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Introduction: Ophthalmia neonatorum is a severe, sight-threatening condition that occurs in neonates worldwide. Etiological factors include chemical agents, viruses, and bacteria, such as Neisseria...

Introduccion: La transmision vertical de Chlamydia trachomatis se presenta del 60% -70% en los hijos de madres infectadas y el riesgo de adquirir conjuntivitis por Chlamydia trachomatis en estos neonatos varia entre el 18% al 70%. Objetivo : detectar la Chlamydia trachomatis por medio de qPCR (Reaccion en Cadena de la Polimerasa por Tiempo Real) en los sacos conjuntivales en recien nacidos por parto normal. Metodos: Se realizo un estudio no experimental, transversal, analizando muestras procedentes de 178 ninos nacidos vivos, en el Hospital Gineco-obstetrico Isidro Ayora, se determino la presencia de Chlamydia trachomatis en muestras de saco conjuntival, por medio de la reaccion en cadena de la polimerasa los laboratorios de Biologia Molecular de la Pontificia Universidad Catolica del Ecuador. Resultados: la edad gestacional de los neonatos mas frecuente es a termino 75.29% que corresponde a 124 pacientes, resultados positivos para Chlamydia trachomatis por qPCR fueron 19 que corresponde al 10.7% y los resultados negativos 159 que corresponde al 89.3% de pacientes, el grupo de edad materna de los neonatos con resultados positivos para Chlamydia trachomatis por qPCR, mas frecuente es el de 14 -19 anos con 31.5%. Conclusiones: La conjuntivitis neonatal por Chlamydia trachomatis es una entidad de subdiagnosticada, que no responde al tratamiento con antibioticos topicos habituales, donde la amplificacion de acidos nucleicos por medio de la qPCR ha sido un importante avance en el diagnostico, debido a que la amplificacion es extremadamente sensible (capaz de detectar una sola copia genomica) y altamente especifica, inclusive en pacientes asintomaticos. Abstract Introduction : The vertical transmission of Chlamydia trachomatis occurs in 60% -70% in the children of infected mothers and the risk of contracting Chlamydia trachomatis conjunctivitis in these affected neonates between 18% and 70%. Objective : to detect Chlamydia trachomatis by means of qPCR (Real Time Polymerase Chain Reaction) in the conjunctival sacs in newborns by normal delivery. Methods: A non-experimental, cross-sectional study was carried out, analyzing analyzed samples of 178 live-born children, at the Gyneco-obstetric Hospital Isidro Ayora, the presence of Chlamydia trachomatis in conjunctival sac samples was determined by means of the chain reaction of polymerase molecular biology laboratories of the Pontifical Catholic University of Ecuador. Results : the most frequent gestational age of the neonates is at term 75.29% corresponding to 124 patients, positive results for Chlamydia trachomatis by qPCR were 19 corresponding to 10.7% and negative results 159 corresponding to 89.3% of patients, the group of maternal age of neonates with positive results for Chlamydia trachomatis by qPCR, more frequent is that of 14-19 years with 31.5%. Conclusions: Chlamydia trachomatis neonatal conjunctivitis is an underdiagnosed entity, which does not respond to treatment with usual topical antibiotics, where nucleic acid amplification by means of qPCR has been an important advance in diagnosis, due to extremely sensitive amplification. (capable of detecting a single genomic copy) and highly specific, including in asymptomatic patients

Health education is key in the prevention of Ophthalmia Neonatorum (ON). However, health education in relation to eye care in Ghana is very low. To determine the knowledge, attitudes and practices (KAPs) of mothers on Ophthalmia Neonatorum (eye infection in newborns), a descriptive cross-sectional design was adopted, using a standardised interviewer-administered questionnaire to collect data. Using a consecutive sampling technique, we enrolled 407 mothers to participate in the study. The overall KAPs of the study participants were assessed using the sum score of each outcome based on Bloom’s cut-off point. Completed data was then analysed using descriptive statistics with SPSS version 22.0 at the level of P < .05. Out of the 407 participants, 321 (78.9%) had not heard about Ophthalmia Neonatorum with nearly 93% having low levels of knowledge on the neonatal infection. We found a significant association between formal education ( P = .001), skilled occupation ( P = .008) and a high level of knowledge on Ophthalmia Neonatorum. The study highlights the need to find improved and alternative methods of educating mothers on Ophthalmia Neonatorum in the bid to reduce blindness attributed to the condition.

BackgroundNeonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due toChlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established.ObjectiveTo examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC andC. trachomatisin the nasopharynx.MethodsA literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers forC. trachomatiswith results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested forC. trachomatisin the eye/ nasopharynx (NP).ResultsThe search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates ofC. trachomatisconjunctivitis in infants in included studies who received silver nitrate was 20–33%; positive NP, 1–28% and pneumonia, 3–8%. Rates ofC. trachomatisconjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0–15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4–33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0–4% developed chlamydial pneumonia.ConclusionNeonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers withC. trachomatisinfection compared to silver nitrate.

BACKGROUND: Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic or antibiotic medication is dispensed into the eyes of newborns, or dispensed systemically, soon after delivery to prevent neonatal conjunctivitis and potential vision impairment. OBJECTIVES: 1. To determine if any type of systemic or topical eye medication is better than placebo or no prophylaxis in preventing ophthalmia neonatorum. 2. To determine if any one systemic or topical eye medication is better than any other medication in preventing ophthalmia neonatorum. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, and three trials registers, date of last search 4 October 2019. We also searched references of included studies and contacted pharmaceutical companies. SELECTION CRITERIA: We included randomised and quasi‐randomised controlled trials of any topical, systemic, or combination medical interventions used to prevent ophthalmia neonatorum in newborns compared with placebo, no prophylaxis, or with each other. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. Outcomes were: blindness or any adverse visual outcome at 12 months, conjunctivitis at 1 month (gonococcal (GC), chlamydial (CC), bacterial (BC), any aetiology (ACAE), or unknown aetiology (CUE)), and adverse effects. MAIN RESULTS: We included 30 trials with a total of 79,198 neonates. Eighteen studies were conducted in high‐income settings (the USA, Europe, Israel, Canada), and 12 were conducted in low‐ and middle‐income settings (Africa, Iran, China, Indonesia, Mexico). Fifteen of the 30 studies were quasi‐randomised. We judged every study to be at high risk of bias in at least one domain. Ten studies included a comparison arm with no prophylaxis. There were 14 different prophylactic regimens and 12 different medications in the 30 included studies. Any prophylaxis compared to no prophylaxis Unless otherwise indicated, the following evidence comes from studies assessing one or more of the following interventions: tetracycline 1%, erythromycin 0.5%, povidone‐iodine 2.5%, silver nitrate 1%. None of the studies reported data on the primary outcomes: blindness or any adverse visual outcome at any time point. There was only very low‐certainty evidence on the risk of GC with prophylaxis (4/5340 newborns) compared to no prophylaxis (5/2889) at one month (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.24 to 2.65, 3 studies). Low‐certainty evidence suggested there may be little or no difference in effect on CC (RR 0.96, 95% CI 0.57 to 1.61, 4874 newborns, 2 studies) and BC (RR 0.84, 95% CI 0.37 to 1.93, 3685 newborns, 2 studies). Moderate‐certainty evidence suggested a probable reduction in risk of ACAE at one month (RR 0.65, 95% 0.54 to 0.78, 9666 newborns, 8 studies assessing tetracycline 1%, erythromycin 0.5%, povidone‐iodine 2.5%, silver nitrate 1%, colostrum, bacitracin‐phenacaine ointment). There was only very low‐certainty evidence on CUE (RR 1.75, 95% CI 0.37 to 8.28, 330 newborns, 1 study). Very low‐certainty evidence on adverse effects suggested no increased nasolacrimal duct obstruction (RR 0.93, 95% CI 0.68 to 1.28, 404 newborns, 1 study of erythromycin 0.5% and silver nitrate 1%) and no increased keratitis (single study of 40 newborns assessing silver nitrate 1% with no events). Any prophylaxis compared to another prophylaxis Overall, evidence comparing different interventions did not suggest any consistently superior intervention. However, most of this evidence was of low‐certainty and was extremely limited. AUTHORS' CONCLUSIONS: There are no data on whether prophylaxis for ophthalmia neonatorum prevents serious outcomes such as blindness or any adverse visual outcome. Moderate‐certainty evidence suggests that the use of prophylaxis may lead to a reduction in the incidence of ACAE in newborns but the evidence for effect on GC, CC or BC was less certain. Comparison of individual interventions did not suggest any consistently superior intervention, but data were limited. A trial comparing tetracycline, povidone‐iodine (single administration), and chloramphenicol for GC and CC could potentially provide the community with an effective, universally applicable prophylaxis against ophthalmia neonatorum.

Background: Pregnant women with Chlamydia trachomatis and Neisseria gonorrhoeae infections can vertically transmit these microorganisms to their newborns through the birth canal and cause neonatal conjunctivitis secondary to sexually transmitted infections. Objectives: In this cross-sectional study, we aimed to evaluate the prevalence of C. trachomatis and N. gonorrhoeae infections among pregnant women attending a hospital in Tehran, and also determine the vertical transmission rate of these two organisms to the eyes of newborns after vaginal delivery. Methods: Endocervical and conjunctival swabs were collected from pregnant women and their newborns within 24 hours after birth. Demographic and clinical data of participants were obtained using a questionnaire and from the hospital records. Then, DNA was extracted and tested by a multiplex PCR assay to detect C. trachomatis and N. gonorrhoeae in specimens. Results: Genital infections of C. trachomatis and N. gonorrhoeae were detected in 9.6% (11 of 125) and 1.6% (2 of 125) of pregnant women, respectively. Among newborns, ocular infection with C. trachomatis was detected in 2 (1.6%), and no case of N. gonorrhoeae infection was found. Both infected infants were born from asymptomatic infected women. Therefore, the vertical transmission rate of C. trachomatis infection was calculated as 18.1%. Our results also revealed that ocular C. trachomatis infection in neonates is significantly in association with genital C. trachomatis infection in pregnant women (OR = 0.16, 95% CI = 0.03 - 0.7, P = 0.002). Conclusions: Pregnant women with asymptomatic infection of C. trachomatis have a key role in the distribution of chlamydial conjunctivitis in newborns. Since ocular prophylaxis in neonates is not effective for chlamydial conjunctivitis, therefore education and screening of pregnant women, as well as treatment of infected cases, remain as the best approach for controlling the disease.

Background: Vision screening in infants is an important part of the medical care of children as some eye abnormalities, if not treated in the first few months or years of life, can lead to irreversible vision loss. Objective: The objective of this cross-sectional, descriptive study was to identify ocular anomalies among infants attending immunization clinics in Nigeria and refer promptly and appropriately. Methodology: Infants were screened across 6 immunization clinics. Screening activities included relevant ocular history, vision assessment, external ocular examination, ocular motility, Hirschberg’s test, pupil examination, and the red reflex test. Infants with abnormal findings were referred for comprehensive eye examination. Result: Of the 142 infants who underwent vision screening, 29 were referred. These referrals were either as a result of ocular abnormalities (n = 22) or presence of risk factors from history (n = 7). The prevalence of ocular abnormalities was 15.5% and neonatal conjunctivitis (38%), was the commonest ocular abnormality found. Others were bacterial conjunctivitis (14%), nasolacrimal duct obstruction (14%), strabismus (14%), capillary hemangiomas (10%), iris nevi (5%), and vernal keratoconjunctivitis (5%). Of the 7 infants referred based on history alone, 6 (85.7%) had a history of prematurity. Conclusion: Conjunctivitis, strabismus, congenital nasolacrimal duct obstruction, and capillary hemangioma are some of the prevalent disorders seen in infants at immunization clinics in Nigeria. Babies at risk of retinopathy of prematurity (preterm birth and oxygen therapy) can be identified. Immunization clinics can serve as good points of vision screening for infants in developing countries to facilitate prompt referral and treatment.

Ophthalmia neonatorum or neonatal conjunctivitis refers to conjunctival inflammation with associated discharge. Onset is within the first 28 days of life and transmission is by delivery via an infected birth canal. The majority of cases are bacterial, the most common bacterial agent being chlamydia; however, it is crucial to consider a viral cause.1 An often underestimated and potentially blinding cause is the herpes simplex virus (HSV), which although common in adults is rare in infants.2 Despite its rare occurrence, GPs must have a high suspicion of HSV conjunctivitis on initial presentation because misdiagnosis in a newborn with an immature immune system has sight-threatening consequences.1,2 Figures 1⇓–3 show a case example of the consequences of late diagnosis. Figure 1. Mother experienced herpetic genital lesions 2 days after vaginal delivery. Onset of neonate’s symptoms on day 5, treated as bacterial infection. Late diagnosis of HSV-1 at week 3 (fluorescein staining). Figure 2. One week after admission. Figure 3. Follow-up 10 months after initial review. Final diagnosis: right-eye herpetic disease (permanent scarring) with secondary glaucoma eventually requiring tube shunt surgery. HSV infections are not always apparent clinically and are common worldwide, with humans being the natural reservoirs. A key feature of HSV-1 and HSV-2 infections is their latency in neural ganglia, a lifelong burden. During its many short reproductive cycles of activation, the virus …

Aim Our aim was to study prospectively the aetiology of neonatal conjunctivitis in a population‐based setting. Methods Altogether 173 neonates with clinical conjunctivitis aged on average 20 (SD 10) days were recruited from child welfare clinics in Oulu, Finland, in 2010–2015. Conjunctival specimens were collected from 167 neonates for multiplex polymerase chain reaction to detect 16 respiratory viruses, from 163 for polymerase chain reaction to detect Chlamydia trachomatis and Neisseria gonorrhoeae and from 160 for bacterial culture studies. The cases were followed up until the age of 18 months. Results Viral conjunctivitis was diagnosed in 8/167 (4.8%; 95% CI 2.1–9.2%), chlamydial or gonococcal conjunctivitis in 0/163 cases (0%; 95% CI 0–2.2%) and other bacterial conjunctivitis in 58/160 (36%; 95% CI 29–44%). Rhinovirus was found at the ocular site in 4/167 (2.4%) neonates, adenovirus in 3/167 (1.8%) and bocavirus in 1/167 (0.6%). The most commonly isolated bacteria included Staphylococcus aureus (16%), Moraxella catarrhalis (9.4%) and Streptococcus pneumoniae (3.1%). None of these pathogens was associated with the 4/173 (2.3%) cases later operated on for persistent nasolacrimal duct obstruction. Conclusion Chlamydia trachomatis was a rare pathogen in neonatal conjunctivitis in a population‐based setting, but respiratory viruses were detected more frequently than indicated earlier.

Background The aim of the project is to retrospectively study the changes in bacterial pathogens in acute neonatal bacterial conjunctivitis from 2002 to 2016 in Southern China. The results may provide the guidance for drug choice for acute neonatal bacterial conjunctivitis. Methods Secretion specimens for bacterial culture were taken from 485 cases with clinically diagnosed acute bacterial neonatal conjunctivitis. Bacterial pathogens were detected by Gram staining and subsequent bacterial culture. Results From the analysis of the bacterial pathogens in 485 cases of acute neonatal conjunctivitis patients from 2002 to 2016 in Southern China, there is an overall trend of decreasing detection of Gram-positive bacteria and increasing detection of Gram-negative bacteria from the conjunctival sac secretions. Gram-positive bacteria in the bacteria-positive samples dropped year by year from 82.6% in 2002 to 72.4% in 2016. Accordingly, the ratio of Gram-negative bacteria increased from 17.4% in 2002 to 27.6% in 2016. Of note, despite the overall trend, there was a significant increase in detection of Gram-positive bacteria and decrease in detection of Gram-negative bacteria from 2011 to 2012. Among the Gram-positive bacteria, there is a trend of increasing percentage of the opportunistic pathogens (an ~60% increase in Staphylococcus epidermidis and Staphylococcus saprophytic) and decreasing percentage of Staphylococcus aureus (~30% decrease) and hemolytic streptococcus (~20% decrease) in the last 15 years. The main Gram-negative bacterium is Neisseria gonorrhoeae. Overall, there is a change in the pattern of bacterial species in acute neonatal bacterial conjunctivitis in Southern China in the last 15 years. Conclusion Our study provides a trend analysis of the bacterial pathogens in the conjunctival sac secretions of the acute neonatal bacterial conjunctivitis patients in Southern China in recent years. This data could provide useful information regarding the treatment options for neonatal bacterial conjunctivitis.

The objective of the present study was to determine the frequency and age distribution of different Chlamydia trachomatis (CT) genotypes causing ophthalmia neonatorum (ON) in Hungary. Using CT specific PCR, we tested 76 conjunctival samples from symptomatic infants up to 3 months old in the National Centre for Epidemiology, Budapest between 2008 and 2016. CT tested positive in 30 of 76 conjunctival samples (39.5 %). The sequencing of the positive samples was successful in every case but one, and resulted in 48% dominance for genotype E (14/29), followed by 24% for genotype G (7/29), 10% for J (3/29), 6.9% for K and F (2/29), and 3.4% for H (1/29). CT must still be regarded as a common pathogen causing ON in Hungary. Routine screening and treatment of pregnant women can be recommended to prevent these conditions. Chronic ON cases can be reduced by early diagnosis. Further research is needed to explain the dominance of genotypes E and G.

BACKGROUND Neonatal conjunctivitis is eye discharge in neonates and it is a common infection in neonates in the first month of life. Worldwide, the incidence of neonatal conjunctivitis varies from 1% to 33% depending on the socioeconomic status of the people in the region. In India, the incidence varies from region to region from 0.9 to 35%. MATERIALS AND METHODS Single center prospective study. All neonates of age 0-30 days delivered and referred from neonatal ward of Chengalpattu Medical College and Hospital with complaints of eye swelling, redness, conjunctival discharge to the eye department for treatment are included in the study. RESULTS In this study, age group from 0-7 days were most commonly affected by neonatal conjunctivitis. Both eyes were commonly affected together. Neonates born by both LSCS and normal vaginal delivery were almost equally affected. The most common organism found in culture and Gram staining was staphylococci. CONCLUSION Neonatal conjunctivitis is more likely to be acquired postnatally. It acquires during the 1 st week and responds well to local application of antibiotics, which covers common causative bacteria.

Aim. Investigation of the features of epidemiological characteristics of infectious morbidity associated with medical care registered in newborns in maternity care facilities of the Republic of Tatarstan. Methods. Retrospective epidemiological study of the morbidity of infections associated with medical care registered in newborns in the Republic of Tatarstan was performed. Epidemiological analysis was carried out using the forms of Federal statistical observation №2 of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing «The information about the infectious and parasitic diseases» (section «Hospital-acquired infections»). Results. Based on the received materials epidemiological analysis of the dynamics of hospital-acquired infectious morbidity in newborns for the period from 2009 to 2015 was performed. Unidirectional trend of infectious morbidity associated with medical care and of various nosological forms was revealed. Downward trend with a negative morbidity growth rate was identified for neonatal pneumonia, osteomyelitis, pyoderma, impetigo, mastitis, panaritium and paronychia of newborns, omphalitis, phlebitis of the umbilical vein and neonatal conjunctivitis. Neonatal morbidity of hospital-acquired otitis media did not changed from the baseline. Prevalent nosological forms of infections associated with medical care among newborns were pyoderma, impetigo, mastitis, panaritium, paronychia (33.6%) and pneumonia (29.5%). Conclusion. The average morbidity of infections associated with medical care in newborns in the Republic of Tatarstan for the period from 2009 to 2015 was 13.0 per 1000 newborns; negative dynamics of the morbidity with negative morbidity growth rate in newborns during this period was revealed (-42.3%).

A baby born at home 14 hours earlier was brought to the neonatology department with bilateral upper palpebral chemosis with purulent secretions and pseudomembranes, with no general signs of infection. The gram staining of a secretion sample shows the presence of Neisseria gonorrhoeae. Intramuscular ceftriaxone treatment was initiated, combined with topical application of rifamycin, dexamethasone, and oxytetracycline. Complete healing without sequelae was obtained after two weeks. This case presents an opportunity to review this preventable pathology and its treatment. The only effective way to prevent it is to raise the awareness of disadvantaged population about the value of antenatal care.

We characterized a case of neonatal conjunctivitis in New York, USA, caused by Neisseria meningitidis by using whole-genome sequencing. The case was a rare occurrence, and the isolate obtained belonged to an emerging clade (N. meningitidis US nongroupable urethritis) associated with an increase in cases of urethritis since 2015.

Chlamydia trachomatis causes the most prevalent bacterial Sexual Transmitted Infection. In pregnant women, untreated chlamydial infections are associated with abortions, premature rupture of membranes, postpartum endometritis, low birth weight and transmission to the newborn. In Córdoba, Argentina, there is little knowledge about the prevalence of Chlamydia trachomatis in women in their third trimester of pregnancy, so, the aim of this study was to evaluate Chlamydia trachomatis prevalence and genotypes present in Cordovan pregnant women with different age and socioeconomic status. Methods and findings Design: prospective study. Settings: Women population from Cordoba city, Argentina. Population: Pregnant women having 35 to 37 weeks of gestation. Methods: Five hundred and nine cervical swabs were collected. Each sample was subjected to DNA extraction and PCR for Chlamydia trachomatis using primers NRO/NLO and CTP1/CTP2. Positives samples were sequenced to determine genotype. Main outcome measures: Demographic data of the patients were collected to detect a population at risk for this infection. Results A prevalence of 6.9% (35/509) for Chlamydia trachomatis infection was detected, with 32/ 295 and 3/214 from pregnant women with low or better economic resources respectively (p = 0,0001). Results showed a significantly increased rate of 11.6% (30/258) in women under 25 years compared with 2% (5/251) in patients over that age (p = 0,00003). Genotype E was the most prevalent. Conclusions With these results, we can say that pregnant women under 25 years old and low economic resources are one of the populations in which the screening programs of Chlamydia trachomatis should focus. Fil: Kiguen, Ana Ximena. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentina Fil: Marramá, Marcela. Dirección de Especialidades Médicas; Argentina Fil: Ruiz, Susana. Laboratorios Lace Sociedad Anónima; Argentina Fil: Estofan, Patricia. Centro Integral de Ginecología; Argentina Fil: Venezuela, Raul Fernando. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentina Fil: Mosmann, Jessica Paola. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentina. Instituto Universitario de Ciencias Biomédicas de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Monetti, Marina Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentina Fil: Rivero, Virginia Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina Fil: Cuffini, Cecilia Gabriela. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

BACKGROUND Neonatal conjunctivitis is frequent and could benefit from daily cleansing with saline. Anyway super infections can occur and therefore antibiotics are frequently needed. Recently alternative therapies (e.g. Echinacea angustifolia) are used for neonatal conjunctivitis to try to reduce antibiotics therapy. The aim of the study was to verify if the use of gauze containing Echinacea angustifolia compared to standard sodium-chloride at the onset of conjunctivitis symptoms is effective in reducing the clinical symptoms and the risk for superinfections. METHODS The study was randomized and controlled. Neonates admitted in a tertiary level Neonatal Intensive Care Unit (NICU), with clinical signs of conjunctivitis during hospital stay, were randomized in two groups: group A (3 times daily ocular cleansing for 48 h with sterile gauze; group B (3 times daily ocular cleansing for 48 h with Iridium® baby gauze (Neoox) containing Echinacea angustifolia and pineapple sativus). An eye swab for cultural analysis was taken at time of presentation (T0) prior to treatment and at the end of ocular cleansing (T1). RESULTS Sixty-three neonates were enrolled (GrA=30 and GrB=33). At T0, eye specimen positivity was found in 16/30 (48%) in group A and in 18/33 (55%) in group B (P=0.9). No statistical differences among groups at T0 regarding culture positivity. After 48 h, babies in Gr A have significantly fewer positive swabs compared to group B (group A: 18/29, group B: 10/32; P=0.009). Neonates in group B who had negative swab at T0 had a significantly reduced risk to have positive culture at T1 (OR 0.28, CI: 0.10-0,80, P=0.01), also considering confounding factors (birth weight, gestational age, mode of delivery) (adjusted OR 0.15, CI: 0.03-0.52, P

Chlamydia trachomatis is a Gram-negative bacterium that causes urogenital tract infections, and ocular infections including trachoma, neonatal conjunctivitis and adult chlamydial inclusion conjunctivitis. A positive C. trachomatis diagnosis in children often raises suspicions of sexual abuse. While outer membrane protein A (ompA) genotypes A–C are non-invasive and are associated with trachoma; ompA genotypes D–K are often associated with sexually transmitted urogenital infections or sexually acquired chlamydial conjunctivitis. A 10-year-old female presented with a 7-month history of unilateral conjunctivitis with itching, watering and hyperaemia. She had recently moved from an urban centre in Afghanistan to the UK. A conjunctival swab taken from the child tested positive for C. trachomatis. Application of ompA genotyping to conjunctival swab chlamydial DNA demonstrated that the C. trachomatis had an ompA genotype C. Chlamydial strains with this ompA genotype cause trachoma and have never previously been associated with urogenital infection. This result supported cessation of child protection investigations.

In developing countries such as Ghana, ophthalmia neonatorum (ON) remains a public health concern. This is because of its unknown etiology patterns, the growing concerns of antibiotic resistance strains and the contribution of ON to childhood blindness. This study was therefore conducted to determine the causative agents, risk factors and the antibiotic sensitivity patterns of micro-organisms associated with ON. A clinic-based prospective study was conducted in the Maternal and Child Health units of six health care facilities in the Central region of Ghana over a period of 17 months. Conjunctival swabs were taken from all neonates with clinical signs of ON. Isolation and characterization of bacteria were done using standard microbiological methods. Additionally, data were collected and analyzed on neonate’s demographics and clinical features of ON. Microbial growth was recorded in 86 cases (52.4%) out of the 110 neonates assessed. Staphylococcus spp. (39.2% of all positive cultures) was the most common causative organism. No case of gonococcus was isolated. Delivery method, vaginal discharge, administration of prophylaxis and weight of neonate were the risk factors associated with the development of ON ( P

Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. AlthoughChlamydia trachomatisis the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surroundingChlamydia trachomatisin pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia.

Introduction: Chlamydia trachomatis (CT) is the most prevalent sexually transmitted bacterial infection, affecting mainly young, sexually active women. Untreated infection may lead to reproductive complications due to tubal damage. Infections during pregnancy may cause preterm labor, low birth weight, perinatal death, and neonatal conjunctivitis and pneumonia. There are few data on CT infection in Brazil. The aim of this study was to determine CT prevalence in infertile and pregnant women. Methods: A cross-sectional study included 77 infertile and 60 asymptomatic pregnant women. First-void urine was tested for CT using PCR (Polymerase Chain Reaction). Blood samples were collected for CT IgG antibodies testing using indirect immunofluorescence. A questionnaire about medical, gynecological, and sexual history was completed by all participants. Results: We found statistically similar prevalence of PCR and IgG antibodies between the groups. There was a 61% prevalence of CT IgG antibodies in infertile women and 56.7% in pregnant women. PCR was positive in only one (1.3%) infertile woman and in none pregnant women. Conclusion: There is a high prevalence of CT IgG antibody in Brazilian pregnant and infertile women, but we found a low prevalence of positive PCR in the urine samples. CT antibodies were associated with sexual behavior and smoking. Keywords: Chlamydia trachomatis , Chlamydia infections, prevalence, nucleic acid amplification techniques; infertility, female; fluorescent antibody technique

We report a case of a 3-day-old boy with Neisseria cinerea conjunctivitis, originally misidentified as Neisseria gonorrhoeae conjunctivitis. Neonates are at increased risk for disseminated gonococcal infection, and physicians should be cognizant of N cinerea and its potential to be mistaken for N gonorrhoeae.

In our recent study in 2015, we showed a significant relationship between increased rate of clinical neonatal conjunctivitis (CNC) and performance of eye red reflex examination. Our study aim was to assess whether improved accessibility of staff to disinfectant gel (via attaching the gel bottle to infant's cradle) will increase the caring staff compliance with hand hygiene and decrease the rate of CNC.Our intervention included attaching bottles of alcohol-based gel to newborns' cradles to ensure full availability and accessibility of hand-wash disinfectant. We included all newborn infants who were born beyond 35 weeks' gestation and stayed in the well-baby nursery. We compared 2 periods: pre-intervention period (n = 9380) versus an intervention period (n = 8087). Three variables were recorded: (1) rate of CNC: number of conjunctival swabs sampled per 1000 newborns whenever an eye discharge was noted, (2) rate of bacterial conjunctivitis: number of positive swabs per 1000 newborns and (3) percentage of positive swabs out of all sampled swabs.Compared with pre-intervention period, the rate of CNC dropped significantly during the intervention period: 28.6/1000 versus 21.3/1000, respectively, P0.01. However, the number of positive bacterial swabs per 1000 newborns (3.2 vs. 2.5) and the percentage of positive bacterial swabs of all sent samples (11.6% vs. 10.8%) were not different between the 2 periods. The majority of pathogens in swabs were Gram-negative sp. without difference between study periods (77.4% vs. 80%), respectively. Univariate analysis showed significant association between rate of CNC and longer length of stay5 days (P0.001) and vaginal delivery. Logistic stepwise regression analysis showed that 4 variables were significantly and independently associated with higher rate of clinical conjunctivitis. These include birth during pre-intervention period [P = 0.018, odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.04-1.54], length of stay 4-5 days (P0.001, OR = 2.23, CI: 1.63-3.06), length of stay7 days (P0.001, OR = 6.51, CI: 4.24-10.02), vaginal delivery (P = 0.004, OR = 1.6, CI: 1.17-2.2) and male gender (P = 0.006, OR = 1.31, CI: 1.08-1.59).Accessibility of a disinfectant gel within each newborn's cradle raised hygiene awareness among the caring staff and contributed to the reduction of CNC rate in the newborn nursery.

The red eye is a heterogeneous complaint with numerous causes including allergic, autoimmune, environmental, infectious, and traumatic causes. Infectious complications (including viral, bacterial, fungal, or parasitic) make up the majority of complaints presenting to the emergency department. A thorough history and physical exam will differentiate these conditions. Conditions can be defined by the area of the eye they affect including conjunctivitis, keratitis, uveitis, etc. These conditions range from benign to ocular emergencies. It is the emergency physician’s job to identify and treat these conditions as well as determine the urgency in which expert consultation is needed.

BACKGROUND:Ophthalmia neonatorum, or neonatal conjunctivitis, is an acute infection that occurs within the first 28 days of life. This aim of this survey was to evaluate the current methods of preventive treatment for ophthalmia neonatorum in maternity hospitals in Croatia. MATERIAL AND METHODS: The annual hospital birth rate in Croatia is approximately 40, 000. A clinical survey was undertaken with data collected using questionnaires sent to all 32 maternity hospitals in Croatia. There was a 100% response rate to the questionnaires. RESULTS: Preventive treatment for ophthalmia neonatorum was administrated to all newborns in 75% (24/32) of Croatian maternity hospitals. In 45.8% of maternity hospitals, (11/32) these procedures were performed within the first hour after birth. In 54.2% of maternity hospitals (13/32), preventive treatment for ophthalmia neonatorum was administrated to all newborns from one to three hours after birth. The main treatment agent was tobramycin (83.3%). Other topical prophylactic treatments included povidone- iodine (8.3%), erythromycin (4.2%), and silver nitrate (4.2%). In 25% of obstetric units, prophylaxis for ophthalmia neonatorum was not used routinely, but in cases of diagnosed neonatal conjunctivitis, antibiotic treatment with tobramycin was mainly used. CONCLUSIONS: A survey of all 32 maternity hospitals in Croatia showed variation in the prevalence of preventive treatment for ophthalmia neonatorum and the methods used. These findings support the need to implement standardized preventive measures that both conform to international clinical guidelines and recognize treatment availability in Croatia, where topical povidone-iodine is currently preferred for the prevention of ophthalmia neonatorum.

Masquerades of lacrimal drainage disorders are not very uncommon [1–3]. They may simulate either an external manifestation of a lacrimal disorder or may mimic the presentations. Among the common masquerades of congenital nasolacrimal duct obstructions include other subtle lacrimal disorders like incomplete punctal canalization and canalicular wall dysgenesis, which can be easily missed, erroneously labeling the patient as a possible CNLDO [3]. Nasal conditions like allergic rhinitis, lacrimal wall maldevelopment, or other nasal mucosal inflammatory disorders may also mimic a CNLDO. Ocular conditions like buphthalmos, neonatal conjunctivitis, and ocular surface inflammatory disorders can also present with neonatal onset of epiphora and discharge. Occasionally subtle medial most ankyloblepharon can also be mistaken for a CNLDO.

Background Vertical transmission can result in neonatal infection and disease. Reducing the transmission of bacterial pathogens from mother to infant may be an effective means of preventing neonatal infection, including bacterial conjunctivitis. Methods In a double-blind, randomized trial, we assessed the effect of administering a single dose of oral azithromycin to women in labour on bacterial colonization of the neonate. A reduction in purulent neonatal conjunctivitis was a secondary objective of the trial. Ocular samples were collected from the lower fornix of infants presenting with clinical signs of purulent conjunctivitis during the first eight weeks of life. Incidence of purulent conjunctivitis was compared between trial arms. Bacterial infection was assessed using PCR and incidence of purulent conjunctivitis due to bacteria was also compared between arms. Results Forty of 843 infants (4.7%) presented clinical signs of purulent conjunctivitis. No significant difference in incidence of purulent conjunctivitis was seen between azithromycin and placebo arms [4.3% (18/419) versus 5.2% (22/424), OR = 0.82, 95% CI (0.44,1.54), p = 0.628]. S. aureus was the most commonly identified pathogen, detected in 38% of cases. Incidence of purulent-conjunctivitis due to bacterial infection was lower in the azithromycin arm [1.2% (5/419) versus 3.8% (16/424), OR = 0.31, 95% CI (0.12–0.82), p = 0.025)]. The incidence of gram-positive bacteria was also lower in the azithromycin arm [1.0% (4/419) versus 3.3% (14/424), OR = 0.28, 95%CI (0.10–0.82), p = 0.029]. Conclusions Oral azithromycin given to women during labour may have the potential to reduce the incidence of bacterial neonatal conjunctivitis. Trial registration ClinicalTrials.gov, identifier NCT01800942 , registration date 26 Feb 2013.

Conjunctivitis is among the most common ophthalmic conditions found in neonatal and pediatric patients. It has a wide range of clinical presentations and outcomes, ranging from self-limiting hyperemia to blindness and life-threatening systemic illness. This review explores the epidemiology, etiology, and diagnosis of conjunctivitis in the neonatal and pediatric population. In addition, it explores recent trends in transmission across different populations and evidence-based approaches that clinicians may use in treating neonatal and pediatric conjunctivitis.

Ophthalmia neonatorum, also called neonatal conjunctivitis, acquired during delivery can occur in the first 28 days of life. Commonly caused by the bacterial pathogen Neisseria gonorrhoeae, infection can lead to corneal scarring, perforation of the eye, and blindness. One approach that can be taken to prevent the disease is the use of an ophthalmic prophylaxis, which kills the bacteria on the surface of the eye shortly after birth. Current prophylaxes are based on antibiotic ointments. However, N. gonorrhoeae is resistant to many antibiotics and alternative treatments must be developed before the condition becomes untreatable. This study focused on developing a fatty acid-based prophylaxis. For this, 37 fatty acids or fatty acid derivatives were screened in vitro for fast antigonococcal activity. Seven candidates were identified as bactericidal at 1 mM. These seven were subjected to irritation testing using three separate methods: the bovine corneal opacity and permeability (BCOP) test; the hen’s egg test—chorioallantoic membrane (HET-CAM); and the red blood cell (RBC) lysis assay. The candidates were also tested in artificial tear fluid to determine whether they were effective in this environment. Four of the candidates remained effective. Among these, two lead candidates, monocaprin and myristoleic acid, displayed the best potential as active compounds in the development of a fatty acid-based prophylaxis for prevention of ophthalmia neonatorum., IMPORTANCE Ophthalmia neonatorum is a painful bacterial infection of the eye in newborns. A common cause is Neisseria gonorrhoeae, which has the potential to cause severe damage to the eye and blindness. This study was designed to identify new and unconventional drug candidates that could be used in an eye ointment to prevent the development of this disease. The drugs that were tested were fatty acid-based compounds. The potential candidates were screened for their ability to kill bacteria in tear fluid without causing damage to the eye. This study identified seven candidates that are fast acting and nonirritating, with two strong candidates for potential use in the eye. Further development and testing are now required to formulate an eye treatment incorporating these drugs to prevent ophthalmia neonatorum.

WOS: 000456953700011, PubMed ID: 30555969, Purpose: The aim of this study was to investigate the aerobic conjunctival flora of neonates and the effects of delivery type on conjunctival flora development in neonates who were born with normal spontaneous vaginal delivery (SVD) or elective caesarean section (C/S) and who were not given prophylactic antibiotic eye drops after birth. Methods: This cross-sectional study included 95 healthy newborns. One day after the delivery, conjunctival samples were taken from newborns who were born with normal SVD or elective C/S, and not given prophylactic antibiotic eye drops after birth. Newborns with conjunctival hyperemia and discharge were excluded from study. Samples were plated in blood agar, EMB, and chocolate agar. These cultures were incubated at 37 degrees C for 24-48 h. Antibiotic sensitivity was evaluated using Kirby-Bauer disc diffusion method. Results: Staphylococcus aureus (S.aureus) growth was observed in 7 (70%) and coagulase negative staphylococcus (CNS) growth in 2 (20%) out of 10 eyes with bacterial growth in 9 culture positive newborns born with C/S. Two S. aureus strains were resistant to methicillin. On the other hand, CNS growth was observed in the conjunctival cultures of 17 out of 19 eyes with bacterial growth in 16 culture positive newborns born with SVD. In 2 eyes with CNS growth, there was also S. aureus growth. The positive cultures for S. aureus were significantly higher in the conjunctival cultures of neonates born with C/S compared to neonates born with SVD, where CNS growth was significantly lower (P = 0.002). All isolates were susceptible to vancomycin, teicoplanin, and gatifloxacin. Two isolates were resistant to methicillin. Conclusions: In deliveries with C/S, the newborn does not contact the vagina. This may result in changes of bacterial characteristic of the flora. Culture positivity for S. aureus was higher in C/S compared to SVD, which may be important in case neonatal conjunctivitis develops. Copyright (C) 2018, Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V.

Neonatal conjunctivitis is usually associated with vagina’s infection by Chlamydia sp., N. gonorrhoeae, and/or other bacteria during delivery. Meningococcal neonatal conjunctivitis is an extremely rare disease. We report a case of neonatal meningococcal sepsis/conjunctivitis and asymptomatic carriage of N. meningitidis from both parents (vagina and nasopharynx). As part of our active surveillance for meningococcal disease at the Tijuana General Hospital (TGH), Mexico, we identified a 3-day-old newborn with meningococcal conjunctivitis and sepsis. The patient had a one-day history of conjunctivitis and poor feeding. Clinical examination confirmed profuse purulent conjunctival discharge, as well as clinical signs and laboratory findings suggestive of bacteraemia. Gram stain from conjunctival exudate revealed intracellular Gram negative diplococci; we presumed the baby had gonorrheal conjunctivitis; however, serogroup Y, N. meningitidis was isolated both from conjunctival exudate and blood. Additionally, isolation of serogroup Y, N. meningitidis was obtained from mother’s vagina and both parents’ nasopharynx. The baby was treated with 7 days of IV ceftriaxone and discharged with no sequelae.

Ophthalmia neonatorum, a form of neonatal conjunctivitis, was seen to be a serious problem in England at the turn of the twentieth century. Midwives were directly implicated in its prevalencewith debate ensuing over the extent towhich they should be taught about ophthalmia neonatorumand the extent towhich they should participate in the diagnostic and therapeutic process. The involvement of midwives in cases of ophthalmia neonatorum has received little attention from historians. Yet it constitutes an important case study for the limitations in theoretical knowledge available to midwives, andfor theprofessionalanddisciplinaryboundaries imposeduponmidwiferypractice following the passing of theMidwives Act in 1902 and the establishment of the CentralMidwives Board. This article addresses the training of midwives in ophthalmia neonatorum and the ways in which midwives were able to utilise such training in their professional practice.

Background Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark). Methods From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values. Results Sequelae management costs 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 untreated chlamydia ranged from £37 to £412. Conclusions There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context.

Introduction: Le but de l'etude etait decrire les aspects epidemiologiques des conjonctivites neonatales dans le canton de Glidji au Sud du Togo. Methodes: Nous avons mene une etude transversale dans les 4 Unites Sanitaires Peripheriques du canton de Glidji du 19 Mars au 13 Mai 2009 soit 8 semaines. Tous les nouveau-nes ont ete inclus et la conjonctivite neonatale etait definie par la presence chez un nouveau-ne d'au moins deux des signes suivants: hyperhemie conjonctivale, oedeme palpebral, chemosis, secretions purulentes, larmoiement. Les parametres etudies etaient l'âge, le sexe, les facteurs de risque, les antecedents, la presence ou non de conjonctivite, les germes en causes et l'evolution sous traitement. Resultats: Sur la periode, 159 nouveau-nes ont ete examines. L'âge moyen etait de 10,9 jours avec des extremes de 0 a 28 jours. Il y avait 80 garcons pour 79 filles soit un sex-ratio de 1,01. Sur les 159 nouveau-nes, 7 cas de conjonctivite ont ete diagnostiques soit une prevalence de 4,4%. Les facteurs de risque identifies etaient l'accouchement par voie basse et la presence d'IST chez la mere pendant la grossesse. Sur les 7 cas de conjonctivite, l'examen cytobacteriologique a permis d'isoler le staphylococcus aureus dans 2 cas. L'evolution des cas de conjonctivite sous traitement etait favorable avec regression des signes des le 3e jour. Conclusion: Les conjonctivites neonatales avaient une prevalence de 4,4% dans le canton de Glidji au sud du Togo et le staphylocoque dore etait le germe en cause. Leur prevention passe par un bon suivi lors de la consultation prenatale et l'instillation de collyre antibiotique a la naissance Pan African Medical Journal 2016; 24

Chlamydial conjunctivitis results from infection by chlamydia parasite and typically affects sexually active teenagers and young adults. It is the most frequent infectious cause of neonatal conjunctivitis in the UK. It is also the most common curable sexually transmitted infection in the UK. Its clinical manifestations in the eye involve the conjunctiva and the cornea. Untreated disease leads to a chronic remittent course of infection, keratitis (infection to the cornea) and possibly iritis (infammation to the iris) and can lead to total loss of vision if left untreated. This article will focus on the main clinical manifestation of chlamydial conjunctivitis and its investigations. Furthermore, the article will focus on the early management and referral of those patients who present with chlamydial conjunctivitis. Early diagnosis and early management help to prevent ocular and sytemic complications.

To determine the prevalence and correlates of neonatal conjunctivitis in infants born to human immunodeficiency virus type 1 (HIV-1) infected mothers.This was a nested case-control study within a perinatal HIV-1 cohort. HIV-1 seropositive mothers were enrolled during pregnancy and mother-infant pairs followed after delivery with assessment for neonatal conjunctivitis at 48 hours and up to 4 weeks after birth. Genital infections (chlamydia, gonorrhea, syphilis, trichomonas, bacterial vaginosis, and candida) were screened for at 32 weeks gestation. Mothers received treatment for genital infections diagnosed during pregnancy and short-course zidovudine. Newborns did not receive ocular prophylaxis at hospital deliveries. Multivariate logistic regression models were used to determine cofactors for neonatal conjunctivitis overall and stratified for infant HIV-1 status.Four hundred and fifty-two infants were assessed and 101 (22.3%) had neonatal conjunctivitis during the first month postpartum. In multivariate analyses using odds ratios (OR) and confidence intervals (CI), neonatal conjunctivitis was associated with neonatal sepsis (adjusted OR 21.95, 95% CI 1.76, 274.61), birth before arrival to hospital (adjusted OR 13.91, 95% CI 1.39, 138.78) and birth weight (median 3.4 versus 3.3 kilograms, p=0.016, OR 1.79, 95% CI 1.01, 3.15). Infant HIV-1 infection was not associated with conjunctivitis.Despite detection and treatment of genital infections during pregnancy, neonatal conjunctivitis was frequently diagnosed in infants born to HIV-1 infected mothers suggesting a need for increased vigilance and prophylaxis for conjunctivitis in these infants. Neonatal sepsis, birth before arrival to hospital, and higher birthweight are factors that may predict higher risk of neonatal conjunctivitis in this population.

Out of 300 newborn infants who had conjunctival swabs inoculated for detection of Chlamydia trachomatis and other bacteria, 72% had bacteria isolated 4 to 6 days after birth. Of these, Staph. albus constituted 51% and Staph. aureus 19%. None of the infants were Chlamydia positive. Five out of 112 mothers (4.5%) were Chlamydia positive from the cervix just before delivery. Nineteen of the neonates were treated for conjunctivitis within the first month of life. Chlamydia trachomatis was isolated from 2, and Staph. aureus, alpha-Streptococci, Pneumococci and Haemophilus influenzae from some of the other infants. A likely diagnosis could be made in 46% of these cases, while the remaining cultures showed only apathogenic bacteria or no growth. There was a fairly good accordance with observation of inflammatory cells in the tear fluid and the clinical picture, 17/19 = 90% showing neutrophilia. Despite failing aetiological diagnosis in several cases, the infants responded satisfactorily to local antibiotic treatment. 75% of the parents replied to questionnaires 2 months after birth concerning conjunctivitis within the first month of life. The replies showed that 58 = 25% had had conjunctivitis, of whom 17% had been treated with antibiotics.

BACKGROUND. Chlamydia trachomatis is the most common sexually transmitted pathogen in adults, which at delivery may be transmitted from mother to child and cause conjunctivitis and pneumonia. In the Netherlands, prenatal chlamydial screening and treatment of pregnant women is not routine practice. The contribution of C trachomatis to neonatal ophthalmic disease has not been studied in the Netherlands and remains unclear. METHODS. At the Sophia Children's Hospital and Rotterdam Eye Hospital, 2 cohorts of infants RESULTS. C trachomatis was detected in 27 (64%) of 42 retrospectively studied infants and 14 (61%) of 23 prospectively studied infants. Mucopurulent discharge was present in 35 (95%) of 37, swelling of the eyes in 27 (73%) of 37, conjunctival erythema in 24 (65%) of 37, respiratory symptoms in 14 (38%) of 37, and feeding problems in 5 (14%) of 37 infants respectively. Before microbiological diagnosis, general practitioners prescribed antichlamydial antibiotics locally to 5 (12%) of 41 and systemically to 4 (10%) of 41 infants who tested positive for chlamydia, and ophthalmologists prescribed to 21 (51%) of 41 and 7 (17%) of 41, respectively. CONCLUSIONS. C trachomatis was the major cause of bacterial conjunctivitis in this population. Clinically, differentiation from other pathogens was not possible. Many infants who tested positive for chlamydia did not receive appropriate antibiotic treatment.

Purpose:To compare the performance of polymerase chain reaction versus conventional methods (cell culture and direct immunofluorescent assay) in diagnosing neonatal chlamydial conjunctivitis and their correlations to the severity of conjunctivitis.Methods:Consecutive cases of neonatal conjunctivitis were recruited over a year. Both eyes were clinically graded according to the severity of conjunctivitis and investigated using the three aforementioned chlamydial tests. Neonatal chlamydial conjunctivitis was assumed if one of these three tests was positive and there was clinical improvement after treatment. Sensitivity and specificity of each of the tests were analyzed.Results:Three hundred sixty-eight sets of chlamydial tests were done for 184 neonates. The percentage of positive results was 93.8% and 71.9% for polymerase chain reaction and conventional methods, respectively. Using positive results in either cell culture or direct immunofluorescent assay as a standard to diagnose neonatal chlamydial conjunctivitis, the sensitivity and specificity of polymerase chain reaction were 92.0% and 97.7%, respectively. If we used polymerase chain reaction as a standard, the sensitivity and specificity of cell culture were 73.3% and 99.7%, respectively. A discrepancy was noted in the number of positive results between polymerase chain reaction and conventional methods in milder disease.Conclusions:Polymerase chain reaction might have a higher sensitivity and similar specificity in diagnosing neonatal chlamydial conjunctivitis compared to conventional methods, and it has an additional advantage as a diagnostic tool in mild disease.

Aim: To evaluate the effectiveness of 2.5% povidone-iodine eye drops (PIED) compared with ophthalmic chloramphenicol (OC) for preventing neonatal conjunctivitis. Methods: 2004 neonates were enrolled from three rural hospitals in a trachoma endemic area. They were randomly assigned to receive either PIED (n = 1024) or OC (n = 974). Infectious conjunctivitis was confirmed by laboratory methods, including specific search for Chlamydia trachomatis by polymerase chain reaction assay. Results: During the first 48 hours after birth, PIED and OC had similar efficacy against bacterial conjunctivitis (95% confidence interval (CI), −0.031 to −0.004; p = 0.01); from day 3 to day 15, PIED was 6% less effective than OC (95% CI, −0.058 to −0.006; p = 0.01); after day 16 there was no significant difference between the groups (95% CI, −0.022 to 0.041; p = 0.57). However, the risk of C trachomatis conjunctivitis was increased in neonates receiving PIED prophylaxis (relative risk = 1.99 (95% CI, 1.07 to 3.71), log-rank p = 0.029). Ocular side effects were rare and self limiting in both groups (p = 0.223). Conclusions: PIED seems to increase the risk of acquiring chlamydial conjunctivitis in neonates. Additional measures are required to prevent mother to fetus transmission of chlamydial infection during pregnancy, delivery, and after birth.

This is a review of epidemiological, microbiological and ophthalmological publications on the importance of multidrug-resistant bacterial strains in medical, particularly ophthalmological, care. Current state of pharmaceutical market and wide variety of generics confuses doctor's (including ophthalmologist's) sense of decision-making on the optimum antibiotic for the treatment of purulent inflammation. Indiscriminate use of antibiotics contributes to multiple drug resistance in bacteria. The world returns to the pre-antibiotic era, in which there was no treatment for severe infectious and inflammatory diseases. The most dangerous multiresistant strains known to medical science and their role in etiology of inflammatory eye diseases are listed in the article. Since neonatal conjunctivitis and postoperative endophthalmitis are the most common ocular inflammatory diseases caused by nosocomial multiresistant bacteria, their etiological classification is also described. Emergence of antibiotic resistance to most frequently used ophthalmic agents and prevention strategies are discussed.Данная статья представляет обзор литературы из эпидемиологических, микробиологических и офтальмологических источников о полирезистентных штаммах бактерий в медицине и офтальмологии. Современное состояние фармацевтического рынка и наличие большого количества 'дженериков' дезориентирует врача в плане выбора оптимального антибиотика для лечения гнойно-воспалительных заболеваний, в том числе в офтальмологии. В результате бессистемного применения антибактериальных препаратов происходит селекция полирезистентных штаммов бактерий. Мир возвращается к ситуации, существовавшей до эры антибиотиков, когда не было средств для лечения тяжелых инфекционно-воспалительных заболеваний. В статье описаны наиболее опасные полирезистентные штаммы бактерий, известные в медицине, определена их роль в этиологии воспалительных заболеваний глаз. Охарактеризована этиологическая структура конъюнктивитов новорожденных и послеоперационных эндофтальмитов как наиболее частых воспалительных заболеваний в офтальмологии, вызванных госпитальными штаммами полирезистентных бактерий. Изложены механизмы формирования лекарственной устойчивости бактерий к наиболее распространенным в офтальмологии антибактериальным препаратам, обозначены пути профилактики селекции полирезистентных штаммов.

Aim Red reflex eye examinations often require opening the eyelids, risking infection. We evaluated links between this procedure and neonatal conjunctivitis. Methods We divided 18 872 neonates of more than 35 weeks of gestation into two birth periods, 2008–2009 and 2010–2011, before and after red reflex examinations were carried out by our facility. The rates of clinical conjunctivitis, bacterial conjunctivitis and bacterial growth percentage were compared between the two periods. Results The 2010–2011 period included more Caesarean deliveries and longer lengths of stay (LOS) than the 2008–2009 period. The clinical conjunctivitis rate increased significantly during 2010–2011 (p = 0.029), but the bacterial conjunctivitis and bacterial growth percentages did not differ between the two periods. Variables that were independently and significantly associated with clinical conjunctivitis included being born in 2010–2011, with an odds ratio (OR) of 1.22, male gender (OR 1.31) and LOS (OR 1.19). Bacterial conjunctivitis was associated with vaginal delivery (OR 3.65), males delivered by Caesarean (OR 2.68) and LOS (OR 1.37). Conclusion Clinical conjunctivitis was significantly associated with the later study period, male gender and LOS. Conjunctival swab sampling increased significantly following the implementation of red reflex examinations, but without changes in the bacterial conjunctivitis rate and the bacterial growth percentage.

Rates of transmission of Chlamydia trachomatis infection from apparently healthy, black, pregnant South African women to their newborns were studied in a setting where tetracycline eye prophylaxis is routinely provided to prevent neonatal conjunctivitis. The postnatal consequences of maternal chlamydial carriage during pregnancy were also evaluated for both mother and child. A total of 77 chlamydia-positive women and their newborns were followed-up. The chlamydial transmission rate from mother to infant was estimated to be 30%. C. trachomatis was detected in the conjunctivae of 39% and in the nasopharynx of 83% of these infants. Tetracycline eye prophylaxis appeared to prevent overt ocular, but not nasopharyngeal infection. Postnatal genitourinary symptoms and signs were found in 52% and 78% of chlamydia-positive mothers respectively with 18% developing post-partum pelvic inflammatory disease. The complex of postnatal maternal genitourinary symptoms and signs in combination with symptoms and signs in the ...

Purpose: To compare the clinical and bacteriological effects of fucidic acid (Fucithalmic(R): 1.0%) and chloramphenicol (Minims(R): 0.5%) eye drops in neonates with a clinical diagnosis of acute conjunctivitis of suspected bacterial origin. Methods: A total of 456 newborns with gestational age > 32 weeks with acute conjunctivitis of suspected bacterial origin acquired within the first 28 days of life were included in the study. They were randomly assigned to a 7-day treatment with eye drops using either fucidic acid (1.0%) (Fucithalmic(R)) applied or chloramphenicol (0.5%) (Minims(R) Chloramphenicol) applied twice per day six times per day. The subjects were followed up with two visits (on days 1 and 8) and by telephone 2 weeks after the end of treatment. Results: Eighty-nine per cent of the neonates treated with Fucithalmic(R) were cured, compared to 87.9% of those treated with Minims(R) Chloramphenicol (n.s). The drug was used as instructed in 90.7% of patients treated with Fucithalmic(R) and in 78.0% of those treated with Minims(R) Chloramphenicol (P < 0.001). Conclusion: Treating neonatal conjunctivitis with fucidic acid is easier than with chloramphenicol and is equally effective.

Despite dramatic declines in the incidence of ophthalmia neonatorum with universal prophylaxis, it remains a clinically important cause of eye disease in newborns. While clear guidelines exist for the treatment of the historically primary agents of ophthalmia neonatorum ( Chlamydia trachomatis and Neisseria gonorrhoeae), it is less clear how to manage newborns with conjunctivitis secondary to other bacterial organisms, particularly those also frequently implicated in neonatal sepsis. We present the case of a 3-day-old well-appearing term infant with unilateral purulent conjunctivitis. The eye culture grew Escherichia coli, an unusual cause of ophthalmia neonatorum. After a limited sepsis evaluation proved negative, the infant was switched to moxifloxacin ophthalmic drops and made a full recovery. This case highlights the challenge of managing a rare presentation with minimal guideline support, as well as the need to consider other bacterial causes of neonatal conjunctivitis which are emerging in the era of routine prophylaxis in the United States.

Purpose: To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing. Methods: Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 μCi 99m technetium pertechnetate was measured by dacryoscintigraphy. Results: According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up. Conclusions: Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.

Conjunctivitis is a very common presentation to general practitioners and general paediatricians. The investigation of conjunctivitis can be a significant cost to microbiology laboratories due to the high volume of samples that can be submitted, particularly from patients in the community. The key issue is to send eye swabs in clinical situations where it can make a difference to management, and limiting the use of eye swabs in routine cases of conjunctivitis which are likely to be due to viruses. For investigation of neonatal conjunctivitis we recommend sending a bacterial swab for routine culture, and also a swab for molecular detection of Chlamydia trachomatis and Neisseria gonorrhoeae. In older children with mild conjunctivitis no swab is necessary unless there is marked conjunctival injection. In this article we also highlight patient populations that require specialist tests to be sent as part of their assessment such as contact lens wearers and sexually active teenagers.

BACKGROUND Primary meningococcal conjunctivitis is assumed to be due to the direct inoculation of Neisseria meningitidis into the conjunctival sac from an exogenous source. According to a literature review, no case of neonatal conjunctivitis infection acquired at delivery from maternal endocervicitis has been published. GOAL To report a case of meningococcal neonatal conjunctivitis acquired at delivery because of the mother's endocervical infection and cross-transmission of the strain with her partner. STUDY DESIGN Strains were characterized by bacteriologic and serologic methods including grouping (agglutination), typing, and subtyping (enzyme-linked immunoabsorbent assay). Molecular analysis was done by pulsed-field gel electrophoresis. RESULTS The three strains (newborn infant, mother, partner) were of the same antigenic formula (C:NT:P1.NT) and exhibited similar NheI and SpeI pulsed-field gel electrophoresis patterns. CONCLUSION The identical phenotypic and genomic analysis of strains is the evidence for N meningitidis transmission at delivery from a maternal endocervical infection to the newborn infant and cross transmission between sexual partners. Fil: Fiorito, Susana M. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Centro Nacional de Referencia en Enfermedades de Transmisión Sexual (CNR-ETS); Argentina. Fil: Galarza, Patricia G. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Centro Nacional de Referencia en Enfermedades de Transmisión Sexual (CNR-ETS); Argentina. Fil: Sparo, Mónica. Hospital Ramon Santamarina; Argentina. Fil: Pagano, Elba I. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Centro Nacional de Referencia en Enfermedades de Transmisión Sexual (CNR-ETS); Argentina. Fil: Oviedo, Claudia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Centro Nacional de Referencia en Enfermedades de Transmisión Sexual (CNR-ETS); Argentina.

Chlamydia trachomatis is considered a major aetiological agent of conjunctivitis in newborns. The objective of the present study was to determine the aetiology of neonatal conjunctivitis and clinico-epidemiological correlates of chlamydial ophthalmia neonatorum. Fifty-eight newborns with signs and symptoms of conjunctivitis were studied. Conjunctival specimens were subjected to Gram staining, routine bacteriological culture, culture for Neisseria gonorrhoeae and direct fluorescent antibody (DFA) staining for diagnosis of C. trachomatis infection. C. trachomatis was detected in 18 (31%) neonates. Findings suggest that since C. trachomatis is the most common cause of neonatal conjunctivitis, routine screening and treatment of genital C. trachomatis infection in pregnant women and early diagnosis and treatment of neonatal Chlamydial conjunctivitis may be considered for its prevention and control.