Infectious Conjunctivitis - Essay Example

Infectious Conjunctivitis Conjunctivitis, or more commonly known as “pink eye” or “red eye,” is the inflammation of the bulbar or palpebral conjunctiva, the transparent and vascularized mucous membrane covering of the eyeball which serves a protective function to the organ. It is triggered by the entry of infectious or non-infectious foreign bodies to the eye which can be viral or bacterial in nature or as a reaction to an allergen which irritate the thin covering. According to Yu (2008), infectious conjunctivitis is a result of the “exogenous inoculation of the mucous membranes lining the surface of the eye and the eyelid” (p. 79). The presence of the foreign bodies (e.g., virus, bacteria, and others) triggers a local inflammatory process and the release of immunoglobulins which is initiated and mediated by the immunocompetent cells called the Langerhans’ cells present in the thin membrane (Agarwal, 2006, p. 6) as well as the T-lymphocytes, lymphokines and other inflammatory mediators (“Toxic Conjunctivitis,” n.d.). Moreover, Stechschulte (2002) pointed out that infectious conjunctivitis is characterized by a “sudden onset of redness with irritation and discharge” (p. 10); the redness result from hyperemia, or the increase of blood flow towards the conjunctiva. Other signs and symptoms include swelling, grittiness, itching, and burning, sensation of a foreign body in the surface of the eye, as well as pain. The most common causes of infectious conjunctivitis both in children and adults are several types of viruses. However, bacterial origins are not uncommon which is more prevalent in children; bacterial cases involving adults, on the other hand, are existing (Murphy & Horan, 2011, p. 843). 2. Of the four microorganisms listed (legionella pheumophila, plasmodium ovale, adenovirus, haemophilus influenza), justify which one is more likely the cause of John’s eye infection. Explain why the other microorganisms from the list are least likely to cause the infection. Conjunctivitis, as it has been mentioned earlier, can be due to the invasion of viruses or bacteria, or results as a form of allergic reaction to foreign bodies that come in contact with the conjunctiva. The determination of whether it is viral, bacterial, or allergic in origin, however, can be done even only by taking the history and examining for clinical presentations of the patient’s affected eye (Kyle, 2008, p. 526). On the other hand, if the cause would seem to present a bacterial origin, laboratory testing can be done to identify what specific type of infectious bacteria cause the inflammation of the conjunctiva. Considering the signs and symptoms presented by John, it is obvious that his was a type of bacterial conjunctivitis; and among the listed microorganisms, it is more likely to be caused by the bacteria Haemophilus Influenza than by adenovirus. Legionella pneumophila and plasmodium ovale are very least likely to be considered to have caused John’s eye condition as they result to different diseases. Both h. influenza and adenovirus can cause inflammation of the conjunctiva but the redness, tenderness, and mucopurulent discharge support the bacterial origin as viral conjunctivitis tend to produce a watery and mucoid discharge. Although it commonly affects those who are immunocompromised such as the elderly, L. pneumophila usually result to Legionnaires’ disease which affects the lungs and Pontiac fever (Chen & Kasturi, 2007, p. 71). Plasmodium ovale, on the other hand, is one of the four different types of plasmodia causing malaria and originates in West Africa (John, Petri, Markell, & Voge, 2006, p. 85). 3. Provide a scientific rationale for why Chloramphenicol was prescribed by the doctor before taking the swab sample. Once infectious conjunctivitis is suspected, it has been accorded as a standard clinical practice to instill topical antibiotic (Rose, et al., 2005, as cited in Elwood, 2007, p. 361). Specifically, Chloramphenicol, a broad spectrum antibiotic, along with fucithalmic, are the drug of choice for bacterial conjunctivitis as it can be effective against nearly all cases of bacterial conjunctivitis (Bentley & Sandhu, 2009, p. 128; Bannister, Gillespie, & Jones, 2006, p. 120). Hence, even without first identifying the exact microorganism through a swab test, the anti-bacterial effect of chloramphenicol is held to be beneficial in the different cases and causes of conjunctivitis. The swab tests, nonetheless, through “culture and sensitivity (C&S) analysis identifies the presence of bacteria in a lesion specimen and their sensitivity to specific antibiotics” (Lippincott Williams & Wilkins, 2009, p. 509). The process is needed to determine the microorganisms by performing C&S as it dictates what treatments are or are not going to be effective in fighting the infection. Moreover, it lessens the possibility of taking the wrong anti-infective treatments which can result to the pathogens’ drug resistance (Timby, 2009, p. 136). This means that the cause of the infection “will have a low probability of responding to a ‘normal’ drug regimen” (Drusano, 2009, p. 33), something that should not be allowed to happen. 4. Identify and discuss the various chemical and cellular mediators which are responsible for the signs and symptoms of John’s condition. John’s conjunctivitis present symptoms that can be grouped into three: redness and swelling, purulent and sticky discharge, and pain. The redness and swelling is basically caused by the local inflammatory process which is initiated and mediated by the Langerhan’s cells, T-lymphocytes and lymphokines as well as the immunoglobulins (particularly IgG and IgA) in the conjunctiva (Hom & Bruce, 2006, p. 60; “Toxic Conjunctivitis,” n.d.) which further affects the glands and other structures connected to the membrane (Beale, 2009, p. 353). According to Beale (2009), When the mucous membranes is inflamed the little glands participate, and from them is poured out an abundant secretion containing numerous particles of bioplasm. The vessels are distended, and that part of the mucous membrane which lines the eyelids and covers the white part (sclerotic) of the eye is reddened and... assumes an appearance which well illustrates the changes taking place in inflammation. (p. 353). The purulent and sticky discharge, nevertheless, serves as an evidence of an on-going infection response made by the body. The Encyclopedia for Family Health (2005) described that pus forms as some of the white blood cells (WBC) that rush to the infected site (the eye -- particularly the conjunctiva) die in the process of fighting the infection. These WBCs then accumulate with the other dead bacteria and components and form a sticky substance called pus (p. 21). Although pain is unlikely in conjunctivitis, the pain sensation felt by John could be an indication of corneal involvement (Lippincott Williams & Wilkins, 2008, p. 249). This is thought to result from the degranulation of mast cells that triggers the release of histamine and other inflammatory mediators mentioned above in response to an invading infection (Bentley & Sandhu, 2009, p. 128). 5. Explain the role of tears as a natural first line of defense produced by the body. Besides its nutrition, metabolism and maintenance of optical clarity functions, the tears act as one of the innate primary defenses against harmful materials that can enter the eye (Pray, 2006, p. 455). Majorly produced by the ophthalmic lacrimal gland, human and even animal tears aid in antibacterial actions in addition to its waste removal functions to prevent damage to the eye (Pray, 2006, p. 455). Naturally, as foreign objects or substances come in contact with the eyes, the tears will flow and try to wash it out (Rosdahl & Kowalski, 2008, p. 469). Other important natural-defense properties, moreover, are its being composed of immunoglobulins, lysozymes, and mucin. All types of immunoglobulins (IgG, IgA, IgM, IgE, and IgD) are present in tears but immunoglobulins A and G are specifically the more abundant. These proteins function to “provide immunity to viruses, bacteria, fungi, and parasites”; lysozyme acts by damaging the bacterial cell walls (Hom & Bruce, 2006, p. 60). Mucins, on the other hand, are thought to “physically entrap and remove irritants” (Dartt, Hodges, & Zoukhri, 2006, p. 23). Therefore, the release of tears is not just a reaction to foreign entry but also a natural defense mechanism. 6. Identify and discuss two infection control issues associated with high dependency aged care facilities that can contribute to the spread of conjunctivitis. There are several issues that arise when it comes to infection control in long-term care elderly facilities. Two of them are the existence high number of people with cognitive impairment (Dominguez-Berjon, Hernando-Briongos, Miguel-Arroyo, Echavarria, & Casas, 2007, p. 250), as well as the ineffectiveness of patient ‘cohorting’ or the “grouping of infectious patients and nursing them within an area of a hospital ward” (National Nursing Research Unit, 2007). Movements and activities of residents to nursing homes with cognitive impairment are difficult to restrict; hence, close monitoring to make sure that there will be no direct contact between people with and without infectious diseases such as conjunctivitis is relatively a hard task to do (Arias, 2010, p. 154). The issue on applying infected patient cohorting, on the other hand, was found ineffective which is unlike the results seen when cohorting or nurses (or the assigning of nurse to work ONLY with infected patients) was applied in promoting control measures to prevent the spread of infection (e.g., conjunctivitis) to patients (National Nursing Research Unit, 2007). 7. Suggest two procedure nurses will need to undertake to prevent the infection from John’s eye being transmitted to another individual. Explain how each procedure will effectively break the chain of infection. Arias (2010) specifically pointed out a number of control measures to prevent the spread of conjunctivitis from one individual to another in a nursing care facility. Two of which include “strict adherence to good hygiene practices by healthcare workers” and the “use of aseptic technique when providing care” (Arias, 2010, p. 154) to effectively break the chain of infection which is made up of the source of infection, host susceptibility, means of entry, mode of transmission, means of escape, and the reservoir interconnected with each other. Washing the hands using the standard technique advised by international health organizations keeps the hand free of contamination and growth of microorganisms such as H. influenza that is identified to be the cause of John’s eye infection which can be transferred by direct contact (Bennalick, 2008, p. 27). The use of sterile technique -- if guidelines are followed strictly -- in the provision of care of the inflamed infectious conjunctiva ensures the nurses or any other healthcare provider “that no organisms are carried to the client” (Rosdahl & Kowalski, 2008, p. 742). References Abscess. (2005). 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