordetella pertussis
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-whooping cough
-7-10 days incubation -3 stages 1) cattrahl (1-2 wks)= common cold, profuse rhinorrhea, sneezing and low grade fever 2)paroxysmal (2-4 wks)= destruction of ciliated epithelium, impairment of mucous clearing, characteristic inspirational whoop w/cough -vomitting -leukocytosis 3)convalescent = 2ndry complications, seizures, pneumonia, encephalopathy |
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what is lab diagnosis for bordetella pertussis
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-FA on aspirated apecimens
-CCBA culture-charcoal-cephalexin blood agar -molecular= PCR, bordet-gengou, regan-lowe -serolog= sp. antiserum agglutination titers against pertussis toxin and hemagglutinin using acute and convalescent toxin |
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what is the treatment for bordetella pertussis
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supportive, in less than 1% of the cases hydration and oxygenation, steroids for babies, elderly
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how can bordetella pertussis infections be prevented
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-DPT vaccine whole cell inactivation 80-85% effective
-DaPT vaccine= multivalent acellular -erythromycin =prophylaxis |
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where is whooping cough endemic
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it is endemic in school children of UK despite being immunized
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