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Epidemiology of genital chlamydial infections in patients with chlamydial conjunctivitis; a retrospective study.

OBJECTIVE: To determine how often chlamydial conjunctivitis is accompanied by a genital chlamydial infection and if there is a correlation between the dominant hand and the eye first infected. METHODS: We retrospectively studied the records of 65 patients with chlamydial conjunctivitis who were referred to the Outpatient Department of Sexually Transmitted Diseases (STD) of the University Hospital Rotterdam by ophthalmologists of the Eye Hospital Rotterdam. The patients have recently been asked by letter if they were left- or right-handed. RESULTS: Twenty of the 37 men (54%) had a positive chlamydial urethral culture. Seventy per cent of these men had no genital symptoms. Eight of the 37 men (22%) had a non-specific urethritis (NSU). Twenty of the 27 women examined (74%) had a positive chlamydial cervical culture. Sixty per cent of these women had no genital symptoms. Eight women with a genital chlamydial infection also had another genital infection. Five women without a genital chlamydial infection had another genital infection. Two women had no genital infection at all. A correlation between the eye infected and left- or right-handedness of the patient could not be found. CONCLUSIONS: A considerable percentage of the patients with a chlamydial conjunctivitis had a concomitant genital chlamydial infection. The majority of them had no genital symptoms. Since patients with chlamydial conjunctivitis and/or their partners possibly have a concomitant genital chlamydial infection, we recommend referral of both patients and sexual partners to an STD clinic for routine examination and systemic treatment when indicated.

Adolescent↗

Compound 48/80-induced conjunctivitis in the mouse: kinetics, susceptibility, and mechanism.

A mouse model of conjunctivitis has been developed by topical application of compound 48/80 (C48/80), an agent that triggers mast cell degranulation. We examined the responsiveness of C57BL/6, C3H/HeN, and ASW/J mouse strains to C48/80 stimulation, and of a mutant strain with mast cell depletion (WBB6F1/J and its sham control). Conjunctivae were collected and examined histopathologically at 15 min and 1,6,24,48 and 72 h after topical C48/80 administration. Conjunctival inflammation developed in all strains, although the severity varied. The conjunctivitis was characterized clinically by irritation, discharge, erythema, and chemosis. Pathology showed conjunctival infiltration with neutrophils, macrophages, CD4+ T lymphocytes, and a few eosinophils. Degranulation of mast cells and evacuation of goblet cells were also observed. Late-phase inflammatory reactions peaked 6-24 h after C48/80 administration and resolved by 48-72 h. WBB6F1/J mice had much less inflammation than their sham controls. In conclusion, topical C48/80 induced a conjunctival inflammatory response similar to allergen-induced conjunctivitis. The depletion of mast cells significantly reduced the inflammation. This model which consistently mimics the clinical signs and histopathological processes of allergic conjunctivitis in humans, is practical and reliable for the evaluation of new anti-allergic medications and for the investigation of conjunctival cellular responses in the allergic inflammatory cascade.

Animals↗

[Reproducible model of a bacterial conjunctivitis].

To test the efficiency of antimicrobial substances on bacterial conjunctivitis under standardized conditions a reproducible model is needed. As there are no data in the literature concerning this topic we have developed a model of bacterial conjunctivitis in the rabbit eye. Instillation of a suspension of Haemophilus influenzae, Staphylococcus epidermidis or Staphylococcus aureus into the cul-de-sac did not result in any effect. Thus, standardized techniques of conjunctival incision were used additionally. A follow-up was done for a period of 2 weeks (degree of conjunctival hyperemia, microbiology). Radial incision of the conjunctiva with injection of an S. aureus suspension (50 microliters of ATCC 29213; 1.35 x 10(8) cells) was done mimicking a branch injury. This resulted in a purulent conjunctivitis over a period of 1 week and disappeared within 14 days. The swabs were negative on day 7. This is the first model establishing a reproducible purulent conjunctivitis in the rabbit. Using this model antimicrobial substances may be tested under standardized conditions.

Animals↗

Inhibitory effect of levocabastine on experimental allergic conjunctivitis in guinea pigs.

The effect of levocabastine on allergic and histamine (Hi)-induced conjunctivitis in guinea pigs was compared with those of cromolyn sodium and amlexanox. Levocabastine inhibited both antigen- and Hi-induced conjunctivitis. Amlexanox had no effect on Hi-induced conjunctivitis; however, the drug elicited a significant inhibition of allergic conjunctivitis. On the other hand, the effect of cromolyn sodium was almost negligible in both cases. Levocabastine moderately inhibited Hi release from guinea pig conjunctiva induced by antigen-antibody reactions. Amlexanox also caused a significant inhibitory effect, whereas cromolyn sodium was not effective in suppressing Hi release induced by antigen challenge. Furthermore, levocabastine prevented an increase in the vascular permeability elicited by both Hi and antigen instillation.

Aminopyridines↗

Ear involvement in ligneous conjunctivitis: a rarity or an under-diagnosed condition?

Conjunctivitis lignosa, a rare affliction of the conjunctiva, is sometimes associated with other disturbances. We present two children with concurrent conjunctivitis lignosa and ear involvement. In these two cases, there were histopathologically verified ligneous changes of the middle ears. Routine haematoxylin and eosin, van Gieson, periodic acid-Schiff (PAS) and alcian blue staining of specimens from the eyes and middle ears revealed findings typical for ligneous conjunctivitis. In addition, new histochemical and immunohistochemical studies for glycosaminoglycans on specimens from the eyes and middle ears showed that the accumulations of the amorphous, cell-deficient material stained strongly but heterogeneously for hyaluronic acid and weakly but uniformly for keratin sulphate. The staining for other glycosaminoglycans, e.g. chondroitin-4-sulphate and dermatan sulphate was confined to vessels and areas rich in collagen fibres and fibroblasts. In patients with conjunctivitis lignosa, the ear involvement may remain undiagnosed due to its resemblance to secretory otitis media with effusion. Since isolated ear involvement may occur, we advocate biopsies for routine haematoxylin and eosin, and specific staining for hyaluronic acid and keratin sulphate, also in children with protracted, refractory otitis media with atypical effusion.

Adolescent↗

The early efficacy of topical levocabastine in patients with allergic conjunctivitis.

BACKGROUND: We investigated the early efficacy of topical levocabastine, an H(1) histamine-receptor antagonist, in improving the clinical symptoms of allergic conjunctivitis. METHODS: Thirty-six patients with allergic conjunctivitis were enrolled. One drop of levocabastine was instilled in one eye and one drop of artificial tears in the contralateral eye. Clinical examinations were performed before, and 15 and 30 minutes after instillation. Symptoms of itching and signs of injection were assessed at each time point. RESULTS: Both levocabastine and artificial tears resulted in a statistically significant reduction in ocular itching. However, levocabastine was significantly more effective. CONCLUSIONS: Although artificial tears had a positive effect in reducing symptoms of allergic conjunctivitis, by the washing out of allergens, levocabastine was more effective than artificial tears in controlling acute symptoms of allergic conjunctivitis, demonstrating that the selective H1 histamine-receptor antagonist action of levocabastine is rapidly effective in a clinical setting.

Administration, Topical↗

Neonatal conjunctivitis caused by Chlamydia trachomatis.

Chlamydia trachomatis is a common cause of neonatal infection in industrialized countries and is acquired from the infected maternal cervix. Multiple mucosal surfaces, including the respiratory and the gastrointestinal tract as well as the conjunctiva, will be colonized by the organism. Conjunctivitis and pneumonia are the illnesses presently recognized as manifestations of these infections. C. trachomatis is isolated from the eye in 14 to 25% of patients with neonatal conjunctivitis and there is often an associated nasopharyngeal infection. The conjunctivitis is often the first clinical manifestation of these potentially systemic infections and therefore systemic therapy is required. The recommended treatment in neonatal chlamydial conjunctivitis is oral erythromycin 25 mg/kg every 12 hours for 14 days. This dose is well tolerated by the infant. Parents of infants with chlamydia infection should be treated with oral erythromycin or tetracyclines. Erythromycin should be given to breast feeding mothers.

Bacteriological Techniques↗

Acute purulent conjunctivitis in Nigerian children in Zaria.

A prospective study of 61 acute purulent conjunctivitis seen in children up to 10 years of age at the Ahmadu Bello University Hospital, Zaria, Nigeria, between October 1975 and September 1976 showed H influenzae as the most common etiologic agent (26.2%), followed by S aureus (16.4%), N gonorrhoeae (14.8), and D pneumoniae (9.8%). N gonorrhoeae was the most common cause of conjunctivitis in the first month of life (43.8%) followed by S aureus (37.5%). Conjunctivitis from H influenzae occurred in older children, was more often bilateral, and had a male predilection. Gonococcal conjunctivitis occurred mostly in neonates and was largely unilateral. A good response to treatment with parenteral penicillin and topical Neosporin or chloramphenicol was noted in all the cases of gonococcal infection.

Anti-Bacterial Agents↗

Acute hemorrhagic conjunctivitis in Southeast Asian refugees arriving in the United States--isolation of enterovirus 70.

During July-September 1980, an epidemic of acute hemorrhagic conjunctivitis (AHC) occurred in several refugee camps and transit centers in Southeast Asia. Of 2,356 refugees examined in Bangkok, 200 (8.5%) had conjunctivitis, including 116 (58%) with hemorrhagic signs. Because increasing numbers of refugees were arriving in the United States with conjunctivitis, a program of surveillance and control was implemented. Enterovirus 70, not previously reported from patients in the Western Hemisphere, was cultured from four arriving refugees. A fourfold rise in titer to enterovirus 70 was found in 10 others, either in the United States or Thailand. After control measures were instituted, the prevalence of the United States or Thailand. After control measures were instituted, the prevalence of conjunctivitis in arriving refugees declined from 49.8 per 1,000 to 3.8 per 1,000. Follow-up of cases after arrival in the United States revealed only one possible secondary case. Extensive epidemics of AHC in the Western Hemisphere are most likely to occur following importation into the humid, coastal areas of Central and South America.

Asia, Southeastern↗

Effect of improved stoves on prevalence of acute respiration infection and conjunctivitis among children and women in a rural community in Kenya.

OBJECTIVES: To estimate the effect of improved stoves on the prevalence of ARI and conjunctivitis among children aged below five years and women aged between 15 and 60 years. METHOD: A field trial or intervention study design, in which cluster and random sampling were used to recruit households with improved stoves. Nearest households with traditional three-stone stoves were recruited as controls. Prevalence of ARI and conjunctivitis among the study subjects was estimated by clinical evaluation and physical observation, and by history (including clinical and socioeconomic information), and compared between the two study groups. RESULTS: The prevalence of ARI among children aged below five years and among women aged between 15 and 60 years were significantly higher in households with the traditional three-stone stoves than in those with the improved stove chi 2 = 31.45 rho = 0.00000, relative risk = 2.6, C.I. 1.86,3.63, and chi 2 = 30.13, rho = 0.00000, Relative Risk = 2.8, C.I. 1.93, 4.06, respectively). Similarly the prevalence of conjunctivitis among children aged below five years and among women aged between 15 and 60 years were significantly higher in households with traditional three-stone stoves than in those with the improved stoves (c2 = 24.18, p = 0.00000, Relative Risk = 3.3, C.I. 2.05,5.32, and chi 2 = 7.6, rho = 0.0057, Relative Risk = 3, C.I. 1.38, 6.54, respectively). CONCLUSION: Prevalence of ARI and conjunctivitis among children aged below five years and also among women aged between 15 and 60 years in households with the traditional three-stone stoves was significantly higher than that in households with improved stoves.

Acute Disease↗

Epidemic gonococcal conjunctivitis in central Australia.

OBJECTIVES: To describe an epidemic of gonococcal conjunctivitis in central Australian Aboriginal children, the responsible phenotypes of Neisseria gonorrhoeae, factors facilitating spread and treatment efficacy. DESIGN: Prospective study of patients with laboratory confirmed or clinical gonococcal conjunctivitis diagnosed from January to July 1991. SETTING: The Alice Springs and Barkly Tablelands Health Districts of the Northern Territory, the Anangu Pitjantjatjara Lands of South Australia and the Ngaanyatjarra Homelands of Western Australia. METHODS: Cases were identified from surveillance data and laboratory notifications, and by active case finding. A community survey explored risk factors. MAIN OUTCOME MEASURES: Age-specific attack rates, auxotype/serovar characterisation of isolates, and clinical response to single dose treatment. RESULTS: We identified 432 cases. The highest attack rate was in the 0-4 year age group (86 per 1000), and the risk of conjunctivitis decreased with age. The odds ratio of secondary infection in household compared with community contacts was 14.5 (P < 0.002; 95% CI, 1.8-120.0). Disease was less common in children with clean faces and hands. The outbreak occurred after unseasonable rains and large community gatherings. Isolates were predominantly IA serovars, less common among central Australian serovars. CONCLUSIONS: The trigger for nonsexually transmitted gonococcal conjunctivitis epidemics remains obscure. Age is a significant risk factor and social and ecological factors may also contribute. Active case finding within affected households and treatment with a suitable penicillin is effective in stopping transmission.

Acute Disease↗

Epidemic mycoplasmal conjunctivitis in house finches from eastern North America.

In the winter of 1993-94, house finches (Carpodacus mexicanus) with severe conjunctivitis (later shown to be caused by Mycoplasma gallisepticum) were first observed in sub-urban Washington D.C. (USA) and adjacent states. Using a large network of volunteer observers in eastern North America, we were able to track the monthly prevalence of the disease between November 1994 and March 1997. Using the information on 24,864 monthly data forms, we describe the very rapid spread of the conjunctivitis epidemic through the eastern house finch population. The epidemic first expanded mainly north, probably carried along by house finches on their return migration, then mainly toward the southeast, and later west. By March 1997, conjunctivitis had been reported from most of the eastern range of the house finch. The prevalence of the disease seemed to fluctuate seasonally with increases in the fall, probably as a result of dispersing juveniles. House finch numbers decreased throughout winter in areas with cold winters and high conjunctivitis prevalence, suggesting significant mortality associated with the disease.

Animals↗

[Vitamin A and carotene concentration in serum in persons with chronic conjunctivitis and pterygium].

In 41 persons with chronic conjunctivitis, 28 persons with pterygium and 61 eye-healthy persons the Vitamin A and carotene blood level have been examined. All persons with chronic conjunctivitis and pterygium have subjective eye disturbances. In persons with chronic conjunctivitis the vitamin A blood level was lower (men 32 mcg%, women 20 mcg%). In almost all persons with chronic conjunctivitis and pterygium delayed dark adaptation was recorded and the skin-mucosal changes are more frequent.

Carotenoids↗

Compound-heterozygous mutations in the plasminogen gene predispose to the development of ligneous conjunctivitis.

Homozygous type I plasminogen deficiency has been identified as a cause of ligneous conjunctivitis. In this study, 5 additional patients with ligneous conjunctivitis are examined. Three unrelated patients (1 boy, 1 elderly woman, and 1 man) had plasminogen antigen levels of less than 0.4, less than 0.4, and 2.4 mg/dL, respectively, but had plasminogen functional residual activity of 17%, 18%, and 17%, respectively. These subjects were compound-heterozygotes for different missense mutations in the plasminogen gene: Lys19 --> Glu/Arg513 --> His, Lys19 --> Glu/Arg216 --> His, and Lys19 --> Glu/Leu128 --> Pro, respectively. The other 2 patients, a 14-year-old boy and his 19-year-old sister, who both presented with a severe course of the disease, exhibited plasminogen antigen and functional activity levels below the detection limit (<0.4 mg/dL and <5%, respectively). These subjects were compound-heterozygotes for a deletion mutation (del Lys212) and a splice site mutation in intron Q (Ex17 + 1del-g) in the plasminogen gene. These findings show that certain compound-heterozygous mutations in the plasminogen gene may be associated with ligneous conjunctivitis. Our findings also suggest that the severity of clinical symptoms of ligneous conjunctivitis and its associated complications may depend on the amount of plasminogen functional residual activity.

Adolescent↗

A coxsackievirus type A24 epidemic of acute conjunctivitis.

The 1975 epidemic of acute conjunctivitis was caused by the return of S.E.C. 1970 virus (CA24). The clinical manifestations of cases seen in the recent epidemic were similar to those seen during the 1970 epidemic caused by S.E.C. 1970 virus (CA24) and the 1971 epidemic caused by S.E.C. 1971 virus (entero-virus type 70). In our opinion, both the S.E.C. 1970 VIRUS (CA24) and S.E.C. 1971 virus (enterovirus type 70) are equally important causes of epidemics of acute conjunctivitis more commonly known as the "Acute Haemorrhagic Conjunctivitis". Although these two enteroviruses affect mainly the eye, apart from conjunctival secretions, they could be transmitted in respiratory droplets and faeces. The authors would prefer to retain the term "Picornavirus Epidemic Conjunctivitis" to denote infection by S.E.C. 1970 virus (CA24) and S.E.C. 1971 virus (enterovirus type 70).

Acute Disease↗

[The incidence of adenoviruses in viral conjunctivitis].

A study about the incidence of Adenovirus on viral conjunctivitis was conducted. A sample design was made and samples of conjunctival exudate were taken from 150 patients with diagnosis of apparently viral conjunctivitis at the "Ramón Pando Ferrer" Ophthalmological Hospital from July to December, 1994. Samples were inoculated in cell culture and the indirect immunofluorescence technique was applied to those with a cytopathogenic effect that suggested infection due to Adenovirus. Monoclonal antibodies were used against Adenovirus allowing to identify them as part of the Adenoviridae family. The hemagglutination technique was used with erythrocytes of monkeys and rats as an indicator system in order to group the isolates previously identified by the indirect immunofluorescence technique. Later on, it was made an analysis by restriction enzymes of the viral genome to enable typing. The results of this study showed an incidence of Adenovirus on viral conjunctivitis of 20%, with a confidence interval between 14 and 26% and a reliability index of 95%. It was proved that serotype 37 caused conjunctivitis more frequently.

Adenovirus Infections, Human↗

Lingeous conjunctivitis with tracheal obstruction. A case report, with light and electron microscopy findings.

A white male infant of 1 year had unilateral membranous conjunctivitis and severe laryngotracheobronchitis which required tracheostomy. Cultures from eye and throat swabs and of fluid suctioned through the tracheostomy grew many organisms, including H. influenzae, adenovirus type 3, and Candida species, but he had no specific immunologic disturbance. Ligneous conjunctivitis was diagnosed. The infant's general condition responded slowly to intensive therapy but the membrane continued to slough off the regrow. The excised membrane contained massive subepithelial deposits of eosinophilic material and a moderately vascular chronic inflammatory-cell infiltrate with numerous mast cells in the perivascular spaces and the hyaline membrane. The conjunctivitis cleared when treated with topical sodium cromoglycate (Intal), a known inhibitor of mediator release from mast-cell granules. The success of Intal therapy in this case supports the theory that mast cells are involved in the pathogenesis of ligneous conjunctivitis.

Anti-Bacterial Agents↗

[Efficacy of specific immunotherapy in children with seasonal allergic rhinitis and conjunctivitis, sensitized to grass pollen].

The aim of this study was the evaluation of efficacy of the specific immunotherapy using Pollinex for 3 years before the period of pollen dust in children with seasonal allergic rhinitis and conjunctivitis induced by grass pollen. The study was carried out in a group of 40 children aged 5-18 years, from the Outpatient Department of Immunology at the National Research Institute of Mother and Child. The children demonstrated clinical symptoms of seasonal allergic rhinitis with conjunctivitis and had a medical history typical for this disease. Diagnostic procedures including skin prick tests and estimation of specific IgE to grass pollen by Pharmacia - CAP system, gave positive results. The efficacy of therapy was monitored by a clinical score with 4-0 points, recording symptoms relating to intensity of rhinoedema, rhinorrhea, sneezing, itching, oedema, conjunctival congestion, pain and lacrimation. In the study group, 39 children (97%) with seasonal rhinitis and conjunctivitis treated by specific immunotherapy (Pollinex) improved. This was confirmed by a statistically significant difference. The results indicate that the specific immunotherapy is an effective treatment of seasonal allergic rhinitis with conjunctivitis in children sensitized to grass pollen.

Adolescent↗