Clinical Features of Bacterial Conjunctivitis in Children

Abstract

Objectives: Conjunctivitis is a common cause of primary care and emergency department (ED) visits. There is a paucity of data in recent literature on the prevalence of pediatric bacterial conjunctivitis, and there are no evidence-based clinical guidelines for empirical treatment. The study objective was to describe clinical features most predictive of bacterial conjunctivitis.Methods: This was a prospective study in a children's hospital ED. Conjunctival swabs for bacterial culture were obtained from patients aged 1 month to 18 years presenting with red or pink eye and/or the diagnosis of conjunctivitis.Results: A total of 111 patients were enrolled over one year. Patients had a mean (AESD) age of 33.2 (AE37.5) months, and 55% were male. Eighty-seven patients (78%) had positive bacterial cultures. Nontypeable Haemophilus influenzae accounted for 82% (71/87), Streptococcus pneumoniae for 16% (14/87), and Staphylococcus aureus for 2.2% (2/87). Five clinical variables were significantly associated with a positive bacterial culture. Regression analysis revealed that the combination of a history of gluey or sticky eyelids and the physical finding of mucoid or purulent discharge had a posttest probability of 96% (95% confidence interval = 90% to 99%). Subjective scoring by physicians for a positive culture was 50.6%.Conclusions: Conjunctivitis in children is predominantly bacterial, with nontypeable H. influenzae being the most common organism. A history of gluey or sticky eyelids and physical findings of mucoid or purulent discharge are highly predictive of bacterial infection. Based on the above data, empirical ophthalmic antibiotic therapy may be appropriate in children presenting with conjunctivitis.

Nontypeable Haemophilus influenzae as a Pathogen in Children

“…Nontypeable H. influenzae is the most common bacterial cause of conjunctivitis in children. 28,29 Conjunctivitis caused by nontypeable H. influenzae is usually acute, but subacute conjunctivitis and keratitis are also seen. 30 Sinusitis is a common complication of viral upper respiratory tract infections in children, estimated to occur in approximately 7% of episodes.…”

The Red Eye: Evaluation and Management

“…A recent study in a pediatric emergency department of children presenting with a red or pink eye and/or had a diagnosis of conjunctivitis, Patel et al noted that 78% had a positive conjunctival culture for bacteria. 3 Patients with bacterial conjunctivitis present with injected bulbar conjunctiva, episcleral vessels, and papillae in the palpebral conjunctiva (Figures 3 and 4), Thick, mucopurulent discharge is usually present, which causes eyelash matting and eyelid closure on waking up in the morning. A history of gluey or sticky eyelids and physical findings of mucoid or mucopurulent discharge was highly predictive of bacterial etiology.…”

“…A history of gluey or sticky eyelids and physical findings of mucoid or mucopurulent discharge was highly predictive of bacterial etiology. 3 Although mild discomfort and photophobia may exist, pain is usually absent and vision is preserved. Preauricular lymphadenopathy is also less frequent.…”

“…In Patel's study, 82% of the conjunctivitis was secondary to nontypeable H. influenzae. 3 The most common etiology in hyperacute cases are Neisseria gonorrhoeae. Hyperacute cases are more dangerous, as they have the propensity to penetrate the cornea.…”

Acute conjunctivitis

“…Using fluorescein drops and the green light of a fundoscope helps to rule out any sign of corneal damage. For children, bacterial causes are more common (Patel, Diaz, Bennett, & Attia, 2007) and risk factors include: nasolacrimal duct obstruction; concomitant otitis media or pharyngitis; and exposure to the condition i.e. at nursery or school.…”