INFECTIOUS DISEASE REVIEW Upper Respiratory Tract Infections

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2. You have completed the assessment in question 1. She does have eyelid matting, had a cold last week and has chronic allergies which she has self-treated with CTM. You assess that she needs medications to prevent eye and lid infections recurrence. Which of the following would you recommend? a. artificial tears without polymer b. a with polymer – two drops four times daily. c. cleansing eye lids with baby shampoo and clean cloth at least daily d. b and c and referral to her eye care professional 3. The patient takes your recommendations and returns the next week wearing dark glasses. She says that she cannot look at lights without squinting and eye pain. Which finding in question 1 does this suggest? 4. What is your next step with this patient? a. offer an antibacterial for her eye b. offer oral and topical decongestants c. offer to call her eye care professional d. a and b key: 1-D, 2-D, 3-B, 4-C Viral Eye Infections (see viral conjunctivitis in figure 2 ) Topical antivirals (Herplex, Vira-A, Viroptic) are for short-term Herpes simplex conjunctivitis only. Many viral organisms may cause viral conjunctivitis. This type of conjunctivitis may be associated with other viral infections such as viral pharyngitis. Some viruses cause infection of the cornea (keratitis) and the conjunctiva simultaneously. The viral forms of conjunctivitis are usually bilateral with red eyes, but with a clear drainage and less exudation than the bacterial forms of conjunctivitis. Herpes simplex is the most common virus for which there is a specific treatment for viral conjunctivitis (idoxuridine[ IDU, Herplex] for IDU-resistant herpes vidaribine (Vira-A) and for Vira-A resistant herpes, trifluridine (Viroptic). Herpes zoster opthalmicus is treated with famciclovir (Famvir) 500mg TID or valacyclovir (Valtrex) 1gTID for 10 days or IV acyclovir to prevent loss of sight in the affected eye. Treatment: Cool compresses and vasoconstrictor drops (i.e., naphazoline) may provide some symptomatic relief. Symptoms generally resolve within 7-10 days in healthy individuals with or without specific antivirals. Meticulous hygiene is necessary to avoid transmission of viral conjunctivitis. Hand washing by the patient and health care providers who come in contact with the patient is essential in avoiding transmission of this VERY contagious condition. Ophthalmologic consult is needed for topical antiviral (eg Stoxil) use longer than 21 days. ALLERGIC Conjunctivitis and Eye Infections (see figure 1) Topical cromolyn (Crolom), lodoxamine (Alomide), nedocromil (Alocril) and pemirolast (Alamast) are mast cell stabilizers for chronic allergic conjunctivitis, not for acute attacks. They may worsen an acute attack. Other alternatives are mast cell stabilizer/antihistamines , azelastine (Astelin/Optivar), epinastine (Elestat), ketotifen (Zaditor) and olapatadine (Patanol), the H-1 antihistamines emedastine (Emadine), livocabastine (Livostin) , and the NSAID ketorolac (Acular) and other NSAIDs (although not approved for this usage-be sure to check for ASA allergy). Topical steroids are not recommended for allergic conjunctivitis due to risk of glaucoma and cataracts with long-term use. Patients with refractory chronic allergic eye problems may require oral antihistamines to suppress the allergic eye process. (Medical Letter 26 Apr 2004; 46:35-6). Never use Chlormycetin (chloramphenicol) eye or topical (Elase/Chlormycetin) preparation for prolonged 16
periods (> 2 weeks) as aplastic anemia has been reported via these routes. Topical Aminoglycosides (gentamicin, neomycin or tobramycin) may add to systemic aminoglycoside levels if peak and/or trough blood levels are being done. Cross-allergenicity between topical and injectable aminoglycosides (e.g. neomycin, streptomycin, gentamicin, tobramycin, amikacin and netilmicin. CASE-3 H.P. a 52 year-old female with recurrent bacterial conjunctivitis developed swollen, reddened eyes after neomycin/polymyxin/bacitracin (Neosporin) Ophthalmic drops usage for 2 days. Six months later she required a course of injectable tobramycin for a pseudomonal UTI and immediately broke out in a florid macular itching rash with the first dose. Even though her chart had AMINOGLYCOSIDE allergy stamped on the front, the prior exposure to the aminoglycosides neomycin in Neosporin and tobramycin did not prevent a re-exposure to these drops. On the first instillation of Tobrex eye drops, she developed an anaphylactoid reaction, which required intravenous steroids. 1. What eye drop would you recommend for her next BC? a, gentamicin b. ciprofloxacin c. TMP d. polymycin-bacitracin 2. She now has an internal stye. What do you recommend? a. hot compresses b. an oral PRP or first generation cephalosporin c. a and b d. neomycin/bacitracin/polymyxin (Neosporin) 3. She is asking for contact lens to replace her eyeglasses. What do you recommend? a. a local eye care professional b. a preventive antiinfective eye drop c. a continuance of her eye glasses d. none of the above Key: 1-b, 2-c, 3-a Monitoring Upper Respiratory Tract Infections (URTIs) (Nose, sinus, ears and throat problems. ACUTE URTIs In acute problems an oral temperature is essential, with no hot or cold beverages 10-15 minutes before taking temperature. Remember that in older persons, the baseline oral temperature may be 95-97 degrees. Also watch for acetaminophen, non-acetyl salicylate, NSAID or oral glucocorticoid usage masking febrile state. Differential Assessment- always check throat, ears and sinuses together In the presence of sinusitis, with facial fullness and frontal headache with even slight temperature elevation, there is a great likelihood of bacterial infection in the sinus area, requiring the same antibiotics as you would see in otitis media. In the patient with sore throat and/or sub-mandibular lymphadenopathy (tender to touch and palpable 17
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Page 3 and 4: 4. Which of her meds could have inc
Page 5 and 6: lungs or nostrils WITH PINCH OF SAL
Page 7 and 8: Urethra, Male- NOTE; USE OF A TEXAS
Page 9 and 10: Eye-NOTE: DRY EYE IN OLDER PATIENTS
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Page 15: BC in CONTACT LENS USERS BC in this
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Page 21 and 22: d. all of the above The correct ans
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Page 28: Case10- a 64 year old smoker has 5

INFECTIOUS DISEASE REVIEW Upper Respiratory Tract Infections

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