Case Study: Infectious Conjunctivitis and its Management

This template must be used to answer the case study.
(Please type your answers within the box underneath each question)
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1. Background of the case study (Total: 5 marks)
1.1 What is infectious conjunctivitis?
Infectious conjunctivitis is an infection of the conjunctiva by bacteria or virus resulting in
inflammation of the conjunctiva and characterized by dilation of the blood vessels of the
eye. People affected by infectious conjunctivitis mostly experience symptoms of red and
swollen eyes, thick discharge from the eye and irritation which persists for less than 3
weeks. There are many types of infectious conjunctivitis such as bacterial, viral,
chlamydial, gonococcal conjunctivitis and non-infectious conjunctivitis (O’Callaghan,
2018). In the case study, John, an 88 years old resident experienced the same symptom
as above in his right hand.
1.2 Of the four micro-organisms listed below, justify which one is more likely to be the cause
of John’s eye infection. Indicate why the other micro-organisms from the list are least likely
to cause the infection.
Legionella pneumophila
Yes or no, with reason:
No, Legionella pneumophila is not the causative organism for John’s eye infection
because it is responsible for causing Legionnaire’s disease, a severe form of pneumonia
which is transmitted from person to person contact. It never causes any type of
conjunctivitis (Kuroki et al., 2017).
Plasmodium ovale
Yes or no, with reason:
No, Plasmodium ovale is not the cause behind John’s eye infection as Plasmodium is the
causative organism for malaria disease and eye pain is not a usual symptom of malaria.
Hence, possibility of infection by Plasmodium ovale is ruled out (Groger et al., 2017).
Adenovirus
Yes or no, with reason:
No,adenovirus is not the cause behind John’s eye infection. Although infective
conjunctivitis can be viral conjunctivitis, however John’s symptom is not linked to viral
conjunctivitis because watery discharge is main clinical manifestation for viral
conjunctivitis. However, John was found to have sticky and thick discharge which is not

related to viral conjunctivitis. Hence, adenovirus is not the main causative organism
behind John’s eye infection.
Staphylococcus aureus
Yes or no, with reason:
Yes, Staphylococcus aureus has been identified as the main causative organism for
John’s eye infection because it is a bacteria and acute bacterial conjunctivitis is most
commonly caused due to Staphylococcus aureus. In addition, symptoms of bacterial
conjunctivitis include redness, sticky discharge from the eye and itching or discomfort in
the eye (O’Callaghan, 2018). John’s symptoms matched exactly with the above
symptoms.
2. Mechanism of action and adverse reactions (Total: 5 marks)
2.1 Describe the mechanism of action of gentamicin?
Gentamicin is a medication to treat bacterial infections of the eye and the skin around the
eyes. It is a protein synthesis inhibiting antibacterial drug that work by binding to the 30s
ribosomal subunit and blocking the bindings of the tRNAs thereby resulting in disruption
for the anticodon of tRNA. This process results in the formation of an initiation complex
that further disrupts the process of protein synthesis (Abelson et al., 2015). Therefore,
bactericidal effect of the drug is seen because of formation of toxic peptides. It kills the
bacteria by disrupting the pathway leading to protein synthesis
2.2 Name two adverse reactions of this drug?
Two adverse effects of the drug include risk of nephrotoxicity or renal damage and risk of
allergic reactions (Cushnie, O’Driscoll & Lamb, 2016).
3. Physiological basis of signs (Total: 10 marks)
3.1 sign 1:
Red eyes
Explanation of this phenomenon:
Red eye is the main clinical manifestation of bacterial conjunctivitis and it occurs because
of the inflammation of the conjunctiva is response to bacterial infection and dilation of the
blood vessels of the eyes. This dilation manifest in the form of red eyes in patient and the
key cellular mediators linked to the inflammation process includes release of histamines
and other cell mediators involved in the inflammatory process pain (Norris, 2019).

3.2 sign 2:
Thick and sticky purulent discharge from the eye
Explanation of this phenomenon:
Purulent discharge from any area is mainly a sign of infection and the drainage changes
colour because of the number of living and dead germ cells and white blood cells within
the area. Purulent discharge in bacterial conjunctivitis occurs due to release of histamines
in response to infection and inflammation. This is often accompanies by eye swelling and
eye pain (Norris, 2019).
3.3 sign 3:
Painful eye
Explanation of this phenomenon:
Painful eye was another clinical symptom for John and this was mostly of the activation of
the normal flora of the eyes in response to infection. The process of inflammation of the
inner lining of the eyes activates the normal defense systems and results in dilation of the
blood vessels. Severe discharge is accompanied with painful eyes too (Gulati & Jain,
2016).
4. Infection control issues (Total: 5 marks)
4.1 Issue 1:
Risk of crowding and presence of other staffs and patients in aged care facility
Discussion as to why this is an issue:
As John is residing at a high dependency care facility, crowding and presence of other
staffs and patient can be a major infection control issue because John cannot be kept
completely isolated from staffs. For his treatment, the aged care staffs will engage in his
care and person to person contact can increase risk of infection for other people in the
residential care patient. Evidence shows that risk of infection is high in clinical setting
because continuous exchange between patient and staffs take place increasing the
possibility of transfer of infection from one person to the other (Khan, Baig & Mehboob,
2017). Hence, the approach to prevent the issue can be isolate the patient or
promote proper hygiene culture in the hospital.
4.2 Issue 2:
Presence of immune-compromised patients