Diagnosis of ophthalmia neonatorum.

Abstract

Ninety consecutively seen babies with eye discharge in the first three weeks of life were examined. Four babies had "sticky eyes" with no evidence of ophthalmia and had uniformly negative cultures and test results for antichlamydial antibody; these babies were excluded. Of the 86 babies with ophthalmia neonatorum, Neisseria gonorrhoeae was isolated from eight, Chlamydia trachomatis from 44, other bacteria alone from 20, and 14 had negative cultures. Three babies with negative cultures had longstanding conjunctivitis and had been treated with chloramphenicol eye ointment; all had antichlamydial IgM antibodies, indicating that the conjunctivitis was chlamydial. Hence the total number of babies whose conjunctivitis was chlamydial was 47. The result of the Gram stained conjunctival smear correlated well with that ofculture and final assessment by the microimmunofluorescence test, enabling an immediate presumptive diagnosis to be made of gonococcal, chlamydial, or bacterial conjunctivitis. Prompt and effective treatment of babies was started. Explanation to the mother and contact tracing were carried out when the confirmatory cultures and antibody tests were completed.The Gram stained conjunctival smear is a highly sensitive, specific, and predictive test for the aetiological agent of ophthalmia neonatorum. By virtue of its simplicity and rapidity the test may be useful in developing countries.

Focal Bacterial Infections

“…In a review by Hammerschlag [681], the incidence of the two major pathogens ranged from 17% to 32% for C. trachomatis and 0% to 14.2% for N. gonorrhoeae in four U.S. studies. In other developed countries such as England [682], investigators found 8 cases of gonococcal infection and 44 cases of chlamydial infection among 86 newborns with ophthalmia neonatorum; in Denmark [683], investigators found that 72% of infants with conjunctivitis at 4 to 6 days after birth had positive cultures, but 70% were caused by staphylococci (S. aureus and S. epidermidis), and chlamydiae were isolated from only 2 of 300 newborns.…”

Chlamydia trachomatis Infections in Neonates

“…Clinically the symptoms of a N. gonorrhoeae infection would begin much earlier than those of C. trachomatis infection, as the former usually starts 2-5 days after birth with a severe purulent discharge that tends to rapid progression leading occasionally to corneal penetration and endophthalmitis (Quirke & Cullinane, 2008). Just as in case of other pyogenic bacteria, the definitive laboratory diagnosis is based on traditional culture of the exudate, however the examination of a Gram-stained smear may be very informative and allows a presumptive, rapid detection of pathogens (Winceslaus et al, 1987).…”

“…Chlamydial ophthalmia may be occasionally superinfected with other agents, which may make the accurate diagnosis more difficult. In complicated, therapy-resistant cases one should consider the presence of N. gonorrhoeae or of other nosocomial pathogens as well (Winceslaus et al, 1987). The elimination of the disease may be interfered not only by secondary infections, but by the recurrence of the original agent as well.…”

Diagnosis of neonatal chlamydial conjunctivitis.

“…4 We have evaluated similar simple techniques using immunofluorescence for comparison (MicroTrak Chlamydia trachomatis direct fluorescent antibody reagent, Syva UK).…”

“…4 The second question put by this document was whether the incidence of iron deficiency could be reduced by appropriate health education. This remains to be answered.…”