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The Relationship between chlamydia trachomatis and chlamydia pneumoniae as the cause of neonatal conjunctivitis (ophthalmia neonatorum).

The authors examined 130 newborns and nursery children from September 1999 till May 2003 from the Prague district for the surmise of chlamydial conjunctivitis. Chlamydia infections were detected in conjunctival smears. Chlamydia trachomatis was confirmed in 20 (15.3%) using ligase chain reaction and C. pneumoniae in 16 (12.3%) children using an indirect immunofluorescent method. Direct captures of chlamydial infections of newborns were included in the study. The authors had also examined 671 newborns in a maternity hospital from January 2002 till May 2003. Conjunctival scraping had been done in 29 (4.3%) cases mainly for mucopurulent conjunctivitis. Chlamydial conjunctivitis was identified only in 4 (0.6%) cases, i.e. C. trachomatis and C. pneumoniae in 2 cases each. Initial clinical symptoms of both types of chlamydial conjunctivitis were similar (mucous discharge with various degrees of eyelid effusion and chemosis mainly on the tarsal conjunctiva). Clinical symptoms of the C. pneumoniae infection were later accompanied by pseudofollicular changes on the tarsal conjunctiva. The complication of this infection was lacrimal obstruction among half of newborns. Clarithromycin in syrup at a dose of 15 mg/kg/per day for 14 days ensured effective treatment of both chlamydial infections. Control scrapings were always negative and simultaneously the pathological conjunctival finding disappeared.

Anti-Bacterial Agents↗

Bacteria in ophthalmia neonatorum.

A four-year study of the bacteria isolated from neonatal eye swabs at Royal Women's Hospital, Brisbane has been carried out. Of infants admitted to nurseries 2.7% (571/21217) had positive cultures. The incidence of infection in permature non-premature nurseries was 9.7% (221/2273) and 1.8% (350/18944) respectively, a highly significant difference. There was a preponderance of Gram-negative organisms in the former (67%) and of Gram-positive organisms in the latter (69%), each a statistically significant difference. Neisseria gonorrhoeae was isolated 8 times (1.4%) during this period.

Bacteria↗

Sympathetic ophthalmia, a genuine autoimmune disease.

Intraocular inflammation of exogenous origin, which may lead to the loss of visual function in both eyes, i.e. SO confronts ophthalmologists much less rarely than might be expected. Epidemiological studies comprising ergophthalmological aspects underscore this. Questions with regard to therapy should consider the fact that the T cell-mediated cytotoxic disease which causes the transition from the initially unilateral subthreshold exogenous uveitis into the bilateral progressive phase is by no means a rare disorder, especially in secondary surgical operations on predamaged eyes with fresh intraocular hemorrhages, vascular neoplasia and secondary glaucoma. This should be recalled again by practicing ophthalmologists, thus enabling the prevention of SO. If SO is a "forme fruste" of retinitis pigmentosa, as is very likely to be the case, further clarification requires clinicopathologic studies in close collaboration with immunologists.

Adolescent↗

Adhesion molecule expression in acute and fibrotic sympathetic ophthalmia.

Samples of iris ciliary body, choroid and retina from normal eyes and from 2 cases of sympathetic ophthalmitis (one acute and one late stage fibrosis) were examined for the expression of the VLA integrins beta 1 and alpha 1-6, and the integrin beta 3, in addition to ICAM-1, VCAM-1, ELAM-1 and CD44 using an APAAP staining technique. The expression of VLA-4, VLA-5, VCAM-1, ICAM-1, and CD44 was significantly increased and ELAM-1 was slightly increased in acute sympathetic ophthalmitis in comparison to fibrotic and normal eyes. VLA-6 was moderately increased in acute and fibrotic cases and VLA-2 VLA-3 and beta 3 were moderately expressed on all tissues examined. The differential expression of molecules known to be involved in lymphocyte activation and adhesion in acute sympathetic ophthalmitis suggests that certain adhesion molecules play a role in the pathogenesis of intraocular inflammation and may be suitable targets for immunotherapy.

Acute Disease↗