Chlamydia conjunctivitis

Distinguish between chlamydial conjunctivitis in adults and newborns. Significantly less frequent are epidemic chlamydial conjunctivitis in children, chlamydial conjunctivitis in Reiter's syndrome.

Chlamydial infection is the most common and the cause of conjunctivitis in newborns; Chlamydial conjunctivitis is detected in 20-50% of children who were born from chlamydia infected mothers. It can be associated with a systemic chlamydial infection, which usually leads to otitis, rhinitis and pneumonia. Chlamydial infection is transmitted from the mother during childbirth, so it is important that both parents are screened for having a sexual infection.

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

[1], [2], [3]

Epidemiology

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

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

[4], [5], [6], [7], [8], [9]

Causes of the chlamydial conjunctivitis

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

[10], [11], [12], [13]

Symptoms of the chlamydial conjunctivitis

The incubation period is approximately 1-2 weeks. Chlamydial conjunctivitis is more often unilateral, without treatment proceeds for a long time, periodically exacerbating.

Chlamydial conjunctivitis begins subacute, characterized by a one-sided or bilateral muco-purulent discharge. Unlike adenoviral infection, conjunctivitis becomes chronic and, if left untreated, can persist for 3-12 months. Characterized by lean mucopurulent discharge. Large follicles, most pronounced in the lower conjunctival vault, can also form on the upper tarsal conjunctiva. Peripheral corneal infiltrates can appear 2-3 weeks after the onset of conjunctivitis. There is a slight increase in regional lymph nodes. Long-term cases are characterized by less pronounced follicular reaction, development of moderate conjunctival scarring and upper pannus. Often, from the side of the defeat, the phenomena of eustachyte are noted: noise and pain in the ear, hearing loss.

Clinically, chlamydial conjunctivitis of newborns proceeds as acute capillary and gstodestriy infiltrative conjunctivitis.

Chlamydial conjunctivitis in newborns is usually manifested 5-19 days after birth. The main symptoms of chlamydial conjunctivitis in newborns: mucopurulent discharge and papillary conjunctival reaction (since infants can not develop a follicular reaction until about 3 months of life). The edema of the eyelids is sharply expressed, the conjunctiva is hyperemic, edematic, with papillary hyperplasia, pseudomembranes can form. Inflammatory phenomena decrease after 1-2 weeks. If active inflammation lasts more than 4 weeks, follicles appear, mainly on the lower eyelids. In 70% of newborns, the disease develops on one eye. Conjunctivitis may be accompanied by pre-limphadenitis, otitis, nasopharygitis and even chlamydia pneumonia.

Trachoma proceeds more benignly than paratrahoma, and it occurs as outbreaks in visitors to bathhouses, swimming pools and children 3-5 years in organized collectives (orphanages and children's homes). Trachoma can begin acutely, subacute or proceed as a chronic process. Usually one eye is affected: they exhibit hyperemia, edema, conjunctival infiltration, follicles in the lower arch. The cornea is rarely involved in the pathological process; identify point erosions, subepithelial point infiltrates. Often there is a small pre-adenopathy.

[14], [15], [16], [17]

Diagnostics of the chlamydial conjunctivitis

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

1. A direct immunofluorescent method using monoclonal antibodies is rapid and inexpensive.
2. Immunofermentyy analysis of chlamydial antigens.
3. The standard one passage in McCoy cell culture (fast culture method) requires at least 3 days.
4. Polymerase chain reaction.

[18], [19], [20]

Treatment of the chlamydial conjunctivitis

It is necessary to examine and treat all sexual partners.

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 laziness for 1-2 weeks.
   • If tetracycline is ineffective, 500 mg of erythromycin is 4 times lazy for 1 week.

Additional therapy includes the installation of antiallergic drops: in the acute period - allergothal or spersallerga 2 times a day, in chronic - alomil or lekrolina 2 times a day, inside - antihistamines and for 5 days. From the second week, eye drops are prescribed dexados or maxidex once a day.

Treatment of chlamydial conjunctivitis in newborns

Without treatment, complications can occur in the form of conjunctival scarring and the upper corneal pannus.

Treatment of chlamydial conjunctivitis in newborns is in the local application of tetracycline. Inside prescribe erythromycin ethylsuccinate in the calculation of 25 mg / kg 2 times a day for 2 nd d.

NB: The use of tetracycline is systemically contraindicated in children under 12 years of age, as well as in pregnant or breast-feeding women, because this can cause dental staining and sometimes fetal hypoplasia.

All the phenomena of conjunctivitis and without treatment can undergo reverse development in 3-4 weeks. Local treatment: tetracycline, erythromycin or phloxal ointment 4 times a day, or ocular drops of okakin or floxal 6 times a day.

Prevention

In the prevention of conjunctivitis of newborns, the modern treatment of urogenital infection in pregnant women occupies a central place.

[21], [22], [23], [24]