Analysis of Infectious Conjunctivitis Case Study in Aged Care

This assignment presents a comprehensive case study analysis of infectious conjunctivitis in an elderly patient residing in a high-dependency aged care facility. The case study delves into the background of infectious conjunctivitis, exploring its causes, symptoms, and the role of microorganisms, specifically differentiating between various potential pathogens like Legionella pneumophila, Plasmodium ovale, Adenovirus, and Staphylococcus aureus. It then examines the mechanism of action and adverse reactions of the prescribed medication, gentamicin. The assignment further explores the physiological basis of observed signs like red, swollen eyes, purulent discharge, and pain. Infection control issues, such as hand hygiene and cleanliness, are discussed, along with the modes of transmission from the patient to others. The assignment concludes by identifying procedures to break the chain of infection, emphasizing elimination of the reservoir and controlling means of transmission. The analysis is supported by relevant literature and adheres to APA 6th edition referencing style.

This template must be used to answer the case study.
(Please type your answers within the box underneath each question)
Student name (LAST NAME first name):
Student number:
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Tutorial session (time and room no.):
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1. Background of the case study (Total: 5 marks)
1.1 What is infectious conjunctivitis?
Infectious conjunctivitis can be referred to as inflammation caused in the conjunctiva that is
usually caused by a particular bacteria or virus. Conjunctiva is the thin and transparent
membrane covering the anterior part of the eye and the inner surface of the eye lids. It is
susceptible to infection as it is in constant exposure with the atmosphere. It causes a
reddening of the eyes and generates a tearing discharge. In some cases people suffering
from conjunctivitis can be sensitive to light (Alfonso, Fawley & Lu, 2015).
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 likely to cause Legionnaire’s diseases also known as
Legionellosis, which is a typical form of pneumonia (Edelstein & Christian, 2015).
Plasmodium ovale
Yes or no, with reason:
No, Plasmodium ovale is a malarial parasite causing tertian malaria in humans.
Conjunctivitis can never be caused due to P. Ovale (Strydom, Ismail & Frean, 2014).
Adenovirus
Yes or no, with reason:
No, Although Viral conjunctivitis are mainly caused by Adenovirus. Viral conjunctivitis
normally exhibits watery discharge and not sticky discharge (Willey, 2014). Furthermore
John had been prescribed with gentamycin, which is an antibiotic and probably will not
work if the infection is a viral infection.
Staphylococcus aureus
Yes or no, with reason:
Yes, the eye infection has been caused by Staphylococcus aureus, because bacterial
conjunctivitis caused purulent, sticky discharge. Whereas viral conjunctivitis causes watery
discharge. Treatment of bacterial conjunctivitis is mainly accomplished with topical

antibiotics like gentamycin. It can cause crusts and flakes around the eyelid border (Nash,
Dalziel & Fitzgerald, 2015).
2. Mechanism of action and adverse reactions (Total: 5 marks)
2.1 Describe the mechanism of action of gentamicin?
Gentamycin is a bactericidal antibiotic that ceases bacterial protein synthesis by binding to
the 30 S unit of ribosome, thus stopping protein synthesis. Thus an incorrect tRNA pairs
with an mRNA codon at the aminoacyl site of the ribosome, signalling the ribosome to
reject the aminoacylated tRNA and the elongation factor complex (Ridolo et al., 2016). As
a result incorrect aa-tRNA is accepted and wrong protein is synthesised. Proteins are not
translated and folding does not takes place causing the bacteria to die (Bassyouni et al.,
2015).
2.2 Name two adverse reactions of this drug?
Anaphylactic reactions and kidney damage (Henao et al., 2016).
Allergic reactions like maculopapular rashes, non-immediate urticarial, toxic epidermal
necrolysis, oedema, rash, itching and gastrointestinal diseases (Henao et al., 2016).
.
3. Physiological basis of signs (Total: 10 marks)
3.1 sign 1:
Red and swollen eye
Explanation of this phenomenon:
Redness and swelling are common mechanisms involved as a consequence of the
inflammatory response generated in the body. The surface tissue present in the eye and
ocular adenexa are colonised by normal flora like Streptococci. The eye becomes swollen
mainly due to inflammation in the eye (Nash, Dalziel & Fitzgerald, 2015). During the
inflammation, chemical mediators like histamine is secreted that causes swelling of the
blood vessels and causes the mucous membrane to be itchy. Swelling is caused due to
the accumulation of fluid and white blood cells. Redness at the site is caused due to the
increased blood flow at the inflamed site (Nash, Dalziel & Fitzgerald, 2015).
3.2 sign 2:
Purulent discharge from the eyes
Explanation of this phenomenon:
Inflammation of eye due to the colonisation of the bacteria can result in the dilation of the
conjunctival vessels causing the oedema and hyperaemia in the conjunctiva. Purulent
discharge is a sign of an infection. This eye discharge is a function of the tear film and is
necessary for the good health of the eye. But the difference in the consistency can

indicate towards any infection (Gupta, McGrath, Bibbo & Wilbur 2014). The discharge
becomes thick because of the dead germ cells as well as the accumulation of white blood
cells like the neutrophils, the macrophages and the cell debris. The white blood cells
accumulate to fight against bacteria (Gupta, McGrath, Bibbo & Wilbur 2014). The
accumulation of the white blood cells is an important part of infection. These discharges
might get accumulated around the eye and surrounding the eye lids.
3.3 sign 3:
Pain
Explanation of this phenomenon:
Pain is a common consequence, when an inflammatory responses is generated in the
body. Conjunctivitis is caused due to the inflammation in the eyes, caused due the
colonisation of staphylococcus aureus (Willey, 2014). Inflammatory response by the
body’s defence system is mainly caused due to the colonisation. During the inflammatory
response chemical mediators such as histamines and bradykinin is secreted by the body.
These mediators stimulates the nerve endings causing pain in the location. Again, there
are reports where it has been found that bacteria induces calcium fluxes and some other
changes in the sensory neurons causing pain. Hence, pain can be correlated to the
amount of bacteria present (Gupta et al., 2017).
4. Infection control issues (Total: 5 marks)
4.1 Issue 1:
Lack of proper hand hygiene
Discussion as to why this is an issue:
Touching the eyes, with hand that is not clean can helps in spreading conjunctivitis
infection. Hand to hand contact with the infected person and then touching the eye with
the infected hand can spread infection (Kluwer, 2017). Tears, eye discharge contains
pathogens which can be transferred to the hands while touching them with hand.
4.2 Issue 2:
Lack of the proper cleanliness
Discussion as to why this is an issue:
In aged care, the caregivers not paying attention to the health and hygiene can contribute

towards the development of conjunctivitis. It is the duty of the caregivers to maintain a
proper cleanliness while grooming the patients (Alfonso, Fawley & Lu, 2015). Proper
cleansing of the eye and using separate equipment by the infected person, discarding
soiled and used clothes- all these needs to be monitored by the caregivers of the aged
care sector. It should be monitored that the patient remains isolated from the other
patients as long the infection does not get cured (Kluwer, 2017). Normally, individuals
suffering from conjunctivitis should wash their hands with soap and warm water for at least
20 seconds. Failure to follow such protocols might have spread the infection or residents
sharing same eye dispenser or dropper for the infected eye might have caused the spread
of infection.
5. Transmission of infection (Total: 5 marks)
5.1 Describe transmission from John to Mary:
Transmission of bacterial conjunctivitis can take place from direct contact of the infected
hand with the eye or any objects that are contaminated with the bacteria. Contact with
infectious tears, faecal matters, eyes and respiratory discharge can infect or contaminate
the hands (Malu, 2014). Direct skin, contact with the infected person, like shaking of
hand, eating using same utensils or sharing same visual devices has been found to be
responsible for the transmission of the disease (Kluwer, 2017). Hence, John might have
got in contact with Mary such as shaking hand or touching might have led to the
transmission of the infections. Again, carers caring for John can also be responsible for
transmitting the infection, by not changing the gloves after attending John. They might
have used the same infected gloves while attending Mary. Used gloves needs to be
disposed off and other contaminated items like hand towels, wash cloths, pillow cases
should be washed with warm water and detergents (Kluwer, 2017).
6. Breaking the chain of infection (Total: 5 marks)
6.1 Identify procedure 1:
The chain of reaction can be broken at some of the points, one such point at which the
chain of reaction can be broken is elimination of the reservoir, before, it is transmitted to
some other healthy person (Kluwer, 2017).
Describe how this effectively breaks the chain of infection:

In bacterial conjunctivitis the reservoir includes the places, where the germs survive and
grow. The most important reservoir for bacterial conjunctivitis are the people who are sick
and healthy. The pathogen transmitted at the time of health care derive primarily from the
human resources. The human resources consisted of the patients, health care personnel,
the household members and the other visitors (Kluwer, 2017). Elimination of the resources
in this heath care setting includes proper handling and disposing of the body fluids
carefully, proper disposal of the soiled dressings, drying of the equipment before storing
them and encouraging the infected person to stay isolated for few days, as the disease is
contagious (Gupta et al., 2017).
6.2 Identify procedure 2:
Another control point for breaking the chain of reaction includes controlling the means of
transmission (Willey, 2014).
Describe how this effectively breaks the chain of infection:
The ways of transmission is the weakest link of the chain of infection. Spreading of
conjunctivitis can be facilitated both by direct as well as indirect contact. This chain of
reaction can be broken by thorough cleansing and disinfection (Nash, Dalziel & Fitzgerald,
2015). Health care personnel should maintain proper hand hygiene by using disinfectants,
right after physical examination of the patient (Carroll, Butel & Morse, 2015). It should be
noted by the caregivers that the patients do not exchange glasses or makeup items can
lead to the transmission of the bacteria. While examining the eyes of the patient, or while
cleaning them, the health care personnel should be donned with the necessary personal
protective equipment like gloves (Alfonso, Fawley & Lu, 2015).
7. Presentation (Total: 5 marks)
7.1 Referencing in-text and in reference list conforms to APA 6th Ed. referencing style.
7.2 Critique supported by relevant literature as prescribed.
7.3 Correct sentence structure, paragraph, grammatical construction, spelling, punctuation
and presentation.

References
Alfonso, S. A., Fawley, J. D., & Lu, X. A. (2015). Conjunctivitis. Primary Care: Clinics in Office
Practice, 42(3), 325-345. DOI: https://doi.org/10.1016/j.pop.2015.05.001
Bassyouni, R. H., Abdelfattah, M. M., Kamel, Z., Mostafa, E. M., Fahmy, I. A., & Elborgy,
E. S. (2015). Conjunctival microbiota and antibiotic resistance pattern in patients
submitted to cataract surgery and antibacterial activity of some plant essential oils.
The Egyptian Journal of Medical Microbiology, 38(3293), 1-9.
Carroll, K. C., Butel, J., & Morse, S. (2015). Jawetz Melnick and Adelbergs Medical Microbiology 27 E.
McGraw-Hill Education.
Edelstein, P. H., & Christian, L. Ü. C. K. (2015). Legionella. In Manual of Clinical Microbiology,
Eleventh Edition (pp. 887-904). American Society of Microbiology.
Gupta, P. K., McGrath, C., Bibbo, M., & Wilbur, D. (2014). Microbiology, inflammation and viral
infections. Comprehensive cytopathology. 4th ed. Philadelphia (PA): Saunders, Elsevier, 82-
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Henao, C., Morales, C., Villa, R. C., & Henao, A. (2015). Gentamicin induced Anaphylaxis, a case
report. The World Allergy Organization Journal, 8(Suppl 1), A269. doi:10.1186/1939-4551-8-
S1-A269
Kluwer, M. W. (2017). Medical microbiology. Indian Journal of Medical Microbiology, 35(1).
Malu, K. N. (2014). Allergic conjunctivitis in Jos-Nigeria. Nigerian medical journal: journal of the
Nigeria Medical Association, 55(2), 166. doi: 10.4103/0300-1652.129664
Nash, A. A., Dalziel, R. G., & Fitzgerald, J. R. (2015). Mims' pathogenesis of infectious disease.
Academic Press.
Ridolo, E., Montagni, M., Caminati, M., Senna, G., Incorvaia, C., & Canonica, G. W. (2014). Emerging
drugs for allergic conjunctivitis. Expert opinion on emerging drugs, 19(2), 291-302.
https://doi.org/10.1517/14728214.2014.902443
Strydom, K. A., Ismail, F., & Frean, J. (2014). Plasmodium ovale: a case of not-so-benign tertian
malaria. Malaria journal, 13(1), 85.
Willey, J. (2014). Prescott’s microbiology-/Joanne M. Willey, Linda M. Sherwood, Christopher J.
Woolverton. MacGraw-Hill, New York.