Chlamydia conjunctivitis

A distinction is made between chlamydial conjunctivitis in adults and newborns. Much less common are epidemic chlamydial conjunctivitis in children and chlamydial conjunctivitis in Reiter's syndrome.

Chlamydial infection is the most common and reportable cause of conjunctivitis in neonates; chlamydial conjunctivitis occurs in 20-50% of infants born to chlamydia-infected mothers. It may be associated with systemic chlamydial infection, which typically results in otitis, rhinitis and pneumonia. Chlamydial infection is transmitted from the mother during birth, so it is important that both parents are screened for sexually transmitted infections.

Of great importance is the preventive treatment of the eyes of newborns, which, however, is complicated by the lack of highly effective, reliable means, since the traditionally used silver nitrate solution does not prevent the development of chlamydial conjunctivitis. Moreover, its installations often cause irritation of the conjunctiva, i.e. contribute to the development of toxic conjunctivitis.

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Epidemiology

The prevalence of chlamydial conjunctivitis in European countries is slowly but steadily increasing; they account for 10-30% of detected conjunctivitis.

Conjunctivitis most often (in 65% of patients) occurs in an acute form, less often (in 35% of patients) in a chronic form.

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Causes chlamydial conjunctivitis

Chlamydial conjunctivitis is sexually transmitted and is caused by the DK serotypes of Chlamydia trachomatis. Patients with chlamydial conjunctivitis are usually young and many have a concomitant sexually transmitted infection (cervicitis in women and urethritis in men), which may be asymptomatic. Infection occurs sexually - from urogenital secretions, although eye-to-eye spread of infection may occur. Infection usually occurs at the age of 20-30 years. Women are ill 2-3 times more often.

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Symptoms chlamydial conjunctivitis

The incubation period is approximately 1-2 weeks. Chlamydial conjunctivitis is usually unilateral, without treatment it lasts a long time, periodically worsening.

Chlamydial conjunctivitis begins subacutely, characterized by unilateral or bilateral mucopurulent discharge. Unlike adenovirus infection, conjunctivitis becomes chronic and, if untreated, may persist for 3-12 months. It is characterized by scanty mucopurulent discharge. Large follicles, most prominent in the inferior conjunctival fornix, may also form on the superior tarsal conjunctiva. Peripheral corneal infiltrates may appear 2-3 weeks after the onset of conjunctivitis. Mild enlargement of regional lymph nodes is observed. Long-standing cases are characterized by a less pronounced follicular reaction, development of moderate conjunctival scarring and superior pannus. Often, symptoms of eustachitis are observed on the affected side: noise and pain in the ear, hearing loss.

Clinically, chlamydial conjunctivitis in newborns occurs as acute capillary and acute infiltrative conjunctivitis.

Chlamydial conjunctivitis in newborns usually manifests itself 5-19 days after birth. The main symptoms of chlamydial conjunctivitis in newborns are: mucopurulent discharge and papillary conjunctival reaction (since infants cannot develop a follicular reaction until approximately 3 months of life). Edema of the eyelids is pronounced, the conjunctiva is hyperemic, edematous, with hyperplasia of the papillae, pseudomembranes may form. Inflammatory phenomena decrease after 1-2 weeks. If active inflammation continues for more than 4 weeks, follicles appear, mainly on the lower eyelids. In 70% of newborns, the disease develops in one eye. Conjunctivitis may be accompanied by preauricular lymphadenitis, otitis, nasopharyngitis and even chlamydial pneumonia.

Trachoma is more benign than paratrachoma and occurs in outbreaks in bathhouse and pool visitors and children aged 3-5 years in organized groups (orphanages and children's homes). Trachoma may begin acutely, subacutely or proceed as a chronic process. Usually one eye is affected: hyperemia, edema, conjunctival infiltration, follicles in the lower fornix are detected. The cornea is rarely involved in the pathological process; punctate erosions, subepithelial punctate infiltrates are detected. There is often a small preauricular adenopathy.

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Diagnostics chlamydial conjunctivitis

Confirmation of the clinical diagnosis of chlamydial conjunctivitis can be achieved by laboratory tests. Given the venereal nature of the disease, a compulsory examination in a urological clinic is necessary to exclude other sexually transmitted diseases. The following tests are currently used.

1. Direct immunofluorescence assay using monoclonal antibodies is rapid and inexpensive.
2. Enzyme immunoassay for chlamydial antigens.
3. A standard single passage in McCoy cell culture (rapid culture method) requires at least 3 days.
4. Polymerase chain reaction.

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Treatment chlamydial conjunctivitis

All sexual partners should be examined and treated.

1. Local: tetracycline ointment 4 times a day for 6 weeks.
2. Systemic therapy with one of the following drugs:
   • Azithromycin 1 g as a single dose.
   • Doxycycline 100 mg 2 times a day for 1-2 weeks.
   • If tetracycline is ineffective - 500 mg erythromycin 4 times a day for 1 week.

Additional therapy includes installation of antiallergic drops: in the acute period - allergoftal or persallerg 2 times a day, in the chronic period - alomila or lecrolin 2 times a day, internally - antihistamines and for 5 days. From the second week, eye drops dexados or maxidex are prescribed 1 time per day.

Treatment of chlamydial conjunctivitis in newborns

Without treatment, complications such as conjunctival scarring and superior corneal pannus may occur.

Treatment of chlamydial conjunctivitis in newborns consists of local application of tetracycline. Erythromycin ethylsuccinate is prescribed orally at a rate of 25 mg/kg 2 times a day for 2 weeks.

NB: Systemic use of tetracycline is contraindicated in children under 12 years of age and in pregnant or breastfeeding women because it may cause tooth staining and occasionally fetal hypoplasia.

All conjunctivitis symptoms may reverse within 3-4 weeks without treatment. Local treatment: tetracycline, erythromycin or floxal ointment 4 times a day or ocacin or floxal eye drops 6 times a day.

Prevention

In the prevention of conjunctivitis in newborns, the central place is occupied by modern treatment of urogenital infections in pregnant women.

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