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Chlamydia trachomatis infection in infants: a prospective study
P M Preece1, J M Anderson, R G Thompson
1New Cross Hospital, Wolverhampton.
Insights
Chlamydia trachomatis infection during pregnancy can cause neonatal conjunctivitis and respiratory issues in infants. However, routine prenatal screening is not recommended due to effective treatment options.
Area of Science:
- Neonatal infections
- Ophthalmology
- Pediatric respiratory diseases
Background:
- Chlamydia trachomatis (C. trachomatis) is a common sexually transmitted bacterium.
- Vertical transmission from mother to infant can occur during childbirth.
- The clinical manifestations of C. trachomatis infection in neonates include conjunctivitis and pneumonia.
Purpose of the Study:
- To prospectively evaluate the incidence and clinical outcomes of C. trachomatis infection in infants born to infected mothers.
- To determine the association between C. trachomatis infection and neonatal conjunctivitis and lower respiratory tract infections.
- To assess the utility of prenatal screening for C. trachomatis.
Main Methods:
- Prospective study involving 198 pregnant mothers positive for chlamydial antigen.
- Infant follow-up for up to six months with C. trachomatis detection via cell culture.
- Clinical assessment for conjunctivitis and lower respiratory tract infections.
- Chlamydial antigen enzyme-linked immunosorbent assay (ELISA) used for screening.
Main Results:
- C. trachomatis was recovered from 25% of infants (43/174).
- Neonatal conjunctivitis was significantly more common in infants with C. trachomatis (47%) compared to those without (14%).
- Lower respiratory tract infections were also more frequent in infected infants (14% vs 2%).
- ELISA showed a high rate of false positives, often associated with Staphylococcus aureus.
- The incidence of C. trachomatis infection was 8.2 per 1000 live births.
Conclusions:
- C. trachomatis is a significant cause of neonatal conjunctivitis and respiratory infections.
- Infant infections are often asymptomatic or present with mild symptoms.
- Effective treatment with oral erythromycin is available.
- Routine prenatal screening for C. trachomatis is not warranted given the availability of treatment and potential for false positives with screening tests.
Abstract:
In a prospective study of Chlamydia trachomatis infection in pregnancy, 198 mothers positive for chlamydial antigen were identified; the infants of 174 were followed for up to six months and C trachomatis was recovered in cell culture from 43 infants (25%). Conjunctivitis occurred in significantly more infants who were positive for C trachomatis (20 of 43, 47%) than in those who were negative (18 of 131, 14%). There were also significantly more lower respiratory tract infections among infants with positive cultures (six of 43, 14%, compared with three of 131, 2%). The chlamydial antigen enzyme linked immunosorbent assay (ELISA) was positive in 61 of 131 infants from whom C trachomatis was not recovered in cell culture. False positive results were usually associated with the isolation of Staphylococcus aureus from samples of pharyngeal aspirate. Our results confirm that C trachomatis infection is a common cause of neonatal conjunctivitis, and respiratory infection in the first few months of life, with an incidence of 8.2/1000 live births. Because the infection is easily treated by oral erythromycin, however, screening during pregnancy is not warranted.