Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns.

BACKGROUND: Neonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due to Chlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established. OBJECTIVE: To examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC and C. trachomatis in the nasopharynx. METHODS: A literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers for C. trachomatis with results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested for C. trachomatis in the eye/ nasopharynx (NP). RESULTS: The search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates of C. trachomatis conjunctivitis in infants in included studies who received silver nitrate was 20-33%; positive NP, 1-28% and pneumonia, 3-8%. Rates of C. trachomatis conjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0-15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4-33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0-4% developed chlamydial pneumonia. CONCLUSION: Neonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers with C. trachomatis infection compared to silver nitrate.

Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010-2015.

Perinatal transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) can result in conjunctivitis in infants. We examined national rates of reported CT/GC conjunctivitis among infants. Surveillance of these infections is heavily affected by the completeness of reported data on specimen source and age. Alternative data sources should be evaluated.

The verification of nucleic acid amplification testing (Gen-Probe Aptima Assay) for chlamydia trachomatis from ocular samples.

OBJECTIVE: Chlamydia trachomatis conjunctivitis may present with extended symptoms, and it can have social ramifications as a sexually transmitted disease. For appropriate therapy, C. trachomatis conjunctivitis should be diagnosed definitively. This study presents the verification of nucleic acid amplification testing (NAAT; Gen-Probe Aptima Combo 2 assay) for detection of C. trachomatis ribosomal RNA (rRNA) from direct ocular samples. DESIGN: Retrospective laboratory verification study. SUBJECTS: Patients with infectious conjunctivitis. METHODS: A battery of 25 true-positive specimens (direct ocular specimens from patients with symptoms consistent with C. trachomatis conjunctivitis and with previously demonstrated positive polymerase chain reaction [PCR] results for C. trachomatis DNA by Roche Amplicor) and 25 true-negative specimens (direct ocular specimens with culture-positive results for herpes simplex virus [n = 5], adenovirus [n = 5], Haemophilus influenzae [n = 5], and Streptococcus pneumoniae [n = 5]), and transport medium (n = 5) were tested for C. trachomatis rRNA by NAAT. These true-negative specimens have differential etiologic agents of infectious conjunctivitis. The 25 C. trachomatis specimens with PCR-positive results (obtained May 1994-May 2012) and 20 true-negative infectious ocular specimens (obtained December 2008-August 2013) were collected with soft-tipped applicators and placed in transport medium. All excess specimens were stored at -80°C. All samples were centrifuged at 13,000 rpm for 1 hour at 6°C. For each sample, using the Aptima Unisex collection blue swab, a specimen was collected from the conical apex of the storage tube where a pellet was formed. The Aptima Unisex collection swab was placed in a tube of Aptima swab transport medium for testing. All samples were tested in duplicate. MAIN OUTCOME MEASURES: Detection of C. trachomatis rRNA. RESULTS: Of 25 true-positive samples, 24 (96%) were positive by NAAT, whereas 25 of 25 true-negative samples (100%) showed negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were determined to be 96%, 100%, 100%, 96%, and 98%, respectively. CONCLUSIONS: The detection of C. trachomatis in ocular specimens by NAAT was verified for laboratory diagnosis. The test will be evaluated prospectively to determine future test performance precisely.

Conjunctival infection with Chlamydia trachomatis in sexual partners of patients with adult inclusion conjunctivitis.

To compare the incidence of conjunctival infection with Chlamydia trachomatis in sexual partners of patients with newly diagnosed adult inclusion conjunctivitis (AIC) and a control group with healthy eyes. We also compare the observed signs and symptoms of conjunctival infection in patients with newly diagnosed AIC and their sexual partners. We performed a prospective comparative case-control study between patients with newly diagnosed AIC confirmed with direct fluorescent antibody (DFA) (n = 11), their sexual partners (n = 11), and a control group of healthy subjects (n = 11). Clinical history, physical examination, and a DFA test for C. trachomatis of a conjunctival scrapping from the tarsal conjunctiva were performed in all patients. A significantly higher frequency of positive DFA tests for C. trachomatis was observed in the sexual partner group (n = 8, 73 %) compared with the healthy control group (n = 2, 18.2 %) (P = 0.03). Ocular symptoms and signs were observed significantly more often in patients from the confirmed clinically active AIC group (n = 11, 100 %) than in their sexual partners (n = 2, 12.5 %). Sexual partners of patients with AIC are at greater risk of having an asymptomatic conjunctival infection with C. trachomatis than healthy subjects. Sexual partners might be considered a bacterial reservoir and a possible source for chlamydia reinfection. Not treating sexual partners might increase the probability of reinfection. More extended studies with a greater sample size should be done.

A suitable and efficient optimization system for the culture of Chlamydia trachomatis in adult inclusion conjunctivitis.

The prevalence of Chlamydia trachomatis infection in the genitourinary tract is increasing, with an annual rise of 9 million cases. Individuals afflicted with these infections are at a heightened risk of developing adult inclusive conjunctivitis (AIC), which is commonly recognized as the ocular manifestation of this sexually transmitted infection. Despite its significant clinical implications, the lack of distinctive symptoms and the overlap with other ocular conditions often lead to underdiagnosis or misdiagnosis of AIC associated with C. trachomatis infection. Here, we established six distinct C. trachomatis culture cell lines, specifically highlighting the MA104 N*V cell line that exhibited diminished expression of interferon regulatory factor 3 (IRF3) and signal transducer and activator of transcription 1 (STAT1), resulting in reduced interferons. Infected MA104 N*V cells displayed the highest count of intracytoplasmic inclusions detected through immunofluorescence staining, peaking at 48 h postinfection. Subsequently, MA104 N*V cells were employed for clinical screening in adult patients diagnosed with AIC. Among the evaluated cohort of 20 patients, quantitative PCR (qPCR) testing revealed positive results in seven individuals, indicating the presence of C. trachomatis infection. Furthermore, the MA104 N*V cell cultures derived from these infected patients demonstrated successful cultivation and replication of the pathogen, confirming its viability and infectivity. Molecular genotyping identified four distinct urogenital serovars, with serovar D being the most prevalent (4/7), followed by E (1/7), F (1/7), and Ia (1/7). This novel cellular model contributes to studies on C. trachomatis pathogenesis, molecular mechanisms, and host-pathogen interactions both in vitro and in vivo. It also aids in acquiring clinically relevant strains critical for advancing diagnostics, treatments, and vaccines against C. trachomatis.

Multiplex PCR testing requires a robust multi-disciplinary strategy to effectively manage identified cases of chlamydial conjunctivitis.

INTRODUCTION: Implementation of an in-house polymerase chain reaction (PCR) multiplex assay by West of Scotland Specialist Virology Centre to improve sample processing means all viral eye swabs are now routinely tested for Adenovirus, Herpes simplex, Varicella and Chlamydia. Concern was raised regarding subsequent management and sexual health attendance for Chlamydia-positive patients identified in eye casualty. METHODS: A retrospective review of virology results identified 76 Chlamydia-positive patients from 1914 eye swabs (4%) from May 2007 to April 2008. Of these results, 12 originated from Glasgow eye casualty and available clinical notes were cross-referenced with the sexual health network (Sandyford). RESULTS: Identified issues included no documentation of implications of testing, poor communication of positive results and poor referral pathways to sexual health for assessment; all leading to inadequate management. A shared care network was created to address these issues. A designated sexual health advisor was identified to improve sexual health referral, specialist assessment, standardised management and contact tracing. Re-audit showed more consistent follow-up. CONCLUSION: New PCR technology has resulted in a shared care approach to address corresponding implications of testing. Effective communication with a structured protocol and a central point of contact has improved follow-up and ensures appropriate best practice management of chlamydial conjunctivitis.

[Purulent keratoconjunctivitis due to Neisseria gonorrhoeae and Chlamydia trachomatis coinfection]. / Conjunctivitis gonorrhoica szövodése Chlamydia trachomatis-infekcióval.

Gonococcal conjunctivitis is a rare infection induced by Neisseria gonorrhoeae and it usually manifests as a hyperacute purulent conjunctivitis. Ocular access of the infectious secretion during sexual intercourse is the way of transmission among adults. Inclusion conjunctivitis caused by the serovars D-K of Chlamydia trachomatis also affects the sexually active population. Authors present a case of a 33-year-old homosexual man who was treated for late latent syphilis formerly. Clinical symptoms were yellow purulent discharge for 3 weeks without any urological or upper respiratory tract symptoms. Conjunctival Neisseria gonorrhoeae and Chlamydia trachomatis infection was identified using cultures and polymerase chain reaction; pharyngeal swab culture and polymerase chain reaction showed positive results for both pathogens. The patient was probably under influence of party drugs at the time of sexual abuse when he became infected. After parenteral and oral cephalosporin and azithromycin therapy the patient had complete recovery within three weeks.

Effect of inflammatory response on in vivo competition between two chlamydial variants in the guinea pig model of inclusion conjunctivitis.

In order to study the interaction of variants in in vivo infection, we employed an azithromycin-resistant mutant (AZ(2)) and its wild-type parent (SP(6)) in the guinea pig model of Chlamydia caviae conjunctival infection. When each strain was inoculated individually into conjunctiva, both attained the same level of growth, but AZ(2) elicited less pathology. However, when equal numbers of the two strains were inoculated together into the guinea pig conjunctiva, SP(6) produced a significantly greater number of inclusion-forming units than AZ(2), and the pathology reflected that of a SP(6) monoinfection. The goal of this study was to further characterize the dynamics of concomitant infection of these two distinct variants, with particular emphasis on the impact of the host response on the in vivo growth of each organism and the development of pathology. Animals infected with AZ(2) had reduced conjunctival infiltration with CD45(+) cells and neutrophils as well as a reduced interleukin-8 (IL-8) response. Gene expression of gamma interferon (IFN-γ), tumor necrosis factor alpha (TNF-α), CCL2, and CCL5 was also significantly lower in AZ(2)-infected animals. The lower inflammatory response induced by AZ(2) was associated with its decreased ability to activate NF-κB via Toll-like receptor 2 (TLR2). In general, the inflammatory response in animals infected with both variants was greater than in infection with AZ(2) alone, resulting in lower numbers of AZ(2) than those of SP(6) in the mixed infection. Our results suggest that the ability to elicit an inflammatory response is an important factor in the dynamics of mixed infection with strains that display different pathological phenotypes.

Atypical ocular Chlamydia trachomatis infections in two patients attending in a second-level hospital: a case report.

AIM: To report two atypical inclusion conjunctivitis cases due to Chlamydia trachomatis in young adults. METHOD: Transcription mediated amplification for C. trachomatis was performed using Aptima Combo 2 Assay (Hologic, Spain). RESULTS: The first patient was managed as an orbital disorder because he had unilateral location, and ptosis was observed. Orbital nuclear magnetic resonance revealed normal results, and conjunctival biopsy did not indicate significant results. For the second patient, thyroid eye disease was suspected, but the orbital nuclear magnetic resonance revealed normal results. Conjunctival exudate samples were collected and sent to the Microbiology Laboratory where C. trachomatis was confirmed. Both patients demonstrated a great improvement with oral azithromycin 1 g. CONCLUSION: Inclusion conjunctivitis could present as unspecified unilateral or bilateral chronic conjunctivitis. Thus, suspecting it would be important in order to prevent spread and wasting diagnostic resources.

Clinical Presentation, Investigation and Control of an Outbreak of Adenoviral Conjunctivitis in a Neonatal Unit at a Tertiary Hospital.

BACKGROUND: Nosocomial spread of adenovirus infection has been reported in neonatal, pediatric and adult medical units. This nonenveloped and hardy virus is resistant to numerous disinfectants thus posing a challenge for control and prevention of adenovirus infections in health care settings. METHODS: An epidemiologic outbreak investigation revealed an adenoviral outbreak in the neonatal nursery as well as in the neonatal screening outpatient department for Retinopathy of Prematurity (ROP). All suspected cases (94 neonates) underwent adenoviral conventional polymerase chain reaction (PCR) and representative samples underwent sequencing by Sanger's method. The clinical features and disease course were studied. Infected babies were started on tobramycin eye drops. Topical steroid eye drops were added for those who developed pseudomembranes. RESULTS: We found 58 cases of laboratory-confirmed neonatal adenovirus conjunctivitis (between July 10 and October 24, 2019). Redness (96%) was the most common presentation followed by discharge (68.9%) and lid edema (51.7%). Pseudomembrane were seen in 77.5% of the infected neonates. Prior ROP examination was carried out in 38 (65.5%) neonates. Respiratory symptoms were present in 7 (12.06%) neonates. Sequencing revealed serotype 8 as the cause of the outbreak. Control measures were strictly implemented. Standard Operating Procedures (SOPs) for ROP screening were revisited, revised and reinforced to prevent future outbreaks. CONCLUSIONS: We observed ROP screening as a risk factor for the development of adenoviral conjunctivitis in neonatal care units. Neonates present with different clinical manifestations as compared with adults. Prompt control measures were implemented to control the adenoviral outbreak.

In vivo confocal microscopy in scarring trachoma.

OBJECTIVE: To characterize the tissue and cellular changes found in trachomatous scarring (TS) and inflammation using in vivo confocal microscopy (IVCM). DESIGN: Two complimentary case-control studies. PARTICIPANTS: The first study included 363 cases with TS (without trichiasis), of whom 328 had IVCM assessment, and 363 control subjects, of whom 319 had IVCM assessment. The second study included 34 cases with trachomatous trichiasis (TT), of whom 28 had IVCM assessment, and 33 control subjects, of whom 26 had IVCM assessment. METHODS: All participants were examined with ×2.5 loupes. The IVCM examination of the upper tarsal conjunctiva was carried out with a Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany). MAIN OUTCOME MEASURES: The IVCM images were graded in a masked manner using a previously published grading system evaluating the inflammatory infiltrate density; the presence or absence of dendritiform cells (DCs), tissue edema, and papillae; and the level of subepithelial connective tissue organization. RESULTS: Subjects with clinical scarring had a characteristic appearance on IVCM of well-defined bands and sheets of scar tissue visible. Similar changes were also seen in some clinically normal subjects consistent with subclinical scarring. Scarred subjects had more DCs and an elevated inflammatory infiltrate, even after adjusting for other factors, including the level of clinical inflammation. Cellular activity was usually seen only in or just below the epithelium, rarely being seen deeper than 30 µm from the surface. The presence of tissue edema was strongly associated with the level of clinical inflammation. CONCLUSIONS: In vivo confocal microscopy can be quantitatively used to study inflammatory and scarring changes in the conjunctiva. Dendritic cells seem to be closely associated with the scarring process in trachoma and are likely to be an important target in antifibrotic therapies or the development of a chlamydial vaccine. The increased number of inflammatory cells seen in scarred subjects is consistent with the immunopathologic nature of the disease. The localization of cellular activity close to the conjunctival surface supports the view that the epithelium plays a central role in the pathogenesis of trachoma. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparison of genovars and Chlamydia trachomatis infection loads in ocular samples from children in two distinct cohorts in Sudan and Morocco.

Trachoma is a blinding disease caused by repeated conjunctival infection with different Chlamydia trachomatis (Ct) genovars. Ct B genovars have been associated with more severe trachoma symptoms. Here, we investigated associations between Ct genovars and bacterial loads in ocular samples from two distinct geographical locations in Africa, which are currently unclear. We tested ocular swabs from 77 Moroccan children (28 with trachomatous inflammation-follicular (TF) and 49 healthy controls), and 96 Sudanese children (54 with TF and 42 healthy controls) with a Ct-specific real-time polymerase chain reaction (PCR) assay. To estimate bacterial loads, Ct-positive samples were further processed by multiplex real-time qPCR to amplify the chromosomal outer membrane complex B and plasmid open reading frame 2 of Ct. Genotyping was performed by PCR-based amplification of the outer membrane protein A gene (~1120 base pairs) of Ct and Sanger sequencing. Ct-positivities among the Moroccan and Sudanese patient groups were 60·7% and 31·5%, respectively. Significantly more Sudanese patients than Moroccan patients were genovar A-positive. In contrast, B genovars were significantly more prevalent in Moroccan patients than in Sudanese patients. Significantly higher Ct loads were found in samples positive for B genovars (598596) than A genovar (51005). Geographical differences contributed to the distributions of different ocular Ct genovars. B genovars may induce a higher bacterial load than A genovars in trachoma patients. Our findings emphasize the importance of conducting broader studies to elucidate if the noted difference in multiplication abilities are genovar and/or endemicity level dependent.

Reducing suspicion of sexual abuse in paediatric chlamydial conjunctivitis using ompA genotyping.

Chlamydia trachomatis is a Gram-negative bacterium that causes urogenital tract infections, and ocular infections including trachoma, neonatal conjunctivitis and adult chlamydial inclusion conjunctivitis. A positive C. trachomatis diagnosis in children often raises suspicions of sexual abuse. While outer membrane protein A (ompA) genotypes A-C are non-invasive and are associated with trachoma; ompA genotypes D-K are often associated with sexually transmitted urogenital infections or sexually acquired chlamydial conjunctivitis. A 10-year-old female presented with a 7-month history of unilateral conjunctivitis with itching, watering and hyperaemia. She had recently moved from an urban centre in Afghanistan to the UK. A conjunctival swab taken from the child tested positive for C. trachomatis Application of ompA genotyping to conjunctival swab chlamydial DNA demonstrated that the C. trachomatis had an ompA genotype C. Chlamydial strains with this ompA genotype cause trachoma and have never previously been associated with urogenital infection. This result supported cessation of child protection investigations.

Impact of azithromycin resistance mutations on the virulence and fitness of Chlamydia caviae in guinea pigs.

Azithromycin (AZM) is a major drug used in the treatment and prophylaxis of infections caused by Chlamydia, yet no significant clinical resistance has been reported for these obligate intracellular bacteria. Nevertheless, spontaneous AZM resistance (Azm(r)) arose in vitro at frequencies ranging from 3 x 10(-8) to 8 x 10(-10) for clonal isolates of Chlamydia caviae, which is a natural pathogen of guinea pigs. Sequencing of the unique 23S rRNA gene copy in 44 independent Azm(r) isolates identified single mutations at position A(2058) or A(2059) (Escherichia coli numbering system). While SP(6)AZ(1) (A(2058)C) and SP(6)AZ(2) (A(2059)C) Azm(r) mutants showed growth defects in cell culture and were less pathogenic in the guinea pig ocular infection model than in the parent SP(6), the three isogenic C. caviae isolates grew equally well in the animal. On the other hand, coinoculation of the C. caviae parent strain with one of the Azm(r) strains was detrimental for the mutant strain. This apparent lack of association between pathology and bacterial load in vivo showed that virulence of the two Azm(r) mutants of C. caviae was attenuated. While chlamydial growth in vitro reflects the ability of the bacteria to multiply in permissive cells, survival in the host is a balance between cellular multiplication and clearance by the host immune system. The obligate intracellular nature of Chlamydia may therefore limit emergence of resistance in vivo due to the strength of the immune response induced by the wild-type antibiotic-sensitive bacteria at the time of antibiotic treatment.

How much is not enough? A community randomized trial of a Water and Health Education programme for Trachoma and Ocular C. trachomatis infection in Niger.

SUMMARY OBJECTIVE: To determine the impact after 2 years of a water and health education (W/HE) programme on ocular Chlamydia trachomatis infection and trachoma. METHODS: We randomized 12 trachoma-endemic communities in Maradi, Niger 1:1 to W/HE intervention and control arms and collected data on 10 of the 12 villages. In the intervention villages, at least one clean water well was constructed, and a 3 month, modest health education programme was provided immediately prior to the 2 year survey. We censused all households, and 557 children ages 1-5 years were randomly selected as sentinel children and examined at baseline and at one and 2 years from baseline. Trachoma was clinically assessed and a swab taken and analyzed for C. trachomatis. Tetracycline eye ointment was provided to all children in either arm during the surveys who had signs of trachoma. RESULTS: Infection with C. trachomatis declined slightly, and not significantly, in the children in the control villages over the 2 years, from 15% to 11%. The decline in infection was more pronounced, and significant, in the children in the intervention villages, from 26% to 15%. However, the change in infection rates in the intervention villages was not significantly different from the change in infection rates in the control villages (P = 0.39, and 0.11 for change from baseline to 1 year and 2 year, respectively). There was also no difference in the change in overall trachoma rates between the two arms. CONCLUSION: These data suggest that the provision of water plus a modest health education programme did not result in a significant difference in trachoma or ocular C. trachomatis infection in endemic communities in Niger. A more substantial health education intervention is likely necessary to produce change.

Bilateral conjunctival MALT lymphoma mimicking chronic conjunctivitis.

BACKGROUND: The diagnosis of conjunctival lymphoid tu-mors is straightforward when they present with a characteristic salmon-pink, pebbly, multinodular appearance. However, rarely a diffuse clinical presentation is encountered, and this may mimic chronic conjunctivitis of other etiologies. CASE REPORT: A 60-year-old man was referred to our clinic with bilateral conjunctival masses in May 2005. With the assumption of chlamydial conjunctivitis, without microbiological or histopathological evidence, tetracycline ointment and oral doxycycline 100 mg twice daily were prescribed. Although a partial response was achieved, 2 months after the treatment, the patient's complaints returned. On second referral to our clinic in March 2006, the patient was re-evaluated. He presented with bilateral conjunctival masses resembling conjunctival lymphoma, and a bilateral diagnostic biopsy was performed. Histopathological evaluation of the biopsy specimens revealed mucosa-associated lymphoid tissue (MALT) lymphoma. The patient received CVP chemotherapy (cyclophosphamide, vincristine, prednisolone). After 6 courses of chemotherapy, he achieved partial remission in both eyes. Currently, 28 months after CVP, sustained remission is obtained. CONCLUSIONS: In these cases, a high index of suspicion is required if one is to avoid a delay in diagnosis, and the importance of correct early diagnosis is obvious.

[Retinal lesion in experimental chlamydia eye infection].

Until the present time, ophthalmic chlamydiasis has been generally associated with diseases of auxiliary organs of the eye and its anterior segment: conjunctivitis and iridocyclitis. The morphological substrate of eye posterior segment lesion caused by C. trachomatis and C. pneumonia was studied in this investigation. The pathomorphological pattern characteristic of chlamydia-induced rabbit retinal and vitreous body lesions is composed of vitreoretinal lymphocyte-macrophageal infiltrations of varying intensity, posterior hyaloid membrane detachment, peripheral foci or folding of the retina, impaired nuclei of photoreceptors and bipolar neurons, pigment epithelial damage occurring in different concurrences in relation to the species of a causative agent and the clinical picture.

Water-filtered Infrared A and visible light (wIRA/VIS) treatment reduces Chlamydia caviae-induced ocular inflammation and infectious load in a Guinea pig model of inclusion conjunctivitis.

Trachoma is a devastating neglected tropical disease caused by Chlamydia trachomatis and the leading global cause of infectious blindness. Although antibiotic treatment against trachoma is efficient (SAFE strategy), additional affordable therapeutic strategies are of high interest. Water-filtered infrared A and visible light (wIRA/VIS) irradiation has proven to reduce chlamydial infectivity in vitro and ex vivo. The aim of this study was to evaluate whether wIRA/VIS can reduce chlamydial infection load and/or ocular pathology in vivo, in a guinea pig model of inclusion conjunctivitis. Guinea pigs were infected with 1 × 106 inclusion-forming units/eye of Chlamydia caviae via the ocular conjunctiva on day 0. In infected animals, wIRA/VIS irradiation (2100 W/m2) was applied on day 2 (single treatment) and on days 2 and 4 (double treatment) post-infection (pi). wIRA/VIS reduced the clinical pathology score on days 7 and 14 pi and the conjunctival chlamydial load on days 2, 4, 7, and 14 pi in comparison with C. caviae-infected, not irradiated, controls. Furthermore, numbers of chlamydial inclusions were decreased in wIRA/VIS treated C. caviae-infected guinea pigs on day 21 pi compared to C. caviae-infected, non-irradiated, controls. Double treatment with wIRA/VIS (days 2 and 4 pi) was more efficient than a single treatment on day 2 pi. wIRA/VIS treatment did neither induce macroscopic nor histologic changes in ocular tissues. Our results indicate that wIRA/VIS shows promising efficacy to reduce chlamydial infectivity in vivo without causing irradiation related pathologies in the follow-up period. wIRA/VIS irradiation is a promising approach to reduce trachoma transmission and pathology of ocular chlamydial infection.

Precision of the Abbott RealTime Assay in the Detection of Ocular Chlamydia trachomatis in a Trachoma-Endemic Area of Ethiopia.

Nucleic acid amplification tests are increasingly used to detect ocular chlamydia infection in trachoma research and programs. To evaluate the reliability of Chlamydia trachomatis detection by the Abbott RealTime CT/NG assay (Abbott Molecular, Inc., Des Plaines, IL) on the m2000 platform, three conjunctival samples were collected from each of 200 children aged 0-9 years in Ethiopia: two from the right eye and one from the left eye. Four aliquots were processed for each child: two from the first right eye sample, one from the second right eye sample, and one from the left eye sample. Sixty-nine swabs were processed in a U.S. laboratory and 131 in an Ethiopian laboratory. Intra-class correlation coefficients (ICCs) were high when comparing two aliquots from the same swab (ICC ranged from 0.96 to 0.99), two separate swabs from the right eye (0.89-0.91), and one right and one left eye swab (0.87-0.89), indicating reliable chlamydial load assessment across different samples and laboratory settings.

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.