BACTERIAL CONJUNCTIVITIS

Question 1

what are the general bacterial conjunctivitis symptoms?

Answer 1

1. unilateral –> bilateral
2. redness
3. pain
4. photophobia
5. Mucopurulent discharge

Question 2

what are the general bacterial conjunctivitis signs?

Answer 2

1. unilateral first, possibility to be bilateral.
2. papillae
3. purulent/mucopurulent discharge
4. bulbar and palpebral conjunctiva injection
5. chemosis

Question 3

tx for acute bacterial conjunctivitis?

Answer 3

• Topical Abx –> trimethoprim/polymyxin B or fluoroquinolone qid x 5-7 days.
• F/U –> every 2-3 days initially –> then every 5-7 days when stable until resolved.

Question 4

what is acute bacterial conjunctivitis? what species(s) is involved?

Answer 4

Bacterial infection most commonly due to:
In neonates:
* Chlamydia Trachomatis
* Neisseria gonorrhoeae
In children:
 H. influenza
 Strep pneumonia
In adults:
 Staph aureus
 S. epidermis

Question 5

acute bacterial conjunctivitis is the most common cause of conjunctivitis in ____?

Answer 5

children <3 yrs old

Question 6

symptoms of acute bacterial conjunctivitis?

Answer 6

1. general bacterial conjunctivitis symptoms
2. acute onset (24hrs)

Question 7

signs of acute bacterial conjunctivitis?

Answer 7

• general bacterial conjunctivis signs
• acute onset (24hrs)
• no cornea involvment + preauricular lymphadenopathy

Question 8

what is (hyper-acute) gonococcal conjunctivitis? what species is involved?

Answer 8

Rare bacterial infection that is due to:
* Neisseria gonorrhoeae
* Neisseria meningitidis

Question 9

who gets gonococcal conjunctivitis?

Answer 9

• Sexually transmitted ocular disease (STD) that is most common in young adults’ w/ history of multiple sexual partners.
• May also be transmitted to infants thru vaginal birth canal in infected mothers.

Question 10

why is gonococcal conjunctivitis improtant to catch early and treat agressively?

Answer 10

• organism involved is neisseria gonorrhoeae - which can invade an intact cornea!

Question 11

symptoms of gonococcal conjunctivitis?

Answer 11

• general bacterial conjunctivitis symptoms
• hyper-acute onset (12-24hrs)

Question 12

signs of gonococcal conjunctivitis?

Answer 12

• general bacterial conjunctivits signs
• hyperacute onset
• pseudomembrane
• postive preauricular lymphadenopathy – usually only in viral infx.
• corneal ulceration –> can progress to perforation.

Question 13

w/u for gonococcal conjunctivitis?

Answer 13

• Thayer-Martin agar (chocolate agar) – used to culture both Neisseria gonorrhoeae & Haemophilus influenzae.

Question 14

what is the pneumonic to remember types of organisms culture in a thayer-martin chocolate agar?

Answer 14

Hershey’s & Nestle Chocolate:
* Haemophilus influenzae
* Neisseria gonorrhoeae

Question 15

tx for gonococcal conjunctivitis?

Answer 15

• If no cornea involvement – tx with ceftriaxone 1g IM plus azithromycin 1g po in single dose.
• If Cornea involvement – tx with ceftriaxone 1g IV + hospitalized
• If pt is allergic to penicillin or cephalosporin – use fluoroquinolones.

Question 16

what is neonatal conjunctivitis (ohpthalmia neonatorum)?

Answer 16

• It is any conjunctival inflammation within the first month of life that can be from any source, non-infectious or infectious.

Question 17

how do you get neonatal conjunctivitis?

Answer 17

• Usually due to transmitted infection from mother during delivery.

Question 18

how to determine bacterial etiology for neonatal conjunctivitis?

Answer 18

“Rule of 5s” to predict the most likely bacterial etiology.
* Neisseria gonorrhoeae - 0-5 days
* Chlamydial Trachomatis - 5 days to 5 weeks
* Strep or H. influenzae - 5 weeks to 5 years

Question 19

the most common infection source in neonatal conjunctivitis?

Answer 19

chlamydia

Question 20

what is used as a prophylactic tx for neonatal conjunctivitis?

Answer 20

erthromycin oinment

Question 21

tx for neonatal conjunctivitis?

Answer 21

• Suspected chemical toxicity –> d/c offending agent + ATs qid + reassess in 24 hrs.
• Suspected chlamydial infx –> azithromycin 20mg/kg po for 3 days
• Suspected gonorrhoeae –> ceftriaxone 25-50 mg/kg IM or IV as a single dose. Also tx for possible chlamydia coinfection –> azithromycin po for 3 days
• F/U –> daily

Question 22

what are the 2 types of conjunctivitis caused by chlamydia? what serotype causes each?

Answer 22

1. adult inclusion conjunctivis - caused by serotypes D-K
2. trachoma - caused by serotypes A-C

Question 23

who gets adult inclusion conjunctivitis? how does someone get adult inclusion conjunctivitis?

Answer 23

• occurs in sexually active adults.
• Most common via direct inoculation (hand-eye, genital-eye, etc.).
• Rare - via contaminated swimming pool water, or shared cosmetic.

Question 24

signs for both chlamydial conjunctivitis?

Answer 24

• Unilateral - then bilateral
• Mucopurulent discharge (can be stringy)
• HUGE Follicles (limbal & palpebral) – inferiorly = for adult inclusion & supeior = trachoma.
• LIL Papillae – mainly in the inferior palpebral conj & fornices.
• Can involve cornea - SEI

Question 25

only bacterial infection that causes follicles on palpebral and bulbar conj?

Answer 25

chlamydial bacterial infx

Question 26

what are specific signs of late-stage trachoma?

Answer 26

* **Arlts lines** - linear white scarring of the *superior* tarsal conjunctiva. * **Herbert’s Pits** - depression on the *superior* limbal conjunctiva after resolution of limbal follicles. * Trichiasis, entropion * Corneal neovas * Severe corneal opacification

Question 27

tx for both chlamydial conjunctivitis?

Answer 27

* single dose of oral azithromycin (1g) --> then daily use of oral doxycycline, tetracycline, or erythromycin for 1-2 wks. * F/u shoud be every 2-3 wks until resolution. * refer to specialist to r/o other STDs. * tx all pt's sexual partners.