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Published on: June 17, 2025
Adult inclusion conjunctivitis diagnosed by polymerase chain reaction and Giemsa stain
Wan-Ju Annabelle Lee1,2,3, Chien-Chin Chen4,5
1Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan.
Abstract:
Adult inclusion conjunctivitis, caused by Chlamydia trachomatis, is easily underdiagnosed with nonspecific ocular manifestation. Combined scrape cytology and molecular testing may be a useful strategy for its early diagnosis. A 24-year-old healthy male complained of blurred vision, foreign body sensation, and watery discharge in his right eye for four weeks. His visual acuity was 20/20 bilaterally at his first visit. Allergic conjunctivitis was the first impression, and topical treatment with corticosteroid and anti-histamine was prescribed. However, he returned five days later without symptom improvement, and his right eye vision declined to 20/40. Subepithelial corneal infiltration of his right eye was observed. According to his personal history, his girlfriend was diagnosed with sexually transmitted chlamydial infection and genital gonorrhea. Under the suspicion of sexually transmitted adult inclusion conjunctivitis, we collected his conjunctival lavage to both real-time polymerase chain reaction, which proved chlamydial infection, and Giemsa stain, which demonstrated typical basophilic intracytoplasmic inclusions. To diagnose adult inclusion conjunctivitis, we can use real-time polymerase chain reaction or Giemsa stain to help us obtain a quick and correct diagnosis.
Insights
Adult inclusion conjunctivitis, often caused by Chlamydia trachomatis, can be diagnosed early using combined molecular and cytology testing. This approach aids in identifying the infection, even with nonspecific eye symptoms.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Adult inclusion conjunctivitis, caused by Chlamydia trachomatis, presents with nonspecific ocular symptoms, leading to underdiagnosis.
- Early and accurate diagnosis is crucial for effective treatment and preventing complications.
Observation:
- A 24-year-old male presented with persistent blurred vision and ocular discomfort, initially misdiagnosed as allergic conjunctivitis.
- Despite topical treatment, his condition worsened, with decreased visual acuity and subepithelial corneal infiltrates observed.
Findings:
- Conjunctival lavage analysis revealed Chlamydia trachomatis infection via real-time polymerase chain reaction.
- Giemsa staining identified characteristic basophilic intracytoplasmic inclusions, confirming the diagnosis.
Implications:
- Combined scrape cytology and molecular testing (real-time PCR, Giemsa stain) offer a valuable strategy for the early and accurate diagnosis of adult inclusion conjunctivitis.
- Prompt diagnosis facilitates timely treatment, potentially preventing vision loss associated with Chlamydia trachomatis ocular infections.

