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Neonatal chlamydial conjunctivitis. A long term follow-up study
I Sandström1, I Kallings, B Melen
1Department of Ophthalmology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
Insights
This study found that Chlamydia trachomatis (Ct) causes neonatal conjunctivitis in infants. Oral erythromycin effectively treated most infections, but some infants experienced persistent asymptomatic infections.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Neonatal conjunctivitis is a common condition in newborns.
- Chlamydia trachomatis (Ct) is a significant cause of neonatal conjunctivitis.
- Early diagnosis and treatment are crucial to prevent complications.
Observation:
- Ct was identified in the eyes of 33 out of 160 infants presenting with neonatal conjunctivitis.
- Ct was also detected in the nasopharynx of 58% of infants with chlamydial conjunctivitis.
- Serum IgG and IgM antibodies to Ct were significantly elevated in infants with conjunctivitis compared to controls.
Findings:
- A 14-day course of oral erythromycin ethylsuccinate with lid hygiene resulted in clinical cure for all infants.
- Despite treatment, one infant had persistent asymptomatic chlamydial eye infection, and others had persistent nasopharyngeal or vaginal infections.
- Relapse of clinical conjunctivitis was not observed during a one-year follow-up period.
Implications:
- Oral erythromycin is effective for treating chlamydial neonatal conjunctivitis.
- Persistent subclinical infections and transmission routes warrant further investigation.
- Monitoring for long-term sequelae and effective prevention strategies are essential.
Abstract:
Chlamydia trachomatis (Ct) was isolated from eyes of 33 out of 160 infants with neonatal conjunctivitis. In nineteen (58%) of the infants with chlamydial conjunctivitis Ct could also be isolated from the nasopharynx. All infants were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 hours for 14 days combined with lid hygiene. All were clinically cured, and none had a relapse of clinical Ct conjunctivitis during an observation period of one year. However, one infant had persistent asymptomatic chlamydial eye infection, two displayed a persistent infection of the nasopharynx, and one infant's vagina was infected despite therapy. Serum IgG antibodies to Ct were significantly more often detected in clinical cases (90%) than in controls (33%) (p less than 0.01). Infants with conjunctivitis developed detectable IgM antibodies to Ct in 43% as compared to 7% in controls (p less than 0.01).