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Incidence of Chlamydia trachomatis and other potential pathogens in neonatal conjunctivitis
S Di Bartolomeo1, D H Mirta, M Janer
1Microbiology Laboratory, National Hospital Professor A. Posadas, Ministery of Public Health, Buenos Aires, Argentina.
Insights
Neonatal conjunctivitis cases declined but remain a concern. Haemophilus influenzae and Streptococcus pneumoniae are prevalent pathogens, while Chlamydia trachomatis incidence also decreased.
Area of Science:
- Neonatal infectious diseases
- Ophthalmology
- Microbiology
Background:
- Neonatal conjunctivitis presents a persistent public health challenge.
- Routine microbiological investigation of conjunctivitis cases was implemented in primary care settings.
Purpose of the Study:
- To determine the bacterial etiology of neonatal conjunctivitis.
- To monitor trends in causative agents and incidence over time.
Main Methods:
- Analysis of 332 infants diagnosed with conjunctivitis between 1995 and 1998.
- Bacterial isolation, characterization, and specific detection of Neisseria gonorrhoeae and Chlamydia trachomatis.
- Chlamydia trachomatis detection via antigen immunodetection and PCR, with genotyping.
Main Results:
- Conjunctivitis incidence decreased from 39.6 to 15.2 cases per 1000 live births.
- Microbial growth was observed in 50.3% of cases; C. trachomatis was detected in 7.83%.
- Haemophilus influenzae (16.9%) and Streptococcus pneumoniae (12.3%) were the most common bacterial isolates.
Conclusions:
- While overall neonatal conjunctivitis cases have decreased, it remains significant.
- Chlamydia trachomatis incidence declined, with seasonal patterns observed.
- Haemophilus influenzae, alone or with S. pneumoniae, is a prevalent pathogen, with winter seasonality.
Objective:
Ocular infection in neonatology is a permanent and important health problem. To improve primary attention, prevention, and control, the study of the potential bacterial etiology of all consecutive cases of conjunctivitis was incorporated as a regular procedure in primary care from July 1995 to December 1998.
Materials And Methods:
Prof. A. Posadas Hospital (Great Buenos Aires) has an average of 4294 births per year. This report analyzes the results obtained in 332 infants (age range, 0-30 d) with conjunctivitis. Clinical conjunctivitis was diagnosed in inpatients and outpatients by the same specialized staff. Isolation and characterization of bacteria were done by conventional microbiologic methods, including specific search for Neisseria gonorrhoeae and Chlamydia trachomatis. Chlamydia trachomatis was studied by antigen immunodetection and polymerase chain reaction, and genotyped by restriction fragment length polymorphism.
Results:
Conjunctivitis had an incidence (cases per 1000 live births) of 39.6 in 1995, 25.3 in 1996, 15.4 in 1997, and 15.2 in 1998. Microbial growth was detected in 167 (50.3%) of 332 cases. Ocular C. trachomatis infection was detected in 26 cases (7.83%). Five of seven isolates in tissue cultures belonged to type E and two to type G. Bacteria from respiratory ecology were the main isolates: Haemophilus influenzae (16.9%), Streptococcus pneumoniae (12.3%), and Staphylococcus aureus (8.7%). Haemophilus influenzae isolates were not serotyped and 17.2% of them were b-lactamase producers. In 15 cases both H. influenzae and S. pneumoniae were isolated together. Of S. pneumoniae, 4.9% were oxacillin resistant.
Conclusions:
There has been a decline in the total number of cases of neonatal conjunctivitis, but the disease is still an important health problem. Chlamydia trachomatis also shows a decreasing profile with an incidence of (cases per 1000 live births) 4.39 in 1995, 1.85 in 1996, 1.01 in 1997, and 0.78 in 1998, and a tendency to show more incidence in spring-summer and significant accumulation of cases in babies between 7 and 9 days of age. Haemophilus influenzae alone (12.3%) or associated with S. pneumoniae (4.5%) appears as a prevalent potential bacterial pathogen. A significant accumulation of H. influenzae and S. pneumoniae cases occurs in winter. In 47.6% of cases, there was no bacterial growth. No significant seasonal differences in percentage of negative cultures or among the three-day age groups were detected. Neisseria gonorrhoeae was not found associated with ophthalmia neonatorum in this series.