Conjunctivitis-otitis syndrome describes the co-occurrence of both pink eye and a middle ear infection. This is attributed to a bacterial infection and tends to be most common in young children. Bacteria and viruses each cause about the same number of pink eye infections in children. Ear infection: If your child has bacterial conjunctivitis, it's common for them to also have an ear infection at the same time. Can ear infections affect your eyes? Your entire face from your ears to your eyes are connected to one another, so if you have issues in your ears, it may lead to pain or other issues with your eyes.

1. CLINICAL
MICROBIOLOGY
Eye and ear infections.
Clinical cases and diagnostics
UNIVERSITY OF EAST SARAJEVO
Faculty of Medicine in Foča

3. Eye infections
• Conjunctivitis is a very common infection
that physicians see primarily in children
and young adults and must distinguish
from more serious ocular conditions such
as keratitis and iritis.

4. Eye infections
• Distinguishing features of keratitis include eye
pain, photophobia, and impaired vision in
addition to diffuse inflammation of the eye, a
gritty irritation, and excessive lacrimation.
• When bacterial conjunctivitis occurs alone, the
most common causative agents include
nontypeable H. influenzae, adenovirus,
pneumococcus, M. catarrhalis, and
staphylococci.

5. • Generally, organisms are introduced into
the eye by direct contact with a carrier’s
hands.
• Rarely, the infecting agent is spread by
respiratory droplets.
Eye infections

6. • Serious infections of the anterior portion of the eye are
associated with herpes simplex virus, P. aeruginosa
(contact lens wearers), and Chlamydia trachomatis (people in
developing nations).
• In addition to the usual symptoms of conjunctivitis,
herpes simplex virus and varicella-zoster virus cause
vesicular lesions on the eyelid. Herpes simplex
conjunctivitis progresses to keratitis in 50% of cases and
is among the most common causes of severe corneal
ulceration and acquired blindness in the United States.
Eye infections

7. Because of the serious nature of herpes
keratoconjunctivitis and the high risk of
recurrence, patients must be referred to an
ophthalmologist.
Eye infections

8. Conjunctivitis / Scleritis
Bacterias Neisseria spp.
Streptococcus spp.
Staphylococcus aureus
Haemophilus spp.
Enterobacteriaceae
Pseudomonas spp.
Mycobacterium spp.
Moraxella lacunata
Chlamydia trachomatis
(inclusion
conjunctivitis and
trachoma)
Direct microscopy i
isolation (secretion,
scraping)
Direct preparation
(Giemsa) - finding of
inclusions in cells;
Antigen detection; PCR;
for trachoma detection
of genus-, species- and
type-specific antibodies
Viruses Adenoviruses
Enteroviruses
Influenza virus
Morbilli virus
Conjunctival smear -
isolation

9. Conjunctivitis / Scleritis
Fungi Candida spp.
Sporothrix schenckii
Direct microscopy and
isolation (secretion,
scraping)
Helminths Onchocerca volvulus
Loa loa
Detection of
microfilariae in skin
scrapings; serology
Finding of microfilariae
in the blood; serology

10. Aspergillus keratitis
Pseudomonas keratitis

11. Endophthalmitis
Bacterias Staphylococcus spp.
Streptococcus spp.
Neisseria gonorrhoeae
Enterobacteriaceae
Pseudomonas spp.
Bacillus spp.
Mycobacterium spp.
Moraxella lacunata
Actynomyces spp.
Nocardia spp.
Chlamydia trachomatis
(inclusion conjunctivitis
and trachoma)
Treponema pallidum
Direct microscopy (Gram) and isolation for
detection
aerobic and anaerobic bacteria and
mycobacteria from
aspirate
Aspirate - PCR; detection of Antibodies in
aqueous humor and serum
Serology
Viruses HSV
VZV
Morbilli Virus
Rubella Virus
Aspirates - direct microscopy and isolation

12. Endophthalmitis
Fungi Candida spp.
Aspergillus spp
Biphasic fungi
Zygomycetes
Fusarium spp.
Aspirates - direct microscopy and isolation
Helminths Onchocerca volvulus
Toxocara canis
Taenia solium
(cysticercosis)
Finding of microfilariae in the aqueous
humor; serology
Serology
Protozoa Acanthamoeba spp.
Toxoplasma gondii
Direct microscopy and isolation
(conjunctival secretion); DNA detection
Serology

13. Case 1

14. Questions and answers
1. Could C.’s mother and father develop the eye
infection?
Yes, J.’s mother and father could develop a similar
infection. This infection is generally spread with direct
inoculation by hand contact. Good hand hygiene
practices can help limit spread among family members.
2. Why did the physician not prescribe antibiotics for the
infection?
A viral infection is responsible for J.’s conjunctivitis. No
effective antiviral treatments are available for this type
of infection. Hence, antibiotics are not necessary for
treatment. Patients will generally improve with
symptomatic therapy within a few days.

15. Ear infections

16. Otitis media
• among the most common infections seen by
primary care providers
• The majority of cases occur in children between 6
and 36 months of age, with an average child
having two episodes per year during the first 3
years of life.

17. Otitis media
• Children are especially susceptible to otitis media
for several reasons:

18. Otitis media
1. One predisposing factor is that the medial orifice of the
eustachian tube is more open in infancy than later in life.
2. Supine feeding (giving a bottle at bedtime) permits reflux
of pharyngeal contents into the lumen of the eustachian
tubes, producing irritation that results in inflammation
and occlusion.
3. the eustachian tube is shorter and more horizontal in
young children, which allows reflux of nasopharyngeal
organisms into the middle ear.

19. Otitis media
• Respiratory syncytial virus, influenza A or B, or
adenovirus.
• The most common bacteria associated with otitis media
are S. pneumoniae, H. infl uenzae, and Moraxella catarrhalis.
• Viral infections can promote bacterial replication in the
middle ear by direct damage to the respiratory epithelium
lining.

20. Ear infections
Otitis externa Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pyogenes
Aspergillus spp.
Candida spp.
Direct microscopy and
isolation (ear canal
swab)
Direct microscopy and
isolation (ear canal
swab)
Otitis media Streptococcus pneumoniae
Haemophilus influenzae
Streptococcus pyogenes
Staphylococcus aureus
Moraxella catarrhalis (children)
Respiratory viruses
Direct microscopy and
isolation (middle ear
punctate)

22. Questions and answers
• 1. Should E.’s sister be brought in and checked for
an ear infection?
Acute otitis media is primarily a clinical diagnosis.
Unless she is experiencing symptoms of otitis media, the
sister does not need to be checked. Also, because the
sister is older, observation might be pursued regardless
of the clinical fi ndings.

23. • 2. Should a culture be obtained before antibiotics are
prescribed?
Tympanocentesis (aspiration of the middle ear fl uid) is
painful and poses more risk than benefi t to patients. For
this reason, it is not routinely performed for culture and
susceptibility testing.Instead, antimicrobial agents that
are effective against the most common otopathogens are
selected empirically.
Questions and answers

24. • 3. How can the physician be sure that amoxicillin is
the right antibiotic for E.?
The primary pathogens associated with otitis media are
pneumococci and e Haemophilus influenzae. Empiric
use of antimicrobials active against these two species is
a reasonable and effective approach.
Questions and answers

25. 4. Could E. have complications of her ear infection?
Most cases of otitis media that are treated with
antimicrobials resolve without complication. However,
patients experiencing recurrent or chronic infections may
develop complications like facial nerve paralysis,
epidural or subdural abscess, or brain abscess.
Questions and answers