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Bacterial Conjunctivitis in Children and Adults Bacterial Conjunctivitis in Children and Adults

Bacterial Conjunctivitis in Children and Adults - PowerPoint Presentation

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Bacterial Conjunctivitis in Children and Adults - PPT Presentation

AKHALILIAN Farabi Hospital Drkhaliliancom Bacterial Conjunctivitis in Children and Adults Bacterial conjunctivitis is less common than viral conjunctivitis in adults In an adult with unilateral ID: 780036

days conjunctivitis corneal chlamydial conjunctivitis days chlamydial corneal conjunctival discharge infection daily bacterial antibiotics purulent influenzae chlamydia erythromycin gonorrhoeae

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Slide1

Bacterial Conjunctivitis in Children and Adults

A.KHALILIAN

Farabi

Hospital

Drkhalilian.com

Slide2

Bacterial Conjunctivitis in Children and Adults

Bacterial conjunctivitis is less common than viral conjunctivitis in

adults

In an adult with unilateral bacterial conjunctivitis >>> NLDO (R/O)

Slide3

Slide4

Acute purulent conjunctivitis

P

urulent

discharge < 3 weeks’ durationS pneumoniae

,

Streptococcus

viridans

,

S

aureus

,

(

acute

blepharoconjunctivitis

)

H

influenzae

(

biotype III previously called H

aegyptius

)

Slide5

Slide6

H influenzae conjunctivitis

Y

oung

children, sometimes with otitis

media

,

A

dults

,

particularly those chronically colonized with H

influenzae

(

smokers, COPD

).

Conjunctival

membranes

do not develop,

peripheral

corneal epithelial ulcers

and

stromal infiltrates

occur more

commonly

.

H

influenzae

preseptal

cellulitis may be associated with fulminant

Haemophilus

Meningitis (up

to 20%

long-term

neurologic

sequelae

)

Slide7

Gram-stained smears and culture of the

conjunctiva in:

N

eonates or

debilitated

or

immunocompromised

individuals

, to

assess the risk of local and systemic complications

S

evere

cases

of

purulent conjunctivitis

, to differentiate it from

hyperpurulent

conjunctivitis,which

generally requires systemic therapy

U

nresponsive

to initial therapy

Slide8

Rx acute bacterial conjunctivitis

Delaying

treatment until day 3 or 4 would significantly

reduce the unnecessary use of antibiotics and would not affect outcomes

If

the conjunctivitis

is improving on day 4,

then

antibiotics may not be necessary at

all.(limited benefit)

Slide9

P

olymyxin

B/trimethoprim (Haemophilus species) Aminoglycosides

or

fluoroquinolone

drops,

B

acitracin

or ciprofloxacin ointment

.

4–6

times daily for approximately

5–7 days

Slide10

Supplemental

oral antibiotics are recommended for patients with

A

cute

purulent

conjunctivitis associated

with pharyngitis,

C

onjunctivitis-otitis

syndrome,

Haemophilus

conjunctivitis

in children

.

Slide11

Cultures of the nose or throat:

A

ssociated

sinusitis or pharyngitis

R

elapsing conjunctivitis

B

ecause organisms

persisting in and colonizing the respiratory mucosa may be the source of infection

.

Slide12

Hyperacute

gonococcal

conjunctivitis

Slide13

Hyperacute

gonococcal

conjunctivitisExplosive onset and very rapid progression of

severe purulent

conjunctivitis

Massive

exudation; severe

chemosis

; eyelid edema; marked

conjunctival

hyperemia,corneal

involment

N

gonorrhoeae

(

STD

,

maternal–neonate

transmission in NVD)

Slide14

N gonorrhoeae

conjectivitis

P

reauricular

lymphadenopathy

C

onjunctival

membranes

.

Keratitis

,the

principal cause of sight-threatening

complications

(15

%–40

%):

D

iffuse epithelial haze,

Epith

defects

,

M

arginal

infiltrates

,

U

lcerative keratitis Corneal melting &perforation

Slide15

N

gonorrhoeae

grows well

on chocolate agar and Thayer-Martin media

Slide16

gonococcal

conjunctivitis without corneal ulceration:

gonococcal

conjunctivitis with

corneal ulceration:

Outpatient basis

1 (

IM

) ceftriaxone (1 g) injection

admitted

intravenous (

IV

) ceftriaxone (1 g IV every 12 hours) for

3 consecutive days.

copious, frequent(every 30–60 minutes) irrigation of the

conjunctival

sac with normal saline

copious, frequent(every 30–60 minutes) irrigation of the

conjunctival

sac with normal saline

Erythromycin, bacitracin or gentamicin ointment, and ciprofloxacin solution

Erythromycin bacitracin

or

gentamicin

ointment, and ciprofloxacin solution

supplemental oral antibiotics for treatment of

chlamydial infection

.(2/3)

supplemental oral antibiotics for treatment of

chlamydial infection

.

Slide17

Rx

Patients

with

penicillin allergy can be given spectinomycin (2 g IM)

O

ral

fluoroquinolones

(ciprofloxacin

500 mg or

ofloxacin

400 mg orally twice daily for 5 days)

Patients should be instructed to refer their sex partners for evaluation and treatment.

Slide18

Slide19

Bacterial conjunctivitis in

neonates

ophthalmia

neonatrum

Chlamydia

trachomatis

S

viridans

S

aureus

H

influenzae

group D Streptococcus

Moraxella

catarrhalis

E coli and other gram-negative rods

N

gonorrhoeae

Slide20

Neonatal

gognococcal

conjectivitis

1%

Bilateral

conjunctival

discharge typically develops

3–5 days after parturition

.

The discharge may

be

serosanguinous

during the first several days, with a

copious purulent exudate

,

severe

corneal complications

, and

endophthalmitis

developing

later

Disseminated

gonococcal

infection with arthritis, meningitis, pneumonia, and sepsis

Slide21

Rx

For

nondisseminated

infections, a single IM or IV ceftriaxone injection (up to 125 mg or a dose of 25–50 mg/kg) or

cefotaxime

at

a single

dose of 100 mg/kg IV or IM

For disseminated infection

, treatment should

be augmented

according to infectious disease consultation.

Slide22

H

ourly

saline irrigation

of the conjunctiva until discharge is eliminated. If corneal involvement

is suspected

, application of

topical erythromycin

or

gentamicin

ointment or frequent application of

a

topical

fluoroquinolone

should be considered.

Topical

cycloplegia

Slide23

Neonatal chlamydia

conjectivitis

There

is no follicular response in newborns.

The

gretaer

amount of

mucopurulent

discharge

Pseudomembranes

Intracytoplasmic

inclusions

The

infection in newborns is more likely to respond to topical medications

.

Slide24

Gram

and

Giemsa stains of conjunctival scrapings are recommended in neonates with conjunctivitis to

identify C trachomatis and N

gonorrhoeae

, as well as other

bacteria

Slide25

Rx of Neonatal chlamydia

conjectivitis

Other Chlamydia-associated infections, such as

pneumonitis and otitis media

, can accompany inclusion conjunctivitis in the newborn.

1- Topical erythromycin or

sulacetamide

+

2- Systemic

erythromycin (12.5 mg/kg oral or IV 4 times daily for 14 days

)

Slide26

Chlamydial conjunctivitis

Chlamydia trachomatis:

T

rachoma: serotypes A–C

A

dult

and neonatal inclusion conjunctivitis: serotypes

D–K

L

ymphogranuloma

venereum

: serotypes L1, L2, and L3

Slide27

Adult

chlamydial

conjunctivitis

Adult chlamydial conjunctivitis

is a sexually transmitted disease

often found

in

conjunction with chlamydial urethritis

or cervicitis

.( systemic disease)

Other modes

of transmission may include

shared eye

cosmetics

and

swimming

pools.

Slide28

Scant

mucopurulent

discharge

Follicular conjunctival response that is most prominent in the lower

palpebral conjunctiva

and

fornix,

P

reauricular

adenopathy

.

Follicles in the bulbar conjunctiva and semilunar

fold( specific sign)

Slide29

F

ine

or coarse epithelial infiltrates, occasionally associated with

subepithelial infiltrates.( sup)

Micropannus

( < 3mm. Sup)

Slide30

Rx

A

dult

chlamydial conjunctivitis often resolves spontaneously in 6–18 months.

A

zithromycin

1000 mg single

dose

D

oxycycline

100 mg twice daily for 7 days

T

etracycline

250 mg 4 times daily for 7 days

E

rythromycin

500 mg 4 times daily for 7 days

Slide31

Patients

and

their sexual contacts should

be evaluated for coinfection with other sexually transmitted diseases, such as syphilis or gonorrhea

Slide32