Tags: Otitis media

Chlamydia

General Considerations Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pneumoniae are among the most prevalent microbial pathogens in humans worldwide. C trachomatis is responsible for a variety of sexually transmitted disease (STD) syndromes in both sexes. In addition, certain serotypes of C trachomatis are responsible for trachoma, the most common infectious cause of blindness in humans. C psittaci is a zoonotic pathogen associated with atypical pneumonia. C pneumoniae infects approximately one-half of the world’s human population and is a cause of upper and lower respiratory tract disease. It has also been associated with atherosclerotic cardiovascular disease. A. Epidemiology. In the United States, genital infections by C trachomatis serovars D through K occur …

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Mycoplasma Pneumoniae Infection & Disease

Mycoplasma Pneumoniae is an important cause of upper and lower respiratory infections in both adults and children. Extrapulmonary involvement, including dermatological, neurological, cardiac, musculoskeletal, and vasculitic involvement, has also been associated with M pneumoniae infection in humans. Essentials of Diagnosis Community acquired pneumonia. Extrapulmonary involvement is not infrequent. Inflammatory cells on sputum Gram stain but no predominant bacterial type. Coombs-positive hemolytic anemia. Cold agglutinin titer of = 1:32. Fourfold change in specific immunoglobulin G (IgG) or IgM titers. General Considerations A. Epidemiology. Infected humans are the only source of M pneumoniae organisms for transmission to new susceptible hosts. M pneumoniae is spread from one individual to another by respiratory droplets produced …

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Important Anaerobes

Essentials of Diagnosis • Foul odor of draining purulence. • Presence of gas in tissues. • No organism growth on aerobic culture media. • Infection localized in the proximity of mucosal surface. • Presence of septic thrombophlebitis. • Tissue necrosis and abscess formation. • Association with malignancies (especially intestinal). • Mixed organism morphologies on Gram stain. General Considerations A. Epidemiology and Ecology. Anaerobic bacteria are the predominant component of the normal microbial flora of the human body. The following sites harbor the vast majority of them: • Skin: Mostly gram-positive bacilli such as Propionibacterium acnes • Gastrointestinal tract: In the oral cavity Prevotella spp., Porphyromonas spp., Peptostreptococcus spp., microaerophillic streptococci, and …

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Important Anaerobes: Clinical Syndromes

Box 1 summarizes different clinical syndromes associated with anaerobic bacteria. The sections that follow describe the various syndromes, including clinical findings. For some syndromes, specific diagnosis and treatment information is included as well. For other syndromes, see summary diagnosis and treatment sections at the end of the chapter. HEAD & NECK 1. EAR & PARANASAL SINUSES The flora in as many as two-thirds of chronic sinusitis and otitis cases includes B fragilis, Prevotella spp., Peptostreptococcus spp., and Porphyromonas spp. It is not surprising that ~50% of patients with chronic otitis media are infected with anaerobic bacteria, B fragilis being the most common. Mastoiditis may arise as a complication in some of …

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Extraintestinal Disease

Clinical Findings A. Signs and Symptoms. Patients with septicemia, wound infections, or ear infections caused by a Vibrio species frequently have a history of shellfish ingestion or saltwater exposure. Clinical manifestations vary depending on the site of infection. Healing wounds, in appropriately exposed individuals, may become secondarily infected by marine vibrios. Suppuration may occur, and subcutaneous abscesses may form. A spreading, violaceous appearance around the wound, which is warm to the touch is indicative of cellulitis. The clinical findings of V alginolyticus-associated otitis media are nonspecific. Findings in V alginolyticus-associated otitis externa include a reddened, often painful external auditory canal. In immunocompromised and debilitated patients, especially those with liver cirrhosis, a …

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Haemophilus, Bordetella, & Branhamella Species

HAEMOPHILUS INFLUENZAE & OTHER HAEMOPHILUS SPECIES Essentials of Diagnosis • Haemophilus influenzae is generally acquired via the aerosol route or by direct contact with respiratory secretions. • The most common associated syndromes include otitis media, sinusitis, conjunctivitis, bronchitis, pneumonia, and, to a lesser extent, meningitis, epiglottitis, arthritis, and cellulitis. • Gram stain shows pleomorphic gram-negative coccobacilli. • In cases of meningitis, epiglottitis, arthritis, and cellulitis, organisms are typically recovered from blood, and type-b polysaccharide capsular material may be detected in the urine. • Organisms and type-b polysaccharide capsule may also be present in other appropriate sterile body fluids, such as cerebrospinal fluid (CSF) in meningitis and joint fluid in arthritis. General …

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Branhamella Catarrhalis: Clinical Syndromes

B catarrhalis causes bronchitis and pneumonia in patients with underlying lung disease, especially chronic obstructive pulmonary disease. It is also a rare cause of invasive disease, including meningitis, endocarditis, bacteremia without a focus, septic arthritis, and cellulitis. In addition, it is a recognized cause of acute conjunctivitis and is periodically mistaken as Neisseria gonorrhoeae in newborn infants with conjunctivitis. B catarrhalis occasionally colonizes the genital mucosa and has been reported as a cause of urethritis. Clinical Findings A. Signs and Symptoms. The signs and symptoms of B catarrhalis acute otitis media and sinusitis are indistinguishable from those present when acute otitis media and sinusitis are caused by other pathogens (Box 8). …

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Bordetella Species: Clinical Syndrome

Classical pertussis occurs in three clinical stages: catarrhal, paroxysmal, and convalescent (Box 5). Clinical Findings A. Signs and Symptoms. The catarrhal stage is characterized by nonspecific upper respiratory symptoms, including rhinorrhea, mild cough, and low-grade fever. During this stage, which typically lasts 1-2 weeks, the disease is highly communicable. The paroxysmal stage is marked by sudden attacks or paroxysms of severe, repetitive coughing, often culminating with the characteristic whoop and frequently followed by vomiting. A marked lymphocytosis usually accompanies this stage of the disease, with lymphocyte counts sometimes exceeding 50,000/mm3 and usually representing 70% or more of total circulating leukocytes. The paroxysmal stage typically lasts 1-4 weeks and can be associated …

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Haemophilus Influenzae: Clinical Syndromes

H influenzae was first isolated during the 1892 influenza pandemic and was originally believed to be the causative agent of influenza. Although subsequent studies revealed the fallacy of this idea, H influenzae has proved to be a common cause of localized respiratory tract and systemic disease, including meningitis, epiglottitis, pneumonia, pyogenic arthritis, cellulitis, otitis media, and sinusitis, among others (Box 1). 1. MENINGITIS Meningitis is the most common and serious form of invasive H influenzae type-b disease. In the mid-1980s, before the introduction of effective vaccines, ~ 10,000-12,000 cases of H influenzae type-b meningitis occurred in the United States each year, and 95% of cases involved children < 5 years old. …

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Pseudomonas Aeruginosa

Essentials of Diagnosis • Nosocomial acquisition. • Predisposing factors include immunosuppression (neutropenia, cystic fibrosis [CF], AIDS, corticosteroid use, diabetes mellitus); presence of a foreign body, prosthesis, or instrumentation; prolonged hospitalization and antibiotic use; intravenous drug use. • Most common infections include pneumonia, bacteremia, urinary tract infection, otitis media, skin and skin structure infections, including ecthyma gangrenosa. • Gram stain shows gram-negative bacilli; recovery of microorganism from culture of blood or other tissue. General Considerations A. Epidemiology. The genus Pseudomonas consists of a number of human pathogens, the most important of which is Pseudomonas aeruginosa. P aeruginosa is an opportunistic pathogen found widely in soil, water, and organic material, reflecting its limited …

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