2. Conjunctivitis
• Conjunctivitis is inflammation of the conjunctiva, the mucous membrane that lines the
eyelid and eye surface. conjunctivitis is usually a minor eye infection that is caused by a
bacteria or virus, but it can develop into a more serious condition. It is the most common
cause of red eye and is quite contagious. It is also called as "pink eye".
3. Etiology
• Conjunctivitis has a number of different causes, including:
• Viruses
• Bacteria such as Gonorrhea or Chlamydia, Staphylococci and Streptococci.
• Chemicals or irritants such as shampoos, dirt, smoke, and pool chlorine.
• Environmental factors or Allergies, like dust, pollen, or a special type of allergy that affects
some contact lens wearers.
4. Pathophysiology
• Conjunctiva covering the whites of the eyes and the membranes on the inner part of the
eyelids.
• These membranes react to a wide range of bacteria, viruses, allergy-provoking agents,
irritants, and toxic agents, as well as to underlying diseases within the body.
• The lining of the eye is usually clear. If irritation or infection occurs, the lining becomes red
and swollen.
5. symptoms and signs
• The symptoms of conjunctivitis differ based on the cause of the inflammation.
• Treatment according to the types of inflammation:
• a) Bacterial Conjunctivitis:
• Usually bacterias are (Staphylococci and Streptococci) and sexually transmitted diseases (gonorrhea or Chlamydia).
• Some patients presenting with bacterial conjunctivitis will have concomitant otitis media. Oftenly children presenting
with a purulent ocular discharge on waking in the morning and abrupt onset of redness to have ears examined for otitis
media.
• Symptoms include; eye-pain, swelling, itching, redness, a moderate to large amount of discharge, usually thick and
yellow or greenish in color and swelling of the lymph nodes infront of the ears.
• Treatment: treated with antibiotics, in the form of eye drops, ointments, Topical broad-spectrum antibiotics
• Erythromycin ointment
• Bacitracin-polymyxin B ointment
• Trimethropim-polymyxin B
• Sulfa drops
• Bacterial pink eye is treated by repeated warm washcloths applied to the eyes.
6. symptoms and signs
• b) Viral Conjunctivitis:
• It occurs most commonly due to adenovirus and is highly contagious.
• Individuals often experience an upper respiratory infection.
• Pink eye, thick ocular discharge, extreme tearing and foreign body sensation.
• Treatment: is supportive and cold compresses are used. Artificial tears
(Carboxymethylcellulose Sodium, Glycerin, Polysorbate 80 and topical vasoconstrictors
like ketotifen, phenylephrine, nedocromil are used.
• Avoid contact with others and wash hands frequently.
7. symptoms and signs
• Allergic Conjunctivitis:
• Symptoms include redness, mild edema of the eyelid, excessive tearing, extreme itching,
string-like mucoid discharge.
• Treatment; avoidance of the allergen if feasible and cold compresses are applied.
Nonprescription ophthalmic products containing a combination of a vasoconstrictor and an
antihistamine are used.
• Chemical or irritant conjunctivitis: Chemical pink eye can result when any irritating
substance enters the eyes.
• Treatment; thorough washing of the eyes with very large amounts of water are very important
if an irritating substance enters the eye.
8. Pharyngitis
• Pharyngitis is an upper respiratory tract acute infection of the oropharynx or nasopharynx. It is also
commonly called as sore throat. It is the reason for 1% to 2% of all outpatients visits.
• Etiology:
• The causes of pharyngitis are as follows;
• Bacterial; group A Beta-hemolytic Streptococcus, or S. pyogenes, is the primary bacterial cause. Group
A Streptococcus is the most common (10% to 30% of persons of all ages with pharyngitis).
• Other less-common causes of acute pharyngitis include groups C and G Streptococcus,
Corynebacterium diphtheriae, Neisseria gonorrhoeae, Mycoplasma pneumoniae, Arcanobacterium
haemolyticum, and Chlamydia pneumoniae.
• Viral; Viruses cause the majority of acute pharyngitis cases. Specific etiologic agents include rhinovirus
(20%), coronavirus (5%), adenovirus (5%), herpes simplex (4%), influenza virus (2%), parainfluenza virus
(2%), and Epstein-Barr virus (<1%).
9. Pathophysiology
• The mechanism by which group A Streptococcus causes pharyngitis is not well defined.
• microrganism may cause alteration in host immunity (e.g., a breach in the pharyngeal
mucosa) and the bacteria of the oropharynx, allowing colonization to become infection.
• Pathogenic factors associated with the organism itself also may play a role. These include
pyrogenic toxins, hemolysins, streptokinase, and proteinase.
• Diagnosis:
• Laboratory tests
• Throat swab and culture or rapid antigen detection testing.
• Monospot test for atypical lymphocytes in blood.
10. Signs and symptoms
• Sore throat
• Pain
• swallowing
• Fever
• Headache, nausea, vomiting, and abdominal pain (especially children)
• Erythema/inflammation of the tonsils and pharynx with or without patchy exudates
• Enlarged, tender lymph nodes
• Red swollen uvula
• cough
11. Treatment1. Desired outcome:
The goals of treatment of pharyngitis are to improve clinical signs and symptoms, minimize ADRs, prevent
transmission to close contacts, and prevent the secondary infections.
2. GENERAL APPROACH TO TREATMENT
• Antimicrobial therapy should be limited to those who have clinical and epidemiologic features of group A
streptococcal pharyngitis with a positive laboratory test.
3. PHARMACOLOGIC THERAPY
• NSAIDS; acetaminophen and NSAIDs to aid in pain relief is strongly recommended.
• Antimicrobial Therapy; Antimicrobial therapy decreases the duration of signs by 1 to 2 days.
• Penicillin; Penicillin is the drug of choice. It has the narrowest spectrum of activity, and it is effective, safe, and
inexpensive. (Penicillin G, Benzathine Penicillin, Amoxicillin).
• Macrolide; In patients who are allergic to penicillin, a macrolide such as erythromycin, azithromycin and
clarithromycin.
• Cephalosporin; or a first-generation cephalosporin such as cephalexin. Second-generation cephalosporins,
such as cefuroxime and cefprozil, or third-generation cephalosporins, such as cefpodoxime and cefdinir.
• Amoxicillin-clavulanate or clindamycin may be considered for recurrent episodes of pharyngitis to maximize
bacterial eradication.
12. TONSILLITIS
• Tonsils are the two lymph nodes located on each side of the back of your throat.
• Tonsillitis is an inflammation of tonsils (the glands of the throat), which results in a sore throat. Most
cases of tonsillitis resolve in a few days without antibiotic medication.
• Aetiology:
• Both virus and bacteria cause tonsillitis but mainly caused by viral infections.
• Bacterial tonsillitis can be caused by Streptococcus pyogenes, the organism that causes strep
throat. If left untreated, strep throat may lead to a more serious condition called rheumatic fever,
which can affect the heart several years later.
• Only about 30% of tonsillitis in children is caused by strep throat. Only 10% of tonsillitis in adults is
caused by strep throat.
• Significant Causative Agent
• Beta-hemolytic streptococci (Group A, C and G)
• Adenovirus
• Eprtein Bare Virus
13. Pathophysiology
• The tonsils are lymph nodes in the back of the mouth and top of the throat.
• They normally help to filter out bacteria and other germs to prevent infection in the body.
• If virus or bacteria cause infection then these tonsils may become red and swollen.
• Tonsillitis is transmitted most commonly from one person to another by social contact
such as droplets in the air from sneezing.
14. Symptoms and signs
• sore throat
• difficulty swallowing or painful swallowing
• a scratchy-sounding voice
• bad breath
• fever
• chills
• earaches
• stomachaches
• headaches
• a stiff neck
• jaw and neck tenderness due to swollen lymph nodes
• tonsils that appear red and swollen
• tonsils that have white or yellow spots
15. Diagnosis
• Physical examination; the tonsils are usually red and may have white spots on them.
The lymph nodes in the jaw and neck may be swollen and tender to the touch.
• Lab test; throat swab test is performed for a strep culture.
16. Treatment
• Non-pharmacologic treatment;
• Drink fluids, especially warm (not hot), plain fluids (to avoid becoming dehydrated).
• Gargle with warm salt water (8 ounces of warm water mixed with 1 teaspoon salt) will ease
sore throat pain.
• Pharmacologic treatment;
• NSAIDs; Throat pain and fever may be improved with over-the-counter pain relievers such as
ibuprofen, acetaminophen.
• Local Anesthetics; Suck on lozenges (containing benzocaine or similar ingredients) to
reduce pain (these should not be used in young children because of the choking risk).
• Antibiotics; For bacterial tonsillitis, penicillin is the most commonly prescribed class of
antibiotics. People who are allergic to penicillin may be treated with erythromycin.
• Surgery; Some patients who have repeated infections may need surgery to remove the
tonsils (tonsillectomy).
