Haemolacria: a case of pseudomembranous conjunctivitis in a neonate.

We report an unusual case of an 11-day-old neonate presenting with haemolacria on a background of sticky conjunctival discharge. This was secondary to Chlamydia pseudomembranous conjunctivitis which responded well to systemic erythromycin. Early appropriate treatment is important to prevent progression of the ophthalmic infection, which could lead to blindness, and to prevent other manifestations of neonatal chlamydial infection, particularly pneumonia, which could be fatal. Management also includes treating the mother and educating about sexually transmitted infections.

Conjunctival fibrosis and the innate barriers to Chlamydia trachomatis intracellular infection: a genome wide association study.

Chlamydia trachomatis causes both trachoma and sexually transmitted infections. These diseases have similar pathology and potentially similar genetic predisposing factors. We aimed to identify polymorphisms and pathways associated with pathological sequelae of ocular Chlamydia trachomatis infections in The Gambia. We report a discovery phase genome-wide association study (GWAS) of scarring trachoma (1090 cases, 1531 controls) that identified 27 SNPs with strong, but not genome-wide significant, association with disease (5 × 10(-6) > P > 5 × 10(-8)). The most strongly associated SNP (rs111513399, P = 5.38 × 10(-7)) fell within a gene (PREX2) with homology to factors known to facilitate chlamydial entry to the host cell. Pathway analysis of GWAS data was significantly enriched for mitotic cell cycle processes (P = 0.001), the immune response (P = 0.00001) and for multiple cell surface receptor signalling pathways. New analyses of published transcriptome data sets from Gambia, Tanzania and Ethiopia also revealed that the same cell cycle and immune response pathways were enriched at the transcriptional level in various disease states. Although unconfirmed, the data suggest that genetic associations with chlamydial scarring disease may be focussed on processes relating to the immune response, the host cell cycle and cell surface receptor signalling.

Can chlamydial conjunctivitis result from direct ejaculation into the eye?

The majority of cases of chlamydial conjunctivitis are thought to result from autoinoculation by the patient of infected genital secretions from themselves or their sexual partners. We noted that some patients had developed symptoms following direct ejaculation into the affected eye. We describe four cases of chlamydial conjunctivitis following ejaculation of semen directly into the eye, which have not been previously described. In only one case was chlamydia detected in the genital tract. In three cases, there was no evidence of genital chlamydial infection; the sources of the eye infection being either from infected genital material of their sexual partners transferred by hands to the eyes, or more likely from direct ejaculate inoculation. It is likely that this mode of transmission is underestimated as a history of ejaculation into the conjunctiva is not normally asked for.

Prevalencia de chlamdia trachomatis en conjuntivitis neonatal determinada mediante las técnicas de inmuno-fluorescencia y amplificación génica / Indirect fluorescence and genic amplification for the determination of chlamydia trachomatis prevalence in neonatal conjunctivitis

Backgrund: Chlamydia trachomatis is one of the most common identifiable infectious agents in neonatal conjunctivitis. It also causes pneumonitis, that is preceded by conjunctivitis in one third of cases. Aim: To asses the prevalence of Chlamydia trachomatis in newborns with conjunctivitis. Patients and methods: In 162 newborns, coming from 14 Primary Health Centers from Santiago de Chile, C. trachomatis was detected by indirect fluorescence and two polymerase chain reaction (PCR 1 and 2), wich amplified different sequences from the common endogenous plasmid. Those patients with positive indirect fluorescence and PCR 2 were definedas infected: Results: The prevalence of C. trachomatis was 8 percent, and the distribution of the positive cases was similar in the different Health Centers. Other isolates were: S. aureus (9.8 percent), S. pneumoniae (8 percent), S. viridans (6.2 percent) y H. influenzae (5.5 percent). Conclusions: The prevalence of C. trachomatis in neonatal conjunctivitis in Chile is similar to that of developed countries. Therefore, C. trachomatis should be considered in the election of antimicrobials for the treatment of neonatal conjunctivitis, to avoid ocular and respiratory complications

[Clinical and laboratory assessment of therapeutic efficacy of maxaquin in treatment of chlamydial conjunctivitis]. / Kliniko-laboratornaia otsenka terapevticheskoi effektivnosti preparata maksakvin v lechenii khlamidiinykh koniunktivitov.

Maxaquin (lomefloxacin), a new fluoroquinolone antibiotic, was used in combined therapy of chlamydial conjunctivitis. The results of treatment of 72 patients were assessed by the clinical manifestations and the laboratory time course of Chlamydia trachomatis antigen in smears from the conjunctiva, detected by enzyme immunoassay. Clinical and laboratory findings proved the high efficacy of the drug and its advantages over traditional therapy and other fluoroquinolones.

Chlamydia trachomatis conjunctivitis. Prevalence and association with genital tract infection.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis in acute conjunctivitis (non-trachoma) in Australia and to examine the source of transmission. DESIGN: A prospective survey of 400 consecutive patients presenting with acute conjunctivitis to the Royal Victorian Eye and Ear Hospital Emergency Department, Melbourne, from May to November 1991. Patients identified with chlamydial conjunctivitis during the survey period and in the following two months were assessed for concomitant genital infection. RESULTS: Chlamydia was the causative organism in 2% of patients with acute conjunctivitis. Of 15 patients with chlamydial conjunctivitis, 11 presented with disease in one eye only, and the same number had had symptoms for longer than two weeks. Many had been seen previously by experienced ophthalmologists, yet there were long delays in making a definitive diagnosis. Ten of the 12 adult patients who were assessed had signs of concomitant genital tract infection, although none had past or current genital tract symptoms. Serotyping of chlamydial isolates from the genital tract and eye showed concordance in individual patients. CONCLUSION: Most cases of ocular chlamydia infection have a genital source. Therefore, it is essential that all patients with chlamydial conjunctivitis and their sexual partners are examined and treated for concomitant genital infection.

Conjuntivitis de inclusión / Inclusion conjunctivitis

De 1973 a 1990 se estudiaron en el Servicio de Microbiología e Inmunología del H.N.G.A.I. trescientos casos diagnosticados como conjuntivitis, de los cuales treinta correspondieron a "Conjuntivitis de inclusión". En estos pacientes se encontraron cuerpos de inclusión y los test de inmunofluorescencia dieron resultados positivos, oscilando sus títulos entre 1/64 y 1/1024.

Genital infection with Chlamydia trachomatis in patients with chlamydial conjunctivitis: unexplained results.

It is generally believed that a chlamydial eye infection in adults is the result of autoinoculation of the eye by infected genital secretion. Genital samples of 60 microbiologically verified, adult, non-trachomatous chlamydial conjunctivitis cases were investigated. Only two of the 38 men and none of the 22 women tested had symptoms of genital infection when the sampling was made for establishing the diagnosis of chlamydial infection. Of the men, 23 (61%), 20 (53%), 19 (50%), and 20 (53%) were positive in urethral samples by culture, ELISA (Chlamydiazyme, Abbott, USA), and immunofluorescence tests (Chlamyset, Orion, Finland and MicroTrak, Syva, Finland), respectively. The corresponding figures for the female urethral samples were 12 (55%), 11 (50%), 9 (41%), and 12 (55%) and for the cervical samples 15 (68%), 15 (68%), 14 (64%), and 14 (64%), respectively. Thirty-nine mothers to neonates with chlamydial conjunctivitis were also studied. In 34 (87%) of the mothers, a genital chlamydial infection could be verified. It has been a general belief that the eye in chlamydial conjunctivitis in adults is generally infected by autoinoculation of infected genital secretion. Different means to explain the discrepancy between the results of the diagnostic tests for the eye and genital samples are considered.

[Sexually transmitted diseases and mother-infant transmission (epidemiology and prevention)]. / Les maladies sexuellement transmissibles et le couple mère-enfant. (Epidémiologie et prévention).

Gonococcal ophthalmia neonatorum may be severe with a high risk of blindness; therefore prophylaxis is mandatory. Chlamydial ophthalmia is less severe and prevention remains less effective. Both microorganisms may be responsible of preterm labour and perinatal deaths. Congenital syphilis is an important public health problem in developing countries. Some recent papers underline the decrease of infestation when mothers may be screened during pregnancy (at least two times in initially seronegative mothers) and correctly treated by beta-lactamines.

Chlamydia trachomatis infections: a health problem of infants.

As a result of chlamydia epidemic in the adult population, the incidence of Chlamydia trachomatis in infants is increasing. Certain population groups are at risk for development of an infection. This article discusses the epidemiology, microbiology, symptomatology, and management of this problem.

Chlamydia trachomatis infections in infants.

In recent years considerable progress has been made in understanding chlamydial infections. The spectrum of pediatric Chlamydia trachomatis infection includes neonatal inclusion conjunctivitis, infantile pneumonia, occasional respiratory or genital tract infections in older children and sexually transmitted diseases in adolescents. The role of maternal chlamydial infection in prematurity and in perinatal death is currently an area of active study. We outline the current knowledge of the biologic characteristics of C. trachomatis, the epidemiologic features of chlamydial infection, and the clinical aspects, diagnosis and treatment of neonatal chlamydial infections.

Chlamydia trachomatis na patoologia médica: revisäo / Chamydia trachomatis in the medical patologic

Clamídias säo bactérias que, no homem, provocam: tracom ocular, tracoma genital, conjuntivite de inclusäo, linfogranuloma venéreo, síndrome de Reiter e a psitacose. É a maior causa de doença sexualmente transmitida, especialmente entre adolescentes e adultos jovens. No presente trabalho säo estudados, além de outros, os aspectos morfológicos, patogênicos e epidemiológicos

[Ophthalmia neonatorum]. / Ophthalmia neonatorum.

Silver nitrate prophylaxis against ophthalmia neonatorum due to Neissera Gonorrhoeae was introduced by Crédé in 1884, when he instilled a drop of 2% silver nitrate into the cul-de-sac of a newborn. Today, the prime cause of ophthalmia neonatorum is infection by Chlamydia trachomatis. The high incidence of this type of conjunctivitis is due to the frequent exposure of the newborn during delivery and to the ineffectiveness of silver nitrate as a prophylaxis against Chlamydia. In the study reported here, 198 infants less than one month old were examined because of severe bilateral conjunctivitis. In the first week of life a chemical irritation caused by Crédé's prophylaxis was found in the majority (59.7%), but in the second and third weeks infections with Chlamydia trachomatis were found in 27% of all cases. Bacteria were responsible for the infection in 52% of the cases. No gonococci were found in any of the patients examined in the course of the study.