1. ENT BACTERIAL INFECTIONS DR K BABA MICROBIOLOGICAL PATHOLOGIST NHLS TSHWANE ACADEMIC DIVISION UNIVERSITY OF PRETORIA

2. Introduction Ear- external, middle and inner ear Middle ear- nares, nasopharynx, auditory tube and the mastoid air space Line with ciliated cells Normal flora of external ear are pneumococci, propionibacterium, Staphylococcus, and Enterobacteriaceae

3. Otitis external Acute –Localised or diffused Localised- staphylococcus aureus and streptococcus pyogenes Diffuse- swimmer’s ear Severe hemorrhagic external otitis media –Pseudomonas aeruginosa

4. Otitis external Chronic- irritation of drainage from middle ear Malignant – necrotizing infection Common in diabetes Pseudomonas aeruginosa Mycoplasma pneumoniae- painful infection of eardrum

5. Otitis media Acute Common in children Pnemococci, Haemophilus influenzae, Streptococcus pyogenes, Others are S. aureus, moraxella, Enterobacteriaceae, anaerobes, Chlamydia trachomatis, and mycoplasma pneumoniae

6. Otitis media Chronic Mainly anaerobes- Peptostreptococcus, Bacteroides, Prevotella, Fusobacterium Complication- mastoiditis Treatment with Amoxicillin/ Amoxi- clavulanate

7. Pathogenesis Local trauma Foreign bodies Excessive moisture Infection from middle ear All this can lead to otitis external

8. Pathogenesis Anatomic abnormalities of auditory tube Negative pressure in the middle ear from inflamed auditory tube following viral infection Pathogenic bacteria then enters from the nasopharynx

9. Laboratory diagnosis Needle aspirates Mastoid swabs Mastoid tissue Microscopy, culture and sensitivity

10. Sinusitis Sinuses are air filled cavities within the head Normally sterile Acute sinusitis- cold / influenza infection Purulent nasal and postnasal discharge Feeling of pressure over the sinus area Cough Sometimes fever

11. Sinusitis Chronic with bacterial colonization Surgery/drainage Treatment with Amoxicillin/ Amoxi- clavulanate Complications- extension to the orbit, skull, meninges, brain

12. Pathogenesis Bacterial complication of common cold Maxillary infection from dental source Inadequate drainage Mucociliary clearance and mucosal damage

13. Etiolgy Haemophilus influenzae Streptococcus pneumoniae Streptococcus pyogenes Moraxella Anaerobes

14. Laboratory diagnosis Puncture and aspiration Sinus drainage is unacceptable because of contamination Microscopy and culture

15. Case 2 A 6 month old baby presents with flu like symptoms. Greyish adherent membrane was found on the tonsil. What is the clinical diagnosis What sample would you send to the laboratory to confirm your diagnosis What are the characteristics of the causative organism How would you manage the patient

16. C. diphtheriae Transmission –droplet infection; hand to mouth Laboratory Diagnosis –Nasopharyngeal secretions or swabs –Throat /nasal swabs –Loffler’s; Hoyle’s; Tellurite containing blood agar –Black and shiny colony –Elek’s for toxin production –Nucleic acid amplification with sequencing

17. Pathogenesis Diphtheria toxin Bacteriophage carrying the tox gene Classic A-B toxin A active subunit and B binding subunit Block protein synthesis Inactivate elongation factor 2 (EF-2) required for polypeptide elongation

18. Diseases Respiratory: tonsilitis, pharyngitis (fever, sore throat, grey pseudomembrane on the tonsils) Cutaneous: ulcerating skin lesion with grey membrane Complications: Severe and potentially fatal; nerve weakness/paralysis; myocarditis/cardiac failure; airway obstruction

19. Management Antitoxin Penicillin/Erythromycin Vaccine is usually administered together with pertusis and tetanus toxoids as DPT

20. Thanks