Gonococcal keratoconjunctivitis

Ullman, Saul; Roussel, Thomas J.; Forster, Richard K.

doi:10.1016/0039-6257(87)90095-6

Cited by 28 publications

(19 citation statements)

References 79 publications

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“…GC may be complicated by uveitis or severe keratitis, sometimes leading to corneal perforation necessitating corneal graft repair, so prompt diagnosis and treatment are essential. [6][7][8][9] There has been an increase in antibiotic resistance amongst gonococcal strains in recent years, including resistance to penicillin, fluoroquinolones, and more recently, oral cephalosporins. [10][11][12] Increasing antimicrobial resistance internationally has sparked concerns that some Neisseria gonorrhoeae strains may become pan-resistant in the near future.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of gonococcal conjunctivitis in adults and neonates

McAnena

Knowles

Curry

et al. 2015

Eye

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Purpose To report the prevalence of gonococcal conjunctivitis (GC) presenting to a tertiary referral maternity hospital (NMH) and a tertiary referral ophthalmic hospital (RVEEH) from 2011 to 2013 and describe the demographics, clinical presentation, and antibiotic susceptibility of Neisseria gonorrhoeae ocular infections. Methods Demographic, clinical, and microbiological data were collected from patients with laboratory confirmed GC. Results There were 27 556 live births at NMH during the study period, and no case of neonatal GC was identified. Fourteen cases of GC were identified at RVEEH in this period, representing a prevalence of 0.19 cases per 1000 eye emergency attendees. Antibiotic susceptibility data were available on nine cases, of which, all were ceftriaxoneand ciprofloxacin sensitive. 64.3% of patients were male, with a mean age of 18 years. The mean duration of symptoms was 3 days. All patients presented with unilateral conjunctival injection and purulent discharge. Eight cases had visual impairment at presentation and their mean visual acuity was 6/15. Corneal involvement was present in 25% of patients. Uveitis was not detected. On receipt of positive culture and/or PCR results, treatment was altered in two thirds of patients. All patients were referred for full STI screening and all patients showed a full clinical recovery 1 week posttreatment. Conclusion We observed that GC presented in young adults with a male predominance and was rare in neonates. In cases of unilateral purulent conjunctivitis, there should be a high clinical suspicion of GC, early swab for PCR and culture, and knowledge of current CDC-recommended antibiotic guidelines.

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Section: Introductionmentioning

confidence: 99%

Prevalence of gonococcal conjunctivitis in adults and neonates

McAnena

Knowles

Curry

et al. 2015

Eye

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“…15 Gonococcal keratoconjunctivitis is a potentially devastating infection because of the ability of N. gonorrhoeae to cause severe, ulcerative keratitis, which may rapidly progress to corneal perforation. [6][7][8] Therefore, it is necessary to obtain an accurate diagnosis and commence parenteral antibiotic treatment as early as possible. However, accurate clinical diagnosis may be delayed due to the relative low incidence of this disease.…”

Section: Discussionmentioning

confidence: 99%

“…A proper diagnosis is vital if this is to be avoided, as the clinical outcome of gonococcal keratoconjunctivitis depends on its level of severity at the commencement of the appropriate therapy. [6][7][8] Ocular gonococcal infection is relatively rare, and during its early stage of development, the resulting keratoconjunctivitis may be attributed to other pathogens, thus delaying a proper clinical diagnosis. Furthermore, N. gonorrhoeae has recently shown increased resistance to antimicrobial agents.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of corneal perforation secondary to gonococcal keratoconjunctivitis

Kawashima

Kawakita

Den

et al. 2007

Eye

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Aims To report five cases of gonococcal keratoconjunctivitis with severe corneal involvement treated with therapeutic keratoplasty. Design Retrospective case series. Methods Five consecutive cases of gonococcal keratoconjunctivitis treated with keratoplasty for corneal perforation, with a mean age of 21.2 years, were analysed by patient's history, surgical approaches, and clinical outcomes, corrected visual acuity at initial visit and last follow-up.

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“…The incidence rates of gonococcal conjunctivitis increase during spring and summer (11). This is a potentially devastating ocular infection, because N. gonorrhoeae can cause severe ulcerative keratitis, which may rapidly progress to corneal perforation (11)(12)(13)(14). Kawashima et al reported that the durations between conjunctivitis and corneal perforation were from 9 to 11 days in 5 cases of gonococcal keratoconjunctivitis (12).…”

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confidence: 99%

Conjunctivitis Caused by Neisseria gonorrhoeae Isolates with Reduced Cephalosporin Susceptibility and Multidrug Resistance

et al. 2013

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bWe report two cases of conjunctivitis caused by Neisseria gonorrhoeae with reduced cephalosporin susceptibility. Patients showed no response to cefmenoxime eye drops and intravenous ceftriaxone administration. The patients' condition improved after the addition of oral minocycline. The isolates contained the mosaic penA for reduction of ␤-lactam susceptibility. CASE REPORTSC ase 1. A 31-year-old man visited a private clinic and presented with conjunctival injection and discharge in his right eye. A diagnosis of acute conjunctivitis was made, and he was treated with a combination of 1.5% levofloxacin (LVFX) and 0.1% betamethasone eye drops 4 times per day. However, his symptoms had worsened 2 days later, and he was referred to our hospital. Slitlamp biomicroscopy revealed severe purulent discharge, conjunctival injection, and eyelid edema in the right eye (Fig. 1A). However, he did not have conjunctival papillae or follicles or corneal epithelial damage. Direct microscopy and bacterial culture of the discharge were performed. Direct microscopy demonstrated the presence of Gram-negative diplococci, and the culture reports confirmed the presence of Neisseria gonorrhoeae. The patient did not have other gonococcal infection, such as pharyngitis or urethritis. We considered conjunctivitis caused by N. gonorrhoeae and began treatment with topical 0.5% cefmenoxime (CMX) every hour and intravenous administration of ceftriaxone (CTRX) (1 g/day) for 3 days. Although the amount of discharge was slightly decreased 1 week after initiating the therapy, conjunctival injection was still active (Fig. 1B). We added oral minocycline (MINO; 200 mg/day) for 2 weeks after obtaining drug susceptibility testing results, and the conjunctivitis resolved within 7 days (Fig. 1C).Case 2. A 28-year-old woman visited a local hospital and presented with conjunctival injection and discharge in the right eye. She was treated with a combination of 1.5% LVFX and 0.1% fluorometholone eye drops 4 times per day. However, the amount of discharge increased, and she was referred to our hospital. Slitlamp biomicroscopy revealed severe purulent discharge and eyelid edema. The patient's condition was similar to the condition shown in Fig. 1A. Microbiological tests revealed the presence of Neisseria gonorrhoeae. She did not have other gonococcal infection. We started treatment with topical 0.5% CMX every hour and intravenous administration of CTRX (1 g/day) for 3 days. As conjunctival infection was still active 3 days later, oral MINO (200 mg/day) was administered for 1 week. Conjunctival inflammation subsided within 5 days after the addition of MINO.Antimicrobial susceptibility testing.

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Gonococcal keratoconjunctivitis

Cited by 28 publications

References 79 publications

Prevalence of gonococcal conjunctivitis in adults and neonates

Prevalence of gonococcal conjunctivitis in adults and neonates

Surgical management of corneal perforation secondary to gonococcal keratoconjunctivitis

Conjunctivitis Caused by Neisseria gonorrhoeae Isolates with Reduced Cephalosporin Susceptibility and Multidrug Resistance

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