Neonatal Chlamydial Conjunctivitis

Abstract

Chlamydia trachomatis (Ct) was isolated from eyes of 33 out of 160 infants with neonatal conjunctivitis. In nineteen (58%) of the infants with chlamydial conjunctivitis Ct could also be isolated from the nasopharynx. All infants were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 hours for 14 days combined with lid hygiene. All were clinically cured, and none had a relapse of clinical Ct conjunctivitis during an observation period of one year. However, one infant had persistent asymptomatic chlamydial eye infection, two displayed a persistent infection of the nasopharynx, and one infant's vagina was infected despite therapy. Serum IgG antibodies to Ct were significantly more often detected in clinical cases (90%) than in controls (33%) (p less than 0.01). Infants with conjunctivitis developed detectable IgM antibodies to Ct in 43% as compared to 7% in controls (p less than 0.01).

Aetiology of neonatal conjunctivitis evaluated in a population‐based setting

“…We conclude that C trachomatis was a rare pathogen in neonatal conjunctivitis in a population-based setting, but respiratory viruses were detected more frequently than indicated earlier. Our findings suggest that it is important to be aware of the local aetiology of neonatal conjunctivitis, as causative agents vary between geographical locations and clinical settings (1)(2)(3)(4)6,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Even though systematic sampling in primary care for all possible pathogens appears to be unnecessary in our setting, routine sampling may still be needed in secondary and tertiary care units and in some geographical locations.…”

“…Chlamydia trachomatis (C trachomatis) and Neisseria gonorrhoeae (N gonorrhoeae) are the most significant bacterial pathogens to be diagnosed in infectious neonatal conjunctivitis, because without treatment they can both lead to serious long-term consequences (8). C trachomatis is considered a major causative agent for neonatal conjunctivitis in many centres (9)(10)(11), but its proportion varies greatly between geographical regions and clinical settings, ranging from 0 to 64% (1)(2)(3)(4)6,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Respiratory viruses cause more than 10% of acute paediatric conjunctivitis (19), but their role during the neonatal period remains unclear.…”

Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis

“…Of the 9 nonrandomized studies, 8 collected data prospectively [ 4 , 15 , 27–30 , 32 , 33 ] and 1 collected data retrospectively [ 34 ]. Two of the studies used the same cohort of neonates but reported different outcomes [ 28 , 29 ]. Four studies were conducted in the United States [ 4 , 25 , 26 , 33 ], 4 in Sweden [ 28–31 ], 1 in Kenya [ 27 ], 1 in Mexico [ 32 ], and 2 in Hong Kong [ 15 , 34 ].…”

“…However, other outcomes, such as adverse effects, complications, and compliance, were likely not measured objectively or independently. Several studies were also at risk of bias as a result of their high percentage of loss to follow-up or lack of a statement regarding follow-up [ 25–27 , 29 , 31 ]. Overall, the risk of bias in the included studies was very serious because of their high loss to follow-up and lack of objective assessment of most outcomes.…”

“…We pooled results from 7 studies that evaluated erythromycin at 50 mg/kg per day for 14 days (161 neonates) [ 4 , 15 , 26 , 29 , 30 , 33 , 34 ]. This dose resulted in a clinical cure of 96% (95% CI, 92%–101%) and a microbiological cure of 97% (95% CI, 94%–100%) ( Figures 2 and 3 ).…”