Ophthalmia neonatorum: Difference between revisions
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**''[[Escherichia coli]]'' | **''[[Escherichia coli]]'' | ||
**''[[Klebsiella pneumoniae]]'' | **''[[Klebsiella pneumoniae]]'' | ||
''[[Serratia | **''[[Serratia marcesscen]]'' | ||
**''[[Enterobacter]]'' | **''[[Enterobacter]]'' | ||
*[[Septic]] viral | *[[Septic]] viral | ||
Revision as of 20:59, 12 September 2016
Template:Ophthalmia neonatorum
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [6]
Synonyms and keywords: Neonatal Conjunctivitis
Overview
Ophthalmia neonatorum is a form of conjunctivitis contracted by newborns during delivery. The baby's eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria gonorrhoeae or Chlamydia trachomatis. Typical treatment is silver nitrate drops. If left untreated it can cause blindness.
Ophthalmia neonatorum, also known as neonatal conjunctivitis, can also be caused by other bacteria, viruses, and chemical irritants (such as silver nitrate). Thus, silver nitrate is not used very often, anymore, because it can cause chemical conjunctivitis, which usually clears up within 2 to 4 days. In most countries neomycin and chloramphenicol eye drops are being used instead.
Ophthalmia neonatorum due to gonococci (Neisseria gonorrhoeae) typically manifests in the first 5 days of life and is associated with marked bilateral purulent discharge. In contrast, conjunctivitis secondary to infection with chlamydia (Chlamydia trachomatis) produces conjunctivitis after day 3 of life, but may occur up to 2 weeks after delivery. Babies infected with chlamydia may develop pneumonitis (chest infection) at a later stage (range 2 weeks - 19 weeks after delivery). Infants with chlamydia pneumonitis should be treated with oral erythromycin for 14 days.[2]
Historical Perspective
- In 1750, neonatal conjunctivitis (ophthalmia neonatorum) was first described by S.T. Quellmaz.[3]
- In 1881, Crédé introduced 2% silver nitrate for the first time as a prophylaxis treatment method for conjunctivitis in the newborns in Leipzig.[4]
Classification
According to the etiology ophthalmia neonatorum may be classified into::[3]
Pathophysiology
Pathogenesis
Neonatal conjunctivitis is occurring in a newborn during the first month of life, and often known as ophthalmia neonatorum. Neonatal conjunctivitis is mainly caused by sexually transmitted diseases agents such as Chlamydia trachomatis, Neisseria gonorrhoeae, and herpes simplex virus (HSV). Chlamydia trachomatis is the most common cause of ophthalmia neonatorum in the developed countries because of higher prevalence of chlamydia as a sexually transmitted disease.
The recognized routes of transmission of the organisms to the newborns include:[5]
- Infected birth canal during vaginal birth
- Transmembrane transmission of the infection
- Transplacental transmission of the infection
Additionally, silver nitrate drops (ocular prophylaxis) can cause ocular irritation and result in chemical conjunctivitis in newborn.[3]
Gross Pathology
On gross pathology, the following are characteristic findings of conjunctivitis:[6]
- Conjunctival injection
- Mucopurulent discharge or non-purulent discharge
- Pseudomembrane formation
- Chemosis
- Eyelid edema
- Conjunctival hemorrhage (specific for Acute hemorrhagic conjunctivitis)
Microscopic histopathological analysis
On microscopic histopathological analysis, the following are characteristic findings of infective conjunctivitis in neonate:[7]
- Mild spongiotic reaction pattern (low power view of the histology)
- Stromal infiltration by polymorphonuclear, leukocytes, plasma cells, mastocytes, and lymphocyte
- Numerous neutrophils (bacterial conjunctivitis)
Causes
Common causes of include:[3][9]
Differentiating ophthalmia neonatorum from Other Diseases
Neonatal conjunctivitis must be differentiated from:[3][9]
- Dacrocysitis
- Congenital glaucoma
- Nasolacrimal duct obstruction
- Preseptal/Orbital cellulitis
- Keratitis
Epidemiology and Demographics
Prevalence and Incidence
- Worldwide, neonatal conjunctivitis or ophthalmia neonatorum still blinds approximately 10,000 babies annually.[10]
Gender
- The incidence of neonatal conjunctivitis does not vary by gender.[11]
Developed Countries
Prevalence of neonatal conjunctivitis has decreased significantly in developed countries since the abandonment of silver nitrate as topical prophylaxis. Current prevalence of neonatal conjunctivitis in developed countries are 5 per 1000 live births.[12]
- In Belgium and Netherlands, the prevalence of neonatal conjunctivitis due to gonococcal infection was estimated 0.04 per 1000 live births.[3]
- In the United States, the prevalence of neonatal conjunctivitis due to gonococcal infection was estiamted 0.3 per 1000 live births.
- In the United States, the prevalence of neonatal conjunctivitis caused by chlamydial infection was estimated 5 to 60 cases per 1000 live births.
- In the United Kingdom, the prevalence of neonatal conjunctivitis caused by chlamydial infection was estimated 4 cases per 1000 live births.[13]
Developing Countries
- In the Africa, the incidence of neonatal conjunctivitis is still high.[13]
Risk Factors
Common risk factors in the development of neonatal conjunctivitis include:[14][15][16]
- Maternal infections harbored in the mother's birth canal
- HIV infected mothers
- Exposure of the infant to infectious organisms
- Premature rupture of membranes (PROM)
- Inadequacy of ocular prophylaxis after birth
- Silver nitrate exposure
- Ocular trauma during delivery
- Mechanical ventilation
- Prematurity
- Poor prenatal care
- Poor hygienic delivery conditions
Screening
Screening for ophthalmia neonatorum is not recommended. However, antibiotic ointment or eye drops is given to all babies immediately after birth to prevent conjunctivitis and other medical conditions in newborns, . Occasionally, this treatment causes a mild chemical conjunctivitis, which usually clears up on its own. Screening has been recommended by CDC in pregnant women for sexually transmitted diseases (STDs) to prevent spreading the infection to the baby.[17][18]
| Organism | Screening Recommendations in Pregnant Women |
|---|---|
| Chlamydia |
|
| Gonorrhea |
|
| Herpes simplex virus |
|
Natural History, Complications and Prognosis
Natural History
Neonatal conjunctivitis is one of the most common infections occurring in the first month of life. Chemical conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, and disappears spontaneously within 2- 4 days. In the absence of adequate prophylaxis, 30% to 42% of infants born by vaginal delivery to infected mothers will develop gonococcal conjunctivitis. Gonococcal conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than other causes of ophthalmia neonatorum. It presents with severe bilateral purulent conjunctivitis, tearing, and eyelids swelling. If left untreated, it may cause corneal involvement such as corneal ulceration, diffuse opacification, and corneal perforation . This may lead to blindness, ultimately sepsis, or death. The onset of chlamydial conjunctivitis is usually later than gonococcal conjunctivitis. In the absence of adequate prophylaxis, 30% to 50% of infants born by vaginal delivery to infected mothers will develop chlamydial conjunctivitis. The incubation period is 5-14 days. Chlamydial conjunctivitis presents with mild hyperemia, watery discharge, eyelid swelling, papillary reaction, and pseudomembrane formation. If left untreated, it can progress to copious and purulent discharge. This may lead to central corneal opacification and blindness. Herpetic conjunctivitis is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days. If left untreated, HSV conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated HSV infection can cause central nervous system (CNS) involvement. Ophthalmia neonatorum caused by pseudomonas is rare but can present with eyelid edema, erythema, and purulent discharge. If left untreated, can progress to corneal perforation, endophthalmitis, blindness, and possibly death.[3][19][20]
Complications
Complications to neonatal conjunctivitis include:[20][21]
- Ocular complications
- Pseudomembrane formation
- Corneal edema
- Thickened palpebral conjunctiva
- Peripheral pannus formation
- Corneal opacification
- Staphyloma
- Corneal perforation
- Endophthalmitis
- Loss of eye and blindness
- Systemic complications of chlamydia conjunctivitis
- Systemic complications of gonococcal conjunctivitis
- Arthritis
- Meningitis
- Anorectal infection
- Septicemia
Prognosis
- Early detection and early treatment of neonatal conjunctivitis is associated with a good prognosis.[20][21]
Diagnosis
History
A history from the patient include:[3][20][21]
- History of sexually transmitted disease (STD) in mother
- Ocular prophylaxis with silver nitrate
Symptoms
Symptoms of neonatal conjunctivitis (ophthalmia neonatorum), based on casualty, may include the following:[20][3][21]
| Causally | Symptomes |
|---|---|
| Gonococcal |
|
| Chlamydial |
|
| Chemical |
|
Physical examination
Ophthalmologic examination of patients with neonatal conjunctivitis or ophthalmia neonatorum is usually remarkable for:[3][22][23]
- Neisseria gonorrhea
- Chemosis
- Severe lid edema
- Mucopurulent discharge
- Corneal involvement (diffuse epithelial edema, ulceration, corneal perforation, and endophthalmitis
- Chlamydia trachomatis
- Chemical
- Mild conjunctival injection
- Epiphora
Laboratory findings
Laboratory findings for neonatal conjunctivitis may include the following:[3][24][25][26][27]
Viral Conjunctivitis
- Positive conjunctival scraping for polymerase chain reaction (PCR) (PCR testing for HSV is more sensitive than viral culture)
- Positive viral culture of corneal epithelial cells for HSV
Chlamydial Infection
- Positive polymerase chain reaction (PCR) of conjunctival scraping
- Positive gram staining or giemsa staining of conjunctival scraping(help characterize the conjunctival inflammatory response)
- Positive DNA hybridization assays
- Direct fluorescent monoclonal antibody staining of smears
- Positive enzyme immuno-assays for chlamydia organisms
Gonococcal Infection
- Positive gram staining of conjunctival scraping for gram-negative intra-cellular diplococci
- Positive special cultures for neisseria species on chocolate agar or Thayer-Martin
Treatment
Medical Treatment
Surgery
Surgical intervention is not recommended for the management of neonatal conjunctivitis (ophthalmia neonatorum).[3]
Primary Prevention
Effective measures for the primary prevention of ophthalmia neonatorum include:[19]
- Educate parents or care providers to wash their hands frequently
- Educate pregnant women on the importance of regular examinations to detect and treat sexually transmitted infections (STD)
- Avoid vaginal delivery (HSV Transmission rates are high for women who acquire genital herpes in the last few weeks of pregnancy)
- Avoid ocular prophylaxis with silver nitrate
Secondary Prevention
Effective measures for the secondary prevention of neonatal conjunctivitis (ophthalmia neonatorum) include:[19]
- Ocular prophylaxis with 0.5% erythromycin ointment or 1% tetracycline hydrochloride be given to all newborns.
References
- ↑ Centers for Disease Control and Prevention's Public Health Image Library[1]
- ↑ "Red Book - Report of the Committee on Infectious Diseases, 29th Edition. The American Academy of Pediatrics". Retrieved 2007-07-12.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
- ↑ "Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn". Am J Dis Child. 121 (1): 3–4. 1971. PMID 5543850.
- ↑ Treadwell P (1994). "Sexually transmitted diseases in neonates and infants". Semin Dermatol. 13 (4): 256–61. PMID 7848819.
- ↑ National Eye Institute (2015) [2] Accessed on June 24, 2016
- ↑ DermNet NZ (2015)[3] Accessed on June 26, 2016
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages
- ↑ 9.0 9.1 Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005
- ↑ Isenberg SJ, Apt L, Wood M (1996). "The influence of perinatal infective factors on ophthalmia neonatorum". J Pediatr Ophthalmol Strabismus. 33 (3): 185–8. PMID 8771523.
- ↑ Moore DL, MacDonald NE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee (2015). "Preventing ophthalmia neonatorum". Can J Infect Dis Med Microbiol. 26 (3): 122–5. PMC 4507834. PMID 26236350.
- ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
- ↑ 13.0 13.1 Schaller UC, Klauss V (2001). "Is Credé's prophylaxis for ophthalmia neonatorum still valid?". Bull World Health Organ. 79 (3): 262–3. PMC 2566367. PMID 11285676.
- ↑ Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E; et al. (2009). "Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers". Ophthalmic Epidemiol. 16 (6): 337–45. doi:10.3109/09286580903144746. PMC 3223245. PMID 19995198.
- ↑ Zar HJ (2005). "Neonatal chlamydial infections: prevention and treatment". Paediatr Drugs. 7 (2): 103–10. PMID 15871630.
- ↑ Nahmias AJ, Visintine AM, Caldwell DR, Wilson LA (1976). "Eye infections with herpes simplex viruses in neonates". Surv Ophthalmol. 21 (2): 100–5. PMID 982267.
- ↑ Centers for Disease Control and Prevention (2015) http://www.cdc.gov/std/tg2015/screening-recommendations.htm Accessed on June 29, 2016
- ↑ Centers for Disease Control and Prevention (2002) http://www.cdc.gov/mmwr/PDF/rr/rr5115.pdf Accessed on June 29, 2016
- ↑ 19.0 19.1 19.2 Matejcek A, Goldman RD (2013). "Treatment and prevention of ophthalmia neonatorum". Can Fam Physician. 59 (11): 1187–90. PMC 3828094. PMID 24235191.
- ↑ 20.0 20.1 20.2 20.3 20.4 Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of [[Neisseria gonorrhoeae]] and [[Chlamydia trachomatis]]". J Infect Dis. 153 (5): 862–9. PMID 3084664. URL–wikilink conflict (help)
- ↑ 21.0 21.1 21.2 21.3 Centers for Disease Control and Prevention (2015)[4] Accessed on June 30, 2016
- ↑ Rours, Ingrid GIJG, et al. "Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants." Pediatrics 121.2 (2008): e321-e326.
- ↑ Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.
- ↑ Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH (2015). "The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil". Clinics (Sao Paulo). 70 (11): 748–50. doi:10.6061/clinics/2015(11)06. PMC 4642493. PMID 26602522.
- ↑ Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). "Adenoviral keratoconjunctivitis". Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
- ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
- ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
![[1]](https://en.wikipedia.org/wiki/Neonatal_conjunctivitis#/media/File:Gonococcal_ophthalmia_neonatorum.jpg){kind=link}