Neonatal ophthalmia in the developing world

Abstract

In the 19th century, the incidence of neonatal conjunctivitis varied between 1 and 14% in Europe, and the disease was a main cause of blindness at that time. Since then the epidemiology of ophthalmia neonatorum (ON) has changed and Chlamydia trachomatis is more frequent than Neisseria gonorrhoeae. Both are still very common causes of ON in the developing world. ON can not be differentiated clinically as to the etiology, but Intracellular Gram Negative Diplococci (IGND) on a Gram stain of an eye smear has an excellent validity and further differentiation can be made using microbiological cultures. All cases of presumed gonococcal conjunctivitis must be treated with effective systemic antibiotics. Systemic treatment with penicillin can still be used in areas where the percentage of beta-lactamase producing strains of gonococci is very low. For other areas a single dose of ceftriaxone intramuscular combined with saline eye washes is the treatment of choice. Chlamydial ON necessitates also systemic treatment with erythromycin. Parents of infants with gonococcal or chlamydia ON also need to be examined and treated. Prevention of gonococcal and chlamydial disease can be done following 3 strategies: antenatal diagnosis and treatment of maternal infections or disinfection of the infants eyes at birth or adequate treatment of infants and parents as soon as a ON has been diagnosed. Crédé's eye prophylaxis with silver nitrate has become a controversial issue, because of concern about the occurrence of chemical conjunctivitis and its ineffectiveness against infections with C. trachomatis.(ABSTRACT TRUNCATED AT 250 WORDS)

Economic hardship and sexually transmitted diseases in Haiti's rural Artibonite Valley.

“…This is particularly problematic for pregnant women, as vertical transmission from asymptomatic mothers to their offspring is a cause of significant morbidity and mortality. [30][31][32][33][34][35] Screening pregnant women in rural Haiti for gonorrhea and chlamydia is difficult. In this study, symptoms elicited during medical history were not predictive of cervical infection.…”

Efficacy of topical ophthalmic prophylaxis in prevention of ophthalmia neonatorum

“…Presence of significant difference between type of delivery and conjunctivitis is indicative of the notion that the route of neonatal acquisition is vaginal delivery which is particularly important in chlamydial conjunctivitis, the most frequent type in recent years. 3,9 We obtained 111 cultures from 138 cases of conjunctivitis. Ninety-one (82%) positive cultures and 20 (18%) negative cultures were reported.…”

“…4 Fortunately, however, incidence of this type of conjunctivitis continues to fall 4 and, in recent years, chlamydial conjunctivitis has been more common. 3,9 The best method of preventing neonatal chlamydial infection is prenatal screening and treatment of pregnant women. The following organisms are less common causes of conjunctivitis: streptococcus beta haemolytic groups A and B, pseudomonas, Neisseria meningitidis, Corynebacterium diphtheriae, Cholesteridium sp., Herpes simplex, Echovirus and Candida.…”

“…The reported incidence of this disease varies, from 1.6% in USA to 23% over the world, and in some studies even 25.6%. [1][2][3] There have been many different aetiologic agents implicated that differ greatly in their virulence and clinical course. [4][5][6][7][8] The aetiologic agents include bacteria, viruses and chemical compounds.…”

Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers

“…1 Neonatal conjunctivitis is caused by infectious or chemical etiologies including sexually transmitted infections (STIs) in pregnancy. 2,3 STIs associated with neonatal conjunctivitis include N. gonorrhea, C. trachomatis and Herpes simplex virus type 2. 4,5,6 Other infectious causes include S. aureus, N. meningitidis and Group B streptococcus.…”