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Μικροβιακές οφθαλμικές λοιμώξεις
Επιπεφυκίτιδα Haemophilus influenzae Διάφορα άλλα μικρόβια Λόγω χρήσης μη αποστειρωμένων φακών επαφής Γονοκοκκική οφθαλμία στα νεογέννητα Neisseria gonorrhoeae Μεταδίδεται κατά τη δίοδο του νεογεννήτου απ΄πο το γεννητικό σωλήνα
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Μικροβιακές οφθαλμικές λοιμώξεις
Chlamydia trachomatis Επιπεφυκίτιδα Μεταδίδεται κατά τη γέννηση Μετάδοση από νερά κολυμβητικών δεξαμενών Αντιβιοτικό εκλογής: Τετρακυκλίνες Τράχωμα (λοίμωξη κερατοειδούς) Υψηλότερη αιτία τύφλωσης παγκοσμίως Μόνιμες βλάβες στον κερατοειδή
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Μικροβιακές οφθαλμικές λοιμώξεις
Figure 21.20
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Μικροβιακές οφθαλμικές λοιμώξεις
Ερπητική κερατίτιδα Herpes simplex virus 1 (HHV-1) Προσβολή κερατοειδούς, μπορεί να οδηγήσει σε τύφλωση Θεραπεία με τριφλουριδίνη Acanthamoeba κερατίτιδα Μεταδίδεται από το νερό Φακοί επαφής
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Μικροβιακές οφθαλμικές λοιμώξεις
Figure 21.21
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Λοιμώξεις ανώτερου αναπνευστικού
Λαρυγγίτιδα-Φαρυγγίτιδα: S. pneumoniae, S. pyogenes, ιοί Αμυγδαλίτιδα: S. pneumoniae, S. pyogenes, ιοί Ιγμορίτιδες: Βακτήρια Επιγλωττίτιδα: H. influenzae
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Λοιμώξεις ανώτερου αναπνευστικού
Από δυνητικά παθογόνα Figure 24.1
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Streptococcal pharyngitis (Strep throat)
Streptococcus pyogenes Resistant to phagocytosis Streptokinases lyse clots Streptolysins are cytotoxic Diagnosis by indirect agglutination Figure 24.3
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Group A Beta Hemolytic Streptococcus
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BETA HEMOLYSIS
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Επιπλοκές φαργγίτιδας από Στρεπτόκοκκο Ομάδας Α
Μέση ωτίτιδα Ιγμορίτιδες Περιαμυγδαλιδικό ή φαρυγγικό απόστημα Τραχηλική αδενίτιδαs
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Streptococcal Cervical Adenitis
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Scarlet Fever (Οστρακιά)
Streptococcus pyogenes Pharyngitis Erythrogenic toxin produced by lysogenized S. pyogenes Figure 24.4
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DISEASES Impetigo Erysipelas
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DISEASES cont. Erysipelas Tonsillitis
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DISEASES cont. Scarlet Fever Toxic Shock
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Diphtheria Corynebacterium diphtheriae: Gram-positive rod
Diphtheria membrane of fibrin, dead tissue, and bacteria Diphtheria toxin produced by lysogenized C. diphtheriae Prevented by DTaP and Td vaccine (Diphtheria toxoid) Cutaneous diphtheria: Infected skin wound leads to slow healing ulcer
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I. Organism -G+, club shaped, pleomorphic, aerobic rod
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I. Organism -G+, club shaped, pleomorphic, aerobic rod
-metachromatic polyphosphate granules
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I. Organism -G+, club shaped, pleomorphic, aerobic rod
-metachromatic polyphosphate granules -reduce potassium tellurite to tellurium metal - black ppt. on tellurite blood agar
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I. Organism -G+, club shaped, pleomorphic, aerobic rod
-metachromatic polyphosphate granules -reduce potassium tellurite to tellurium metal - black ppt. on tellurite blood agar -subtypes gravis, intermedius, mitis: severity of infection differs depending on growth rate of subtype
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II. Clinical -usually presents as throat infection w/ sore throat, fever, sometimes swollen lymph glands -”pseudomembrane” forms at back of throat - may obstruct airway (“la garottilla”)
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Pseudomembrane in Diptheria
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Anatomy of the Ear
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Anatomy of the Ear 3 Semicircular canals 4 Cochlea
1 Tympanic Membrane 2 Maleus Incus Stapes 3 Semicircular canals 4 Cochlea 5 Cochlear Nerve 6 Oval Window 7 Eustachian Tube 8 Orifice 9 Round Window10 Middle Ear Cavity
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Otitis externa Otitis media Ear infections
tympanic membrane Otitis externa Otitis media Exogenous organisms via external auditory canal Endogenous organisms via eustachian tube
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Otitis Media Epidemiology and Pathophysiology:
age - almost all children have one or more episodes before age 6 about 10% of children develop OM by age 3 months peak incidence between ages 6 and 15 months
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Otitis Media Etiology: abnormal function of the eustachian tube
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Otitis Media Microbiology (AOM) Streptococcus pneumoniae 35%
Haemophilus Influenzae % Moraxella catarrhalis % Alpha-hemolytic streptlococci % GAB-hemolytic streptococci % Staphylococcus aureus % Psuedomonas aeruginosa % Treated with broad-spectrum antibiotics Incidence of S. pneumoniae reduced by vaccine
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Otits Media Microbiology (COM) Haemophilus influenzae 15%
Moraxella catarrhalis % Streptococcus pneumoniae % Alpha-hemolytic streptococci 3% Staphylococcus aureus % Pseudomonas artuginosa 2% GAB hemolytic streptococci %
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Otitis Media Inflamation of the middle ear
Acute Otitis Media (AOM) - rapid onset of redness and bulging of the tympanic membrane, decreased mobility, pain, perforation with otorrhea
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Otitis Media Figure 25.7
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AOE: Mild to Moderate Stage
Progressive infection Symptoms Pain Increased pruritus Signs Erythema Increasing edema Canal debris, discharge
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AOE: Severe Stage Severe pain, worse with ear movement Signs
Lumen obliteration Purulent otorrhea Involvement of periauricular soft tissue
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Otitis Externa
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COE: Signs Asteatosis Dry, flaky skin Hypertrophied skin
Mucopurulent otorrhea (occasional)
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Otomycosis: Signs Canal erythema Mild edema
White, gray or black fungal debris
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Otomycosis
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Herpes Zoster Oticus: Symptoms
Early: burning pain in one ear, headache, malaise and fever Late (3 to 7 days): vesicles, facial paralysis
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Erysipelas Acute superficial cellulitis
Group A, beta hemolytic streptococci Skin: bright red; well-demarcated, advancing margin Rapid treatment with oral or IV antibiotics if insufficient response
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Otitis externa Organisms - Pseudomonas aeruginosa
- Staphylococcus aureus - Aspergillus spp. Treatment - oral antibiotics – NO! - topical broad spectrum (thick drops or wicks) - cotricosteroids Prevention - avoid predisposing events. ( post swim drops, blue tack, ear “ NO GO” zone)
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Sinusitis 32 million cases annually in U.S.
% of colds are complicated by sinusitis Most acute sinusitis occurs from viral and bacterial co-infection
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Sinusitis
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Sinusitis
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Sinusitis Minor Symptoms Major symptoms Headache Facial Pain*
Nasal Obstruction Nasal Discharge Postnasal Drainage Hyposmia Fever Minor Symptoms Headache Halitosis Fatigue Oral Pain Cough Ear pain, pressure, fullness *Location = diagnosis
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Sinusitis Microbiology
S. pneumoniae and H. influenzae cause 70% of sinusitis Anaerobes, S. aureus and M.catarrhalis cause most of remaining 30%
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Common cold Rhinoviruses (50%) Coronaviruses (15-20%)
Rhinoviruses attached to ICAN-1 on nasal mucosa
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Microbial Diseases of the Lower Respiratory System
Bacteria, viruses, & fungi cause: Bronchitis Bronchiolitis Pneumonia
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Lower Respiratory System
The ciliary escalator keeps the lower respiratory system sterile. Figure 24.2
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Pertussis (Whooping Cough)
Bordetella pertussis: Gram-negative coccobacillus Capsule Tracheal cytotoxin of cell wall damaged ciliated cells Pertussis toxin Prevented by DTaP vaccine (acellular Pertussis cell fragments) Figure 24.8
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Pertussis (Whooping Cough)
Stage 1: Catarrhal stage, like common cold Stage 2: Paroxysmal stage: Violent coughing sieges Stage 3: Convalescence stage
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Tuberculosis Mycobacterium tuberculosis: Acid-fast rod. Transmitted from human to human M. bovis: <1% U.S. cases, not transmitted from human to human M. avium-intracellulare complex infects people with late stage HIV infection Figure 24.9
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Tuberculosis Figure
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Tuberculosis Figure
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Tuberculosis Figure
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Tuberculosis Treatment of Tuberculosis: Prolonged treatment with multiple antibiotics Vaccines: BCG, live, avirulent M. bovis. Not widely used in U.S.
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Tuberculosis Diagnosis: Tuberculin skin test screening
+ = current or previous infection Followed by X-ray or CT, acid-fast staining of sputum, culturing bacteria Figure 24.11
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Pneumomoccal Pneumonia
Streptococcus pneumoniae: Gram-positive encapsulated diplococci Diagnosis by culturing bacteria Penicillin is drug of choice Figure 24.13
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Pneumomoccal Pneumonia
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Haemophilus influenzae Pneumonia
Gram-negative coccobacillus Alcoholism, poor nutrition, cancer, or diabetes are predisposing factors Second-generation cephalosporins
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Mycoplasmal Pneumonia
Mycoplasma pneumoniae: pleomorphic, wall-less bacteria Also called primary atypical pneumonia and walking pneumonia Common in children and young adults Diagnosis by PCR or by IgM antibodies Figure 24.14
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Mycoplasmal Pneumonia
Figure 11.19a, b
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Legionellosis Legionella pneumophila: Gram-negative rod
L. pneumophila is found in water Transmitted by inhaling aerosols, not transmitted from human to human Diagnosis: culturing bacteria Treatment: Erythromycin
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Psittacosis (Ornithosis)
Chlamydia psittaci: gram-negative intracellular bacterium Transmitted by elementary bodies from bird dropping to humans Reorganizes into reticulate body after being phagocytized Diagnosis: culturing bacteria in eggs or cell culture Treatment: Tetracycline
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Chlamydial Pneumonia Chlamydia pneumoniae
Transmitted from human to human Diagnosis by FA test Treatment: Tetracycline
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Mycoplasmal pneumonia
Mycoplasma pneumoniae: pleomorphic, wall-less bacteria Also called primary atypical pneumonia and walking pneumonia Common in children and young adults Diagnosis by PCR or by IgM antibodies
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Q fever Figure 24.15
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Viral Pneumonia Viral pneumonia as a complication of influenza, measles, chickenpox Viral etiology suspected if no cause determined Respiratory Syncytial Virus (RSV) Common in infants; 4500 deaths annually Causes cell fusion (syncytium) in cell culture Symptoms: coughing Diagnosis by serologic test for viruses and antibodies Treatment: Ribavirin
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Influenza Chills, fever, headache, muscle aches (no intestinal symptoms) 1% mortality due to secondary bacterial infections Treatment: Amantadine Vaccine for high-risk individuals
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Influenza Hemagglutinin (H) spikes used for attachment to host cells
Neuraminidase (N) spikes used to release virus from cell
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Influenza Figure 24.16
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Influenza Antigenic shift Changes in H and N spikes
Probably due to genetic recombination between different strains infecting the same cell Antigenic drift Mutations in genes encoding H or N spikes May involve only 1 amino acid Allows virus to avoid mucosal IgA antibodies
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Influenza serotypes A: causes most epidemics, H3N2, H1N1, H2N2
B: moderate, local outbreaks C: mild disease
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Histoplasmosis Histoplasma capsulatum, dimorphic fungus (a) 37˚
Figure 24.17
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Pneumocystis Pneumonia
Pneumocystis jiroveci (P. carinii) found in healthy human lungs Pneumonia occurs in newly infected infants & immunosuppressed individuals Treatment: Timethoprim-sulfamethoxazole Figure 24.22
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Blastomycosis Blastomyces dermatitidis, dimorphic fungus Found in soil
Can cause extensive tissue destruction Treatment: amphotericin B
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Opportunistic fungi involved in respiratory disease:
Aspergillus Rhizopus Mucor Mucor rouxii Figure 12.2b, 12.4
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