Chlamydial

Chlamydia Conjunctivitis
Chlamydia Conjunctivitis
Is caused by Chlamydia Trachomatis bacteria
Devide into 3 types:
1. Trachoma: serotypes A–C
2. Adult and neonatal inclusion conjunctivitis: serotypes D–K
3. lymphogranuloma venereum: serotypes L1, L2, and L3
Trachoma
• Trachoma is an infectious disease that occurs in communities with poor
hygiene and inadequate sanitation.
• It affects approximately 150 million individuals worldwide and is the
leading cause of preventable blindness.
• Transmission may also occur by flies and household fomites,
• Trachoma typically begins in childhood as a bilateral chronic follicular
conjunctivitis that due to recurrent episodes progresses to conjunctival
scarring
Trachoma
Symptoms and Signs:
Foreign-body sensation, redness, tearing, and mucopurulent discharge.
Clinical diagnosis of trachoma requires at least 2 of the following clinical
features:
1.
2.
3.
4.
1
Follicles on the tarsal conjunctiva (usually upper tarsal)
Limbal follicles and their sequelae (Herbert pits) HALLMARK OF TRACHOMA
Typical tarsal conjunctival scarring
Vascular pannus most marked on the superior limbus
2
3
4
Trachoma
WHO made a simple severity grading for other trained personnel other
than ophthalmologists based on the presence or absence of 5 key
signs:
1. Follicular conjunctival inflammation
2. Diffuse conjunctival inflammation
3. Tarsal conjunctival scarring
4. Aberrant lashes
5. Corneal opacification
Trachoma
Management:
WHO made SAFE' strategy for the management of trachoma.
• S: Surgery for Trichiasis and Ectropion
• A: Antibiotics for C. trachomatis infection
• tetracy- cline 1% ophthalmic ointment, applied twice daily for 2 months, and
oral azithromycin 1000 mg, given as a single dose.
• Oral erythromycin is recommended for treat- ment of rare tetracyclineresistant cases.
• F: Facial cleanliness
• E: Environmental change to improve sanitation and increase access to
clean water.
Adult and neonatal inclusion conjunctivitis
• a sexually transmitted disease often found in conjunction with
chlamydial urethritis or cervicitis.
Mode transmission:
1. Direct/Indirect contact with infected genital secretions.
(newborn and sexually active transmission)
2. Shared eye cosmetics
3. Inadequately chlorinated swimming pools
Adult and neonatal inclusion conjunctivitis
Symptoms and Sign:
Adult
Newborn
• Local:
 Papillae and follicles especially in lower
tarsus.
 Scant mucopurulent discharge
 Superficial Keratitis superiorly.
 Palpable preauricular adenopathy.
 Small Micropannus
 No pseudomembrane
• Local: papillary conjunctivitis, a
moderate amount of exudate, and in
hyperacute casespseudomembranes
occasionally form and can lead to
scarring.
• < 3 months: no follicle formation
• > 3 months: follicles appear , WHY ?
• Systemic: Otitis media
• Systemic: pharyngitis, otitis media, and
interstitial pneumonitis.
Adult and neonatal inclusion conjunctivitis
• Laboratory Finding:
• Enzyme Immunosorbent Assay (ELISA)
• PCR
• Direct fluorescent antibody test- use for newborn to prevent systemic
complication
• How to differentiate Inclusion Conjunctivitis and Trachoma:
• Inclusion conjunctivitis occurs in SEXUALLY ACTIVE adolescents or adults,
whereas active, follicular trachoma usually occurs in young children or others
living in or exposed to a community with endemic trachoma.
• Conjunctival scarring is VERY RARE in adult inclusion conjunctivitis.
• HERBERT’S PITS are a hallmark of trachoma.
Adult and neonatal inclusion conjunctivitis
Treatment:
Adult
• Azithromycin, 1 g in a single dose
• Doxycycline, 100 mg orally twice daily
for 7 days
• Erythromycin, 2 g/d for 7 days. (for
tetracycline resistant or pregnant
woman)
• Treat sexual partner.
Newborn
• Oral erythromycin suspension, 50
mg/kg/d in four divided doses for at
least 14 days
• Why Systemic not Topical?
• Chlamydial infection also involves the
respiratory and gastrointestinal tracts.