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  • Title: Ophthalmia neonatorum in Bangkok: the significance of Chlamydia trachomatis.
    Author: Sergiwa A, Pratt BC, Eren E, Sunona TC, Hart CA.
    Journal: Ann Trop Paediatr; 1993; 13(3):233-6. PubMed ID: 7505547.
    Abstract:
    In a prospective 2-month case-controlled study, 17 cases of neonatal conjunctivitis were diagnosed. A statistically significant association between neonatal conjunctivitis and the presence of Chlamydia trachomatis (five cases) and Staphylococcus aureus (five cases) was shown. No cases of gonococcal conjunctivitis were found, perhaps because of the routine use of silver nitrate (1%) drops. C. trachomatis conjunctivitis could not be diagnosed on clinical grounds, nor was examination of Giemsa-stained conjunctival scrapes sufficiently sensitive to detect all cases. In order to prevent the long-term morbidity of C. trachomatis infection in both mother and child, specific aetiological diagnosis using immunodiagnostic or cultural procedures is required. All 1033 children under 1 month of age attending the ophthalmology clinic at the Children's Hospital, Mahidol University, over the 2-month period July to August 1991 were entered in the study of ophthalmia neonatorum [ON]. Control neonates had either neonatal jaundice or mild respiratory distress but no signs of conjunctivitis. 2 controls matched for age and sex were chosen for each neonate with conjunctivitis. Demographic, social, medical, and obstetric histories were obtained from the mothers by direct questioning. 17 children (1.6%) had neonatal conjunctivitis. 5 neonates (30%) vs. none of the control neonates were infected by C. trachomatis as confirmed by ELISA and immunofluorescence. 5 (30%) of those with ON and significantly ( .03) fewer (6%) controls were infected with S. aureus. Coagulase-negative staphylococci, Acinetobacter anitratus, Pseudomonas spp., and diphteroids were isolated as or more frequently from control neonates. Chlamydial ophthalmia presented between 5 and 10 days after delivery. Of the neonates infected with S. aureus, 1 presented at less than 5 days of age, 2 presented at 5-10 days, and 2 at over 10 days; all of them were boys. Pus cells were on Gram-stained smears in all of the 15 patients tested and in 4 (12%) of the controls. 11 (64%) of the 15 patients had more than 5 pus cells per high power field, whereas only 1 ((3%) of the controls had similar numbers. Bacteria were seen in smears from 8 (53%) of the 15 patients tested and in 8 (23%) of the controls. Giemsa-stained smears of scrapes were available from 14 of the patients. Intracytoplasmic inclusions were seen in the conjunctival epithelial cells of 5 (35%) patients with ON, 3 of which were shown to contain C. trachomatis by ELISA and immunofluorescence. Of the various risk factors studied, only those women with a vaginal discharge during pregnancy (odds ration 6.7, 0.007), and those using non-barrier-type contraceptives (odds ratio 29.3, p 0.0002) were more likely to produce a child with ophthalmia neonatorum.
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