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Moraxella catarrhalis
17%
16/96
Neisseria meningitidis
4%
4/96
Pseudomonas aeruginosa
3%
3/96
Staphylococcus aureus
Streptococcus agalactiae
71%
68/96
Select Answer to see Preferred Response
This patient is presenting with ear pain and a bulging tympanic membrane which is concerning for a middle ear infection. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common causes. Acute otitis media can present with a fever, ear pain, and a bulging tympanic membrane. Sudden pain and ringing in the ear followed by relief of symptoms can occur if the tympanic membrane ruptures. Children are more prone to middle ear infections due to the anatomy of their Eustachian tube, which may prevent proper middle ear aeration and drainage. Diagnosis is usually performed by visualizing the tympanic membrane (though pneumatic otoscopy can also be performed). Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common causes of acute otitis media. The treatment of this condition can involve observation for 24-48 hours to see if it improves. Antibiotics are recommended in children younger than 6 months of age and in children 6 months to 2 years of age if the diagnosis is certain. Otherwise, observation for 24-48 hours is appropriate to monitor for symptom improvement followed by treatment with amoxicillin if symptoms persist. Incorrect Answers: Answer 2: Neisseria meningitidis is a common cause of meningitis which would present with a fever, headache, photophobia, meningeal signs, and a lumbar puncture demonstrating low glucose, high protein, and high neutrophils. Answer 3: Pseudomonas aeruginosa is a possible cause of malignant otitis externa which presents with ear canal drainage and severe pain with a fever in an elderly/immunocompromised patient. Answer 4: Staphylococcus aureus is a common cause of many dermatologic and systemic infections. Antibiotics that cover for MRSA include vancomycin, linezolid, and daptomycin. Answer 5: Streptococcus agalactiae can cause several bacterial infections of the newborn including sepsis, pneumonia, and meningitis in mothers who are not treated for group B streptococcus prior to delivery. Bullet Summary: Otitis media is commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
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