Chlamydia conjunctivitis in a child

Chlamydia is an independent type of microorganism that exhibits the properties of viruses and bacteria. Reproducing in epithelial cells, they form clusters in the cytoplasm - Halberstadter-Provacek bodies.

ICD-10 code

• A74.0+ Chlamydial conjunctivitis (H13.1).
• P39.1 Conjunctivitis and dacryocystitis in the newborn.

Chlamydial conjunctivitis in adults and adolescents (paratrachoma)

The causative agent is Chlamydia trachomatis, the incubation period is 10-14 days.

Currently, it is increasingly common in adolescents aged 13-15 years, associated with early onset of sexual activity. In girls, it is 2-3 times more common than in boys. Conjunctivitis is associated with urogenital chlamydial infection, which can be asymptomatic and occurs when infected discharge from chlamydia-affected eyes, the urogenital tract, or personal hygiene items, where chlamydia remain viable for 24 hours, gets on the mucous membrane of the eye.

Most often one eye is affected, bilateral process occurs in about 1/3 of patients. Onset of the disease is acute, with pronounced swelling of the eyelids, ptosis of the upper eyelid and narrowing of the palpebral fissure. Characteristic are hyperemia, swelling and infiltration of the conjunctiva of the eyelids and transitional folds, formation of large loose follicles located in regular rows in the lower fornix. Moderate mucopurulent discharge becomes abundant and purulent as the disease progresses. Swelling, infiltration and vascularization of the upper limbus often occur. Superficial, fine-point corneal infiltrates may appear, not stained with fluorescein. From the 3rd to 5th day of the disease, painless enlargement of the preauricular lymph nodes develops on the affected side, in some cases accompanied by noise and pain in the ear, hearing loss. Common manifestations include urogenital chlamydial infection (cervicitis, cervical erosion, urethritis, prostatitis).

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Chlamydial conjunctivitis of newborns

The disease is associated with urogenital chlamydial infection of the mother. The incidence of chlamydial conjunctivitis reaches 40% of all conjunctivitis in newborns. The disease occurs acutely on the 5th-10th day after birth, mainly in one eye. Abundant liquid pus with an admixture of blood appears in the conjunctival cavity. Edema of the eyelids, hyperemia and edema of the conjunctiva, enlargement of the papillae are expressed. The disease proceeds as acute papillary or subacute infiltrative conjunctivitis, follicles appear if conjunctivitis lasts up to the 4th week of the child's life. Inflammatory phenomena subside after 1-2 weeks. Extraocular manifestations of the infection are possible: pneumonia, otitis, pharyngitis, vulvovaginitis, proctitis.

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Epidemic chlamydial conjunctivitis

The disease occurs in outbreaks among visitors to baths, swimming pools and children aged 3-5 years in organized groups. Epidemic chlamydial conjunctivitis may begin acutely, subacutely or be chronic. Most often, one eye is affected. Examination reveals hyperemia, edema, conjunctival infiltration, papillary hypertrophy, and follicles in the lower fornix. The cornea is rarely involved in the pathological process. Painless preauricular adenopathy is noted. All conjunctival manifestations disappear (often without treatment) after 3-4 weeks.

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Treatment of chlamydial conjunctivitis

In case of abundant purulent discharge - rinsing of the conjunctival cavity with 2% boric acid or nitrofural (furacilin). In instillations - picloxidine, sodium colistimethate + rolitetracycline + chloramphenicol (colbiocin) 6 times a day or eye ointments (tetracycline, erythromycin or ofloxacin) 4-5 times a day.

In case of swelling and severe irritation of the conjunctiva, add instillations of antiallergic drops (antazoline + tetryzoline, diphenhydramine + naphazoline, olopatadine) 2 times a day.