CHLAMYDIA TRACHOMATIS CAUSING NEONATAL CONJUNCTIVITIS: WHAT KIND OF PREVENTION?

AIMS Chlamydia trachomatis is one of the most common sexually transmitted agents. Infants born vaginally to infected mothers may present with conjunctivitis (20-50%) and/or pneumonia (5-20%) [1]. Chlamydia spp. is a frequent identifiable cause of neonatal conjunctivitis, in association with S. aureus, E. coli, N. gonorrhoeae. Topical eye drops such as silver nitrate 1% effectively prevent gonococcal neonatal conjunctivitis; however, antibiotic topical agents are commonly used in the clinical practice in the attempt to prevent also chlamydial infections. METHODS Topical ocular prophylaxis with fusidic acid was instituted early after birth. Data about new cases of chlamydial conjunctivitis from September 2011 to August 2012 were recorded. Data included length and course of pregnancy, maternal diseases, delivery method, newborn weight, postnatal course. RESULTS Two cases of isolated chlamydial conjunctivitis were recorded. Both infants (one male, one female) were born by vaginal delivery. They were full term, healthy infants,without ocular malformations, whose mothers were treated with neither systemic nor local antibiotics near delivery. Birth weight: 3,400 and 2,380 g respectively. Pregnancy courses are unknown. Both infants received antibiotic prophylaxis in each eye 20 minutes after delivery. The age of presentation for conjunctivitis was between day 10 and 12 of life. Infants presented with hyperemic conjunctiva, mucopurulent discharge and swollen eyelids. The male infant also had blood-stained eye discharge. Ophthalmological examinations showed follicular conjunctivitis. Definite diagnosis was made by detection of Chlamydia DNA by PCR on specimens obtained by swabbing the conjunctiva. Both infants were treated with systemic Clarithromycin at 10 mg/kg/day in 2 doses for 14 days, after an electrocardiogram was performed. No long-term ocular sequelae were found. CONCLUSIONS In addition to the typical features of chlamydial conjunctivitis, a follicular conjunctivitis was demonstrated at ophthalmological examination in both our neonates. Prophylaxis with fusidic acid did not prevent all cases of chlamydial neonatal conjunctivitis. In the absence of information about pregnancy, screening for Chlamydia spp. may be an effective practice to prevent neonatal infection and related complications.