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28 Cards in this Set

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s/s of sinusitis (9)
thick, colored post nasal discharge
congested nasal passages
headache
fever
facial pain, pressure
cough
no taste, smell
halitosis
ear clogging
how do most cases of sinusitis and otitis media occur?
most result from a viral cold/ URT infection; congestion (effusion)(PMN infiltrate)leads to stasis (blocked flow of mucus) and accumulation of bacteria
most cases of sinusitis and otitis media are caused by what organism?
strep pneumonia
s/s otitis media
fever
irritability
otalgia (ear ache)
anorexia
vomiting
bulging tympanic mbr (bacterial)
middle ear effusion (fluid)
what is a bulging tympanic membrane indicative of?
bacterial otitis media infection
epidemiology of otitis media
most common bacterial infection in children
most frequent reason for prescribing antibiotics
how do pts with otitis media usually present?
initially- persistent ear ache
hearing loss
fever (up 40.5, 105)
nausea
vomiting
diarrhea
erythematous, bulging tym mbr
accompanying or preceding URI
how do otitis media infections usually resolve?
spontaneous with drainage
what are the 3 main organisms that cause sinusitis and otitis media?
strep penumonia
haemophilus influenza
moraxella catarrhalis
syndromes caused by haemophilus influenza
sinusitis
otitis media
epiglotittis
bronchitis
pneumonia
meningitis
charac H. influenza
G- bacilli (coccobacilli, short, stumpy)
facultative anaerobe
fastidious (req supplements in growth media)
normally found in human resp tract (can be asx carriers of pathogenic strain)
what does h. influenza require to grow on agar?
chocolate agar (nutrients rel from heated RBCs)
Hemin (factor x)
NAD+ (factor v)
could also grow in plaques after beta hemolysis
what does it mean for a strain to be nontypeable or serotypable?
serotypable strains have capsules with polysaccharide Ag, a-d)
nontypable-no capsule
what is the most virulent strain of h. influenza?
Hib
virulence factors for h. influenza
PRP capsule on Hib
IgA protease
pili
clinical diseases caused by h. influenza
(meningitis before Hib vaccine)
otitis media
LRT infection in CF or other underlying diseases
20% prod beta lactamase
epiglottitis
what is apiglottitis? who is it seen in?
obstruction of airway
primarily in children (2-4) or adults (20-40)
emergency
what is the most common cause of epiglottitis?
Hib
s/s epiglottitis?
sore throat (misdiagnosed as strep)
fever
drooling
dysphagia-difficulty swallowing
muffled voice
respiratory distress (stridor- high pitched sound from turbulence in airway)
diagnosis and tx of epiglottitis?
lateral x ray of neck
laryngoscopy
cricothyrotomy (obstructed airway)
IV antibiotics
blood culture
lab diagnosis of h. influenza
chocalte agar culture
rapid PRP capsular Ag (Hib)
tx of Hib
augmentin (amoxicillin and clavulonic acid)
trimethoprim/sulfamethoxazole (TMP/SMX)
cephalosporins if severe
prevention and control of Hib
vaccine- directed against capsule; must be conjugated (toxoid) b/c treating infants

rifampin-eliminate carriers
charac of moraxella catarrhalis
G- cocci
often seen intracellularly (PMNs) in mucous mbrs
95% are B-lactamase positive
normal pharyngeal flora in kids, adults
catalase pos
DNase
what syndromes does moraxella catarrhalis cause?
otitis media, sinusitis
bronchitis and pneumonia (less common; pts with chronic lung disease)
meningitis, bacteremia, endocarditis (rare, immunocompromised)
how do you diagnose a moraxella catarrhalis infection?
gram stain
culture
treatment of moraxella catarrhalis infectoin?
augmentin (amoxicillin and clavulonate)
oral cephalosporins
TMP/SMX
how does the presence or absence of a bulging tympanic membrance determine treatment?
bulging- bacterial; high dose amoxicillin immediately

not bulging- may be viral; wait 48-72 hours and check again; tx for pain in the meantime