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C.D. Salpietro, G. Bisignano, F. Fulia, A. Marino, I. Barberi Infections of the conjunctiva are frequent in the neonatal period. While Neisseria gonorrhoea and chemical agents were considered as the main etiologies of ophtalmiae neonatorum in the past, Chlamydia trachomatis is today a major cause of neonatal conjunctivitis. Thus in a study of 180 unior bilateral neonatal conjunctivitis the authors found a prevalence of Chlamydia trachomatis infection of 41 %. The importance of the etiological diagnosis of neonatal conjunctivitis is emphasized, in order to define a specific treatment. Etiological diagnosis of Chlamydia trachomatis infection is based upon immunofluorescence and molecular diagnosis techniques (PCR, LCR). Prevention of neonatal Chlamydia trachomatis conjunctivitis relies upon screening and treatment of Chlamydia trachomatis infections in pregnant women and their partners. Treatment requires oral macrolides, the topical treatment being ineffective.

Incidence of chlamydial infection depends on maternal colonization during pregnancy, which is different in each population. The transmission is not obligatory but when present, it occurs at birth through the genital tractus. Chlamydia trachomatis infection is the first cause of neonatal conjunctivitis, with no influence of eye lotion application at birth. C. trachomatis is also responsible for interstitial pneumonia with possible consequences on the lung function. The laboratory diagnosis relies on the identification of intracellular bacteria in patient samples by the mean of culture or PCR. Systemic antibiotherapy by macrolides is always necessary, with local application in the case of conjunctivitis. The key point is the detection of colonization of pregnant women with identified risk factors. In positive case, oral treatment of both parents is recommended.

Background Economic evaluations of chlamydia screening programmes do not consistently show that widespread chlamydia screening is cost-effective, which shows uncertainty in some of the assumptions incorporated into the models used. We explored differences in cost estimates used in published cost-effectiveness analyses. Methods Studies were identified from a systematic review of cost-effectiveness analyses of chlamydia screening commissioned by the European Centre for Disease Prevention and Control (2014). We included studies from developed countries that took a national health service or statutory health insurance system perspective for comparison with the English setting (n=14; England, Scotland, the Netherlands, Sweden, Ireland, Denmark, Canada, and Australia). Management costs for seven major sequelae of chlamydia infection (pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, chronic pelvic pain, epididymitis, neonatal conjunctivitis, and neonatal pneumonia) were extracted from each paper. We adjusted costs to 2013–14 pounds sterling using the Hospital & Community Health Services index and historical Bank of England foreign currency exchange rates. We assessed the effect of considering different sequelae, management costs, or both on the estimated cost-effectiveness of chlamydia screening by applying unit costs of sequelae included in each paper to one set of literature-derived progression probabilities to estimate an overall cost of sequelae per chlamydia infection. Findings Only half of the studies included all seven major chlamydia sequelae. Papers commonly referred to one previously published source that mostly included older estimates (>10 years old). Sequelae management costs per case ranged from £171 to £3635 (pelvic inflammatory disease), £953 to £3615 (ectopic pregnancy), £546 to £6752 (tubal factor infertility), £159 to £3341 (chronic pelvic pain), £22 to £1008 (epididymitis), £11 to £1459 (neonatal conjunctivitis), and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of chlamydia using a standard set of progression probabilities ranged from £37 to £412. Interpretation The large disparities in estimated unit costs of chlamydia sequelae considered in existing cost-effectiveness analyses can be attributed to different assumptions about disease management pathways and costs from different country perspectives. Therefore, updated cost-estimates for chlamydia sequelae specific to the English setting are needed to inform future economic evaluations of chlamydia control programmes in England. Funding None.

Ophthalmia neonatorum is the most common eye infection in the first month of life. The etiologies have been attributed to chemical, bacterial, and viral agents. Neonatal bacterial conjunctivitis is caused by many species of bacteria, the most important being Neisseria gonorrhoea and Chlamydia trachomatis. Eikenella corrodens is a Gram-negative bacillus. It is a fastidious, slow growing, facultative anaerobic bacterium that may be found as the normal flora of the human mouth, nasopharynx, gut, and genitourinary tract. Its role in causing infections in humans has been recognized in the last 2 decades with an increasing role in head and neck infections. In this report, we present present a case of neonatal conjunctivitis caused by E. corrodens.

Resume Chlamydia trachomatis est connue depuis des annees comme cause du trachome et de millions de cas de cecite, surtout dans les pays en developpement. Les infections oculaires a Chlamydia en pays industrialises n'ont ete reconnues que recemment et la transmission y est le plus souvent par voie sexuelle. Cette revue discutera les aspects ophtalmologiques des infections a Chlamydia , plus specifiquement le paratrachome des adultes et la conjonctivite des nouveau-nes.

C H LA M Y D I A T R A C H O M A T I S is the m o s t c o m m o n identifiable infectious cause of neonatal conjunctivitis, accounting for !7% to 32% of all cases? 4 However, cultures for C. trachomatis are not widely available, require cell culture methods, and may take 2 to 7 days to perform. Availability of rapid antigen detection tests for detection of C. trachomarls would provide an alternative to culture and aid in making the correct diagnosis and instituting appropriate therapy. Chlamydiazyme (Abbott Laboratories, North Chicago, Ill.) is a solid-phase enzyme immunoassay for the direct detection of chlamydial antigen in clinical specimens and has been evaluated in genital specimens in adults. We compared this method with chlamydial culture for the diagnosis of conjunctivitis in infants.

Summary Pasteurella multocida is well documented as a zoonotic source of infection. We report a case where the maternal infection was initially subclinical leading to post partum septicaemia and neonatal conjunctivitis. There is strong circumstantial evidence of zoonotic infection.