Department of Microbiology

FMUI-Jakarta, 2013
Eye
Nose and Upper Respiratory Tract
Ear
Sinus



Staphylococcus epidermidis and Lactobacillus spp. >>

Propionibacterium acnes

Staphylococcus aureus <30%

Haemophilus influenzae: 0,4 to 25%

Moraxella catarrhalis, Enterobacteriacea , streptococci
(S.pyogenes, S.pneumoniae , alpha-hemolytic and
gamma-hemolytic forms) <<


The eyelashes: prevent entry of foreign material
into the eye

The lids blink 15 to 20 times per minute
secretions of lacrimal glands and goblet cells
wash away bacteria and foreign matter

Lysozyme and immunoglobulin A

The delicate intraocular structures are envelope
in a touch: collagenous coat ( sclera, cornea)


If the barriers are broken by penetrating
injury or ulceration infection may occur

Infection can also rich the eye via the
Bloodstream
Nervous system: HSV by movement along
trigeminal nerve

Conjunctivitis
Inflammation of the conjunctiva
Keratitis
Inflammation of the cornea
Endophthalmitis
Inflammation of the uveal tract or posterior
chamber; usually an intraocular infective cause
Orbital cellulitis
inflammation of the periocular tissue
Blepharitis
Inflammation of the margins (edges) of the eye lids
Choroidoretinitis and uveitis
Inflamation of the retina and underlying choroid or the uvea.
Lacrimal infection; canaliculitis
chronic inflammation of the lacrimal canals (eyelid swells and
thick,mucopurulent discharge)
Dacryocystis
Infection of the lacrimal sac
Dacryo-adenitis
Acute infection of the lacrimal gland

Neisseria gonorrhoeae ophthalmia
neonatorum
Severe purulent conjunctivitis, occurs on the first
or second day of life
Corneal damage, blindness in later life

Staphylococcus aureus
sticky eyes: 5-10 days after birth
Autogenous infection from nose or skin fingers
Pseudomonas aureginosa
Opportunist cause, following trauma, present of
foreign body, operation on the eye, defective
immune response
Complication: invasion of the eye and blindness
Source: contaminated multi-dose containers of
eye drops, wet nail brushes, soap dishes

Haemophilus influenzae
Neisseria meningitidis
Streptococcus penumoniae
Severe purulent conjunctivitis
Treponema pallidum
Intertitisl keratitis (congenital syphillis syndromes)
blindness
Leptospira
Conjunctivitis as a part of Weils disease


nonmotile coccoid bacteria, obligate
intracellular parasites of eukaryotic cells

cause trachoma inclusion conjunctivitis (TRIC):
congenital infection ( follicular keratoconjunctivitis),
4-7 days after birth
Late life: mild-severe kerato-conjunctivitis, corneal
damage
Surface molecules that bind specifically to
receptors on host cells

Transmission: contact (contaminated flies,
fingers, towels), swimming pools

Trachoma: chronic repeated infections,
prevalent when there is poor access of water,
preventing regular washing of the hands and
face
Rubella
Contracted during intra-uterine life and may
cause congenital eye lesion, incl. cataracts

Adenovirus
Non-purulent conjunctivitis, often association
with pharyngitis
Type 8 epidemic keratoconjunctivitis,
associates with dust particles of factories or
hospitals
Herpes simplex
Superficial corneal dendritic ulcers extend
corneal damage
Debilitated or immunosuppressed patients, steroids

Varicella zooster
Conjunctivitis
Ophthalmic division of trigeminal nerve is frequently
involved

Measles virus: via blood

Fusarium, Candida, and Aspergillus sp.

Very rare

Immunosupressed patient

Follow operations on the cornea in
immunologically normal patients
Eyelid infection: Staphylococcus aureus

Orbital and inner eye infections
Cellulitis of the skin around tge eyes
Spreading infection from adjacent sinuses
A mixed infection is often present

Choroidoretinitis
Cytomegalovirus, AIDS, Rubella
Swabs for bacterial or fungal culture:
Direct smears and inoculation of plates
Stuarts transport medium

Conjunctival scrapings and cultures for
chlamydia

Swabs for virus isolation

Serology

Common species colonizing these areas include:
Streptococci, Staphylococci, Diphtheroids , Gram-
negative cocci
Anaerobic bacteria

Some of the aerobic bacteria found in healthy
individuals are potentially pathogen e.g.:
S. aureus, S. pneumoniae, S. pyogenes, N meningitidis
MRSA=Methicillin Resistant Staphylococcus aureus
Candida

Bacteria carried in the majority of people
Streptococcus viridans, Neisseria spp.,
Diphtheroids
Anaerobic cocci, fusiforms, Prevotella spp.,
Bacteroides

Respiratory bacterial pathogens that may be
carried asymptomatically
S.pyogenes, S.pneumoniae
Haemophilus influenzae
Corynebacterium diphtheriae
Organisms sometimes associated with
transient colonization secondary to antibiotic
therapy
Coliforms Klebsiella spp., E.coli, etc.
Pseudomonas spp.
Candida albicans
Nose
detection of MRSA carriers

Nasopharyngeal swabs
diagnosis of Bordetella
pertussis

Nasopharyngeal swabs and
washings
diagnosis of viral disease
Throat
detection of
streptococcal
pharyngitis
Candida albicans penetrating the epithelium with
its pseudomycelia causing thrush
Prolonged administration of broad spectrum
antibiotics
Immunity is impaired: HIV infection, malignancy,
newborn, infants, and elderly

Diagnosis: Gram stain and culture of scraped
material

Treatment:
Topical antifungal agents: nystatin, fluconazole



Iritation in the outer ear and a scanty
discharge

Causes:
Bacterial: S.aureus, Proteus spp.,
Pseudomonas aeruginosa
Fungal: Aspergillus niger, Candida albicans
Acute diffuse otitis externa (swimmers ear)
maceration (softening of tissue) of the ear
from swimming and/ or hot, humid weather
(Pseudomonas aeruginosa)

Chronic otitis externa
results from the irritation of drainage from
middle ear with chronic suppurative otitis
media and perforated eardrum

Malignant otitis externa
necrotizing infection that spreads to
adjacent areas of soft tissue, cartilage and
bone
Pseudomonas aeruginosa and anaerobic
bacteria
Eldery diabetic patients
Most common in infants and young children
Causative agents:
Viruses >>
Bacteria:
Streptococcus pneumoniae
Haemophillus influenzae
Streptococcus pyogenes
Staphylococcus aureus
Moraxella catarrhalis
Anatomic and physiologic abnormalities
of the auditory tube predispose
individuals to develop otitis media

Infants and small children: auditory tube
is open more widely





Auditory tube
Protecting the middle ear from
nasopharyngeal secretions
Draining secretions produced in the middle
ear into the nasopharynx
ventilating the middle ear so that air
pressure is equilibrated with that in the
external ear canal



Chronic suppurative otitis media
No adequate treatment of OMA
Chronic discharge of pus through a perforation in
the ear drum, some obvious loss of hearing
present

Causative agent = etiologies of OMA + Gram-
negative bacilli (Proteus, Pseudomonas,
Bacteroides)
Mastoiditis: detected by tenderness or
swelling behind the pinna

Meningitis

Otogenic brain abscess
May follow a previous attack of otitis media but
sometimes etiology is uncertain

Effusion present in the middle ear, serous or
mucinous, fluctuating hearing loss

Drainage may required

Recurrent attacks

Cultured of fluid is often sterile
Specimen collection for culture:
Outer: swab
Inner: aspirate
Mastoid: taken on swabs during surgery

Specimens should be transported aerobically
and anaerobically
Transport medium
Room temperature
Less than 2 hours

Use moistened swab to remove any debris or crust
from ear canal

Obtain sample by firmly rotating swab in outer
canal

For otitis externa, vigorous swabbing is required
surface swabbing may miss streptococcal cellulitis.

Tympanocentesis should be reserved for
complicated, recurrent, or chronic persistent
otitis media.
For intact eardrum, clean ear canal with
soap solution and collect fluid via syringe
aspiration. Submit in sterile container.
For ruptured eardrum, collect fluid on
flexible shaft swab via an auditory
speculum. Transport time <2 hours
Sinuses: air-filled
cavities within the
head

The sinuses are
normally sterile
develops during the course of a cold or
influenzae illness and tend to be self-limited
lasting 1 to 3 weeks.

Symptoms: purulent nasal and postnasal
discharge, a feeling of pressure over the sinus
areas of the face, cough, and nasal quality to the
voice.

Complication: local extension into the orbit,
skull, meninges or brain, and development of
chronic sinusitis
Most cases: bacterial secondary infection

5% - 10% of acute maxillary sinus infection
result from a dental infection.

The primary problem associated with chronic
sinusitis are: inadequate drainage, impaired
mucocilliary clearance, and mucosal damage

Young adults:
Haemophilus influenzae,
Streptococcus pneumonia
Streptococcus pyogenes,
Moraxella cattarrhalis.

Children:
S. pneumoniae,
H. influenzae,
M. catarrhalis
Rhinovirus

Otolaryngologist obtain the material from
maxillary sinus by puncture and aspiration or
during surgery

Transported in aerobic and anaerobic condition

Once received by the laboratory :
Gram-stained smears
Aerobic and anaerobic cultures , identification
Susceptibility tests