Conjuntivitis folicular crónica en el lactante / New born chronic follicular conjunctivitis

Caso clínico: Se presenta un caso de conjuntivitis folicular crónica del lactante que debuta como ptosis y dacriorragia. Mediante técnica de reacción en cadena de polimerasa (PCR) se diagnosticó Chlamydia trachomatis como agente etiológico y se trató con eritromicina tópica y sistémica. El contagio se produjo en el canal del parto. Discusión: La conjuntivitis de inclusión del lactante es muy infrecuente en nuestro medio. El método diagnóstico más sensible y específico es la PCR. Se debe identificar la fuente de contagio y hacer un tratamiento precoz y completo de todos los portadores para evitar las complicaciones de la cronicidad

Case report: A case of chronic follicular conjunctivitis in an infant presenting with ptosis and dacryorrhea is reported. Polymerase chain reaction (PCR) test identified Chlamydia trachomatis as the causative agent. The patient was treated with topic and systemic erythromycin. The infection was probably transmitted during delivery. Discussion: Chronic follicular conjunctivitis in infants is very uncommon in our environment. The most sensitive and specific diagnostic test is PCR. It is necessary to identify the original focus of infection and to provide specific treatment to all the carriers as soon as possible to avoid and prevent chronic complications (Arch Soc Esp Oftalmol 2008; 83: 559-562)

Conjuntivitis postnatal en un paciente premature causada por cytomegalovirus / Cytomegalovirus induced postnatal conjunctivitis in a premature patient

El citomegalovirus (CMV) constituye en la actualidad el principal virus causante de infecciones congénitas, neonatales y perinatales en la población pediátrica sana. La conjuntivitis por CMV es una entidad muy poco frecuente apenas recogida en la literatura. Se presenta ocasionalmente en niños inmunodepremidos con procesos leucémicos. También se ha podido detectar la presencia de CMV en las lágrimas de pacientes con mononucleosis por CMV, enfermos de SIDA y pacientes sometidos a trasplante renal. Se presenta un caso de conjuntivitis neonatal en un paciente con presencia del virus en el tracto respiratorio y orina. Debido a que el proceso inflamatorio y el aislamiento viral sólo se detectó en un ojo, se postula la posibilidad de que el proceso de autoinoculación a través de las manos del paciente sea la causa del proceso (AU)

Cytomegalovirus (CMV) is actually the principal viral etiological agent of congenital, neonatal and perinatal infections in healthy pediatric patients. The conjunctivitis caused by CMV is an infrequent pathology described in the literature. This entity has been occasionally described inimmunossuppresed children with leukemic processes. The virus could be detected in the tears of CMV mononucleosis children, AIDS patients and patients with kidney transplants. We report a neonatal CMV conjunctivitis in a child with this virus in the respiratory tract and urine. Because the inflammatory process and the viral isolation could be detected in one eye only, we postulated that the auto-inoculation, with hands, could be the cause of the conjunctivitis process (AU)

Síndrome de Goldenhar. Manifestaciones intraútero y tras nacimiento / Goldenhar syndrome. Intrauterine and postnatal features

El síndrome de Goldenhar fue descrito por primera vez en 1952 por Maurice Goldenhar como la asociación entre diferentes anomalías de la región facial, frecuentemente oculares y auriculares. Debido a la complejidad de sus manifestaciones, es conocido como displasia óculo-aurículo-vertebral (AU)

Goldenhar syndrome was first described in 1952 by Maurice Goldenhar as the association of various facial anomalies. The most frequent anomalies are ocular and auricular. Due to the complexity of its manifestations, this syndrome is also known as oculo-auriculo-vertebral dysplasia (AU)

[Ocular signs in Rubinstein-Taybi's syndrome]. / Semne oculare în sindromul Rubinstein-Taybi.

Rubinstein-Taybi syndrome, known also as "Broad Thumb-Hallux syndrome", was first recognized by Rubinstein and Taybi in 1963 and is characterized by somatic and ophthalmologic signs. Most commonly somatic changes are: broad thumbs and hallux, craniofacial dysmorphism, growth and psychomotor retardation. Most frequently reported eye anomalies are: antimongoloid slant of the palpebral fissures, strabismus, congenital obstruction of the lacrimal excretory system, colobomas of the iris and of the optic nerve head, ametropia.

The importance of prenatal factors in childhood blindness in India.

The causes of visual loss in 1411 children attending schools for the blind in different geographical areas in India are described. Ninety-three percent (1318) of the children were severely visually impaired (SVI) or blind (i.e. corrected acuity in the better eye of <20/200 [<6/60]). In 60% of SVI/blind children vision loss was attributable to factors operating in the prenatal period, in 47% the prenatal factors were known and definite, and in 13% prenatal factors were the most probable causes. Hereditary retinal dystrophies and albinism were seen in 19% of SVI/blind children and 23% had congenital ocular anomalies. There were variations in the relative importance of different causes by state. The observed pattern of causes of visual loss is intermediate between those seen in industrialised countries and in the poorest developing countries. This suggests that strategies to combat childhood blindness in India need to address concurrently both preventable and treatable causes. The need for aetiological studies, particularly on anophthalmos and microphthalmos, is highlighted.

PIP: A cross-sectional study of 1411 children 3-15 years of age attending schools for the blind in 9 states of India in 1993 investigated the causes of visual impairment. 113 of these children (8%) were severely visually impaired and 1205 (85%) were blind. Severe visual impairment or blindness was hereditary in 23% of cases, attributable to intrauterine factors in 2%, related to perinatal factors in 1%, acquired postnatally in 28%, and of undetermined etiology in 46%. The most common mode of inheritance in hereditary cases was autosomal recessive (52%). Retinal dystrophies and albinism together accounted for 84% of hereditary disorders. Vitamin A deficiency was implicated in 19% of cases. If children with congenital anomalies were combined with those in whom definite hereditary or intrauterine factors were identified, 47% of all cases of severe visual impairment and blindness in this study were attributable to prenatal factors. This rate increases to 60% if undetermined cases presumed to involve prenatal factors are included. The 4 major causes of visual impairment and blindness were vitamin A deficiency, congenital ocular anomalies, inherited retinal dystrophies, and cataract. There were variations in the relative importance of these causes by state. The observed pattern of causes of visual loss is intermediate between those seen in developed countries and the poorest developing countries. Strategies to combat childhood blindness in India should address both preventable and treatable causes. Of particular importance in India, given the high proportion of autosomal recessive disorders, is education about the risks involved in consanguineous marriages.

Corneal blindnesses in tropical environment.

Corneal blindnesses make up a main public health problem in numerous developing countries where they constitute a sign of low sanitary level. The main diseases which cause corneal blindnesses are: Trachoma. Xerophthalmia. Measles. Corneal ulcerations and keratitis. Onchocercosis. Neonatorum ophthalmia. Leprosy. Injuries. Some therapeutic practices. Epidemiological analysis leads to the definition of risk groups: Small children. Isolated rural communities. Unhealthy urban communities. Out of place populations. Under-fed populations. Only a joint prevention can be able to fight against this social, economic, a human plague constituted by corneal blindnesses. Simple prevention measures which are often not very expensive, showed their efficiency. They are as follows: Individual and collective hygiene measures. Improvement of alimentary conditions. Earliness and quickness in ocular care. Vaccination against measles. Improvement of the care to mother and child. Sanitary education for prevention. These prevention tasks are supported by the health workers who are spread out inside the population. Their formation, the means they are granted with constitute a main priority which has to be taken into account in the choices and the decisions to be made in order to fight against blindness linked with cornea opacification with efficacy.

Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis.

Among 149 consecutive infants with ophthalmia neonatorum in Nairobi, Neisseria gonorrhoeae was recovered from 43%, Chlamydia trachomatis from 13%, and both microorganisms from 4%. Three of five isolates of C. trachomatis belonged to trachoma serovars. The sensitivity and specificity of a gram-stained smear for the diagnosis of gonococcal conjunctivitis were 86% and 90%, respectively. Patients with gonococcal conjunctivitis had more purulent discharge, a higher clinical severity score, and a younger age at onset of disease. Corneal epithelial edema with superficial keratitis was present in four (16%) of 25 patients with gonococcal conjunctivitis but in none of 22 other patients (P = .07). N. gonorrhoeae or C. trachomatis was isolated from the pharynx in 11 (15%) and six (23%) cases, respectively. Oropharyngeal gonococcal infection was associated with coughing (P = .007).

Subclinical pneumonia due to serotypes D-K of Chlamydia trachomatis. Case reports of two infants.

Pneumonia due to serotypes D-K of Chlamydia trachomatis occurred in a 10-week-old baby, who had been successfully treated with chlortetracycline eye ointment for chlamydial ophthalmia neonatorum, and in a 7-week-old baby being treated for the same condition. Clinical signs of pneumonia were minimal. Such chlamydial pneumonia in infants must be under-diagnosed. Infants with chlamydial ophthalmia neonatorum are now routinely treated with erythromycin suspension by mouth in addition to chlortetracycline eye ointment.

Staphylococcal ophthalmia neonatorum and the staphylococcal scalded skin syndrome.

A 3-week-old infant had neonatal ophthalmia neonatorum, treated in a routine manner which rapidly developed into an advanced case of staphylococcal scalded skin syndrome. The infant had sudden onset of widespread erythematous and tender areas of skin with subsequent exfoliation of large surface areas. We emphasize the recognition of this syndrome and the understanding that it may rapidly become a serious consequence of staphylococcal ophthalmia neonatorum. We stress the need for initial microbiologic studies and early antibiotic therapy for ophthalmia neonatorum.