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28 Cards in this Set
- Front
- Back
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s/s of sinusitis (9)
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thick, colored post nasal discharge
congested nasal passages headache fever facial pain, pressure cough no taste, smell halitosis ear clogging |
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how do most cases of sinusitis and otitis media occur?
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most result from a viral cold/ URT infection; congestion (effusion)(PMN infiltrate)leads to stasis (blocked flow of mucus) and accumulation of bacteria
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most cases of sinusitis and otitis media are caused by what organism?
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strep pneumonia
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s/s otitis media
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fever
irritability otalgia (ear ache) anorexia vomiting bulging tympanic mbr (bacterial) middle ear effusion (fluid) |
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what is a bulging tympanic membrane indicative of?
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bacterial otitis media infection
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epidemiology of otitis media
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most common bacterial infection in children
most frequent reason for prescribing antibiotics |
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how do pts with otitis media usually present?
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initially- persistent ear ache
hearing loss fever (up 40.5, 105) nausea vomiting diarrhea erythematous, bulging tym mbr accompanying or preceding URI |
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how do otitis media infections usually resolve?
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spontaneous with drainage
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what are the 3 main organisms that cause sinusitis and otitis media?
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strep penumonia
haemophilus influenza moraxella catarrhalis |
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syndromes caused by haemophilus influenza
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sinusitis
otitis media epiglotittis bronchitis pneumonia meningitis |
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charac H. influenza
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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) |
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what does h. influenza require to grow on agar?
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chocolate agar (nutrients rel from heated RBCs)
Hemin (factor x) NAD+ (factor v) could also grow in plaques after beta hemolysis |
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what does it mean for a strain to be nontypeable or serotypable?
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serotypable strains have capsules with polysaccharide Ag, a-d)
nontypable-no capsule |
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what is the most virulent strain of h. influenza?
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Hib
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virulence factors for h. influenza
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PRP capsule on Hib
IgA protease pili |
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clinical diseases caused by h. influenza
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(meningitis before Hib vaccine)
otitis media LRT infection in CF or other underlying diseases 20% prod beta lactamase epiglottitis |
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what is apiglottitis? who is it seen in?
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obstruction of airway
primarily in children (2-4) or adults (20-40) emergency |
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what is the most common cause of epiglottitis?
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Hib
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s/s epiglottitis?
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sore throat (misdiagnosed as strep)
fever drooling dysphagia-difficulty swallowing muffled voice respiratory distress (stridor- high pitched sound from turbulence in airway) |
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diagnosis and tx of epiglottitis?
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lateral x ray of neck
laryngoscopy cricothyrotomy (obstructed airway) IV antibiotics blood culture |
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lab diagnosis of h. influenza
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chocalte agar culture
rapid PRP capsular Ag (Hib) |
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tx of Hib
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augmentin (amoxicillin and clavulonic acid)
trimethoprim/sulfamethoxazole (TMP/SMX) cephalosporins if severe |
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prevention and control of Hib
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vaccine- directed against capsule; must be conjugated (toxoid) b/c treating infants
rifampin-eliminate carriers |
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charac of moraxella catarrhalis
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G- cocci
often seen intracellularly (PMNs) in mucous mbrs 95% are B-lactamase positive normal pharyngeal flora in kids, adults catalase pos DNase |
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what syndromes does moraxella catarrhalis cause?
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otitis media, sinusitis
bronchitis and pneumonia (less common; pts with chronic lung disease) meningitis, bacteremia, endocarditis (rare, immunocompromised) |
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how do you diagnose a moraxella catarrhalis infection?
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gram stain
culture |
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treatment of moraxella catarrhalis infectoin?
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augmentin (amoxicillin and clavulonate)
oral cephalosporins TMP/SMX |
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how does the presence or absence of a bulging tympanic membrance determine treatment?
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bulging- bacterial; high dose amoxicillin immediately
not bulging- may be viral; wait 48-72 hours and check again; tx for pain in the meantime |
