II. Pathophysiology
- See Chlamydiaceae
- Organism: Chlamydia Trachomatis subtypes D to K
- Contrast with subtypes A to C (Trachoma)
- Contrast with subtypes L1 to 3 (Lymphogranuloma venereum)
- Neonatal Inclusion Conjunctivitis (NIC)
- Transmission during Vaginal Delivery
- Conjunctivitis onset 5-14 days after birth
- Associated with development of Chlamydia Pneumonia
- Initial watery discharge becomes copious and purulent
- Adult Inclusion Conjunctivitis (AIC)
- Affects <2% with genital tract Chlamydia
- Transmission
- Sexually Transmitted Infection (oculogenital)
- Historical: Non-chlorinated swimming pools (1900)
- Acute follicular Conjunctivitis >5 days post-exposure
- Contrast with Trachoma
- See Trachoma
- Trachoma is a non-Sexually Transmitted Disease spread by hand to hand contact between children
- Trachoma is the leading cause of blindness in the world (primarily in developing countries)
- Trachoma is caused by different Chlamydia strains (Serotypes A to C)
- Contrast with the STI vertical transmission Chlamydia Conjunctivitis described here (Serotypes D to K)
- However, both demonstrate inclusion bodies on palpebral Conjunctival cell scrapings
III. Signs
- May present as subacute case (>4 weeks)
- Unilateral Conjunctivitis with hyperemia and mucopurulent discharge (stringy mucous discharge)
-
Lymphoid follicle formation (also seen in some Viral Conjunctivitis)
- Tiny, rice grain size, gelatinous pale bumps on the Conjunctiva at fornix
IV. Labs
-
Chlamydia Trachomatis testing
- Chlamydia DNA Probe or NAAT (better Test Sensitivity) OR
- Nasal Swab for Chlamydia Direct Fluorescence Antibody (low Test Sensitivity)
- Intracytoplasmic Inclusion Bodies
- Historically used to identify Chlamydia Conjunctivitis (replaced by PCR)
- Responsible for the Chlamydial Conjunctivitis naming (Inclusion Conjunctivitis)
- Microscopy of cell scrapings from the palpebral Conjunctiva (inner Eyelid lining)
- Small Basophilic (deep purple) inclusion bodies seen within Conjunctival cells
- An inclusion body is a Chlamydia Initial Body (Chlamydia Reticulate Body)
- Inclusion bodies are indistinguishable from those seen with Trachoma
- Historically used to identify Chlamydia Conjunctivitis (replaced by PCR)
V. Causes
- Chlamydia Trachomatis
- Less common Chlamydia Conjunctivitis causes
VI. Differential Diagnosis
VII. Management
- See Trachoma
- Adult Inclusion Conjunctivitis (AIC)
- Azithromycin 1 g for 1 dose (or Doxycycline 100 mg twice daily for 7 days) AND
- Topical Erythromycin ointment to eye twice daily for 21 days
- Neonatal Inclusion Conjunctivitis (NIC)
- Erythromycin Base or EES 50 mg/kg/day divided four times daily orally for 14 days
VIII. Prevention
-
Erythromycin (or Tetracycline) ophthalmic ointment
- Applied to newborns eyes within 1 hour of delivery
- Sexually Transmitted Disease Prevention
- Sexually Transmitted Disease surveillance in Pregnancy
IX. References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Yanoff (1999) Ophthalmology, Mosby, p. 1.7
- Katusik (2003) Am J Ophthalmol 135(4): 447-51 [PubMed]
- Lietman (1999) Ophthalmol Clin North Am 12(1) [PubMed]
- Mabey (2005) Cochrane Database Syst Rev (2): CD001860 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSHCZE) | Zánět spojivek (konjunktivitida) charakterizovaný nálezem inkluzí (tzv. iniciálních tělísek) ve stěrech ze spojivky. Bývá způsoben chlamydiemi. Projevuje se hnisavou sekrecí. Vyskytuje se u novorozenců (inkluzní blenorea) nebo dospělých (tzv. konjunktivitida z plaveckého bazénu). Léčí se antibiotiky, dospělým lze podávat tetracyklin, novorozencům např. erythromycin. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (MSH) | An infection of the eyes characterized by the presence in conjunctival epithelial cells of inclusion bodies indistinguishable from those of trachoma. It is acquired by infants during birth and by adults from swimming pools. The etiological agent is CHLAMYDIA TRACHOMATIS whose natural habitat appears to be the genito-urinary tract. Inclusion conjunctivitis is a less severe disease than trachoma and usually clears up spontaneously. |
| Definition (CSP) | infection of the eyes characterized by the presence in conjunctival epithelial cells of inclusion bodies indistinguishable from those of trachoma; it is acquired by infants during birth and by adults from swimming pools; the etiological agent is Chlamydia trachomatis whose natural habitat appears to be the genito-urinary tract. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D003235 |
| ICD9 | 077.0 |
| ICD10 | A74.0 |
| SnomedCT | 111840005, 186674002, 186733005, 154370006, 266202002, 56009001, 266109000, 231861005 |
| English | Blennorrhea, Inclusion, Blennorrheas, Inclusion, Conjunctivitides, Inclusion, Conjunctivitis, Inclusion, Inclusion Blennorrheas, Inclusion Conjunctivitides, Inclusion Blennorrhea, Inclusion Conjunctivitis, inclusion blenorrhea, paratrachoma, paratrachoma (diagnosis), inclusion conjunctivitis, inclusion conjunctivitis (diagnosis), Conjunctivitis chlamydial, Conjunctivitis, Inclusion [Disease/Finding], conjunctivitis inclusion, chlamydial conjunctivitis, conjunctivitis chlamydia, Conjunctivitis;chlamydia, Trachoma inc. conjunctivitis, Inclusion blenorrhoea, Chlamydia conjunctivitis, Inclusion blennorrhea, Paratrachoma, Chronic conjunctivitis due to Chlamydia trachomatis, Inclusion conjunctivitis due to Chlamydia trachomatis, Chlamydial conjunctivitis, Chlamydial conjunctivitis (disorder), Inclusion blennorrhoea, Inclusion conjunctivitis (disorder), Inclusion blenorrhea, Inclusion conjunctivitis, chlamydia conjunctivitis |
| Italian | Congiuntivite da Chlamydia, Congiuntivite da inclusione, Blenorragia da inclusione, Blenorrea da inclusioni, Congiuntivite da inclusioni |
| Dutch | inclusie-blennorroe, Conjunctivitis door Chlamydia, Chlamydia-conjunctivitis, inclusie-conjunctivitis, Blenorroe, inclusie-, Conjunctivitis, inclusion-, Inclusion-conjunctivitis |
| French | Blennorrhée à inclusions, Conjonctivite à Chlamydia, Conjonctivite à inclusion, Conjonctivite à inclusions |
| German | Einschlussblenorrhoe, Chlamydienkonjunktivitis, Einschlusskonjunktivitis, Konjunktivitis durch Chlamydien, Bindehautentzündung, Einschluß-, Blennorrhoe, Einschluß-, Einschlußblennorrhoe, Konjunktivitis, Einschluß- |
| Portuguese | Blenorreia de inclusão, Blenorreia de Inclusão, Conjuntivite a clamídia, Conjuntivite por inclusão, Conjuntivite de Inclusão |
| Spanish | Blenorrea de inclusión, Blenorrea por inclusión, conjuntivitis por inclusión, blenorrea por inclusión, conjuntivitis por inclusión (trastorno), blenorrea de inclusión, conjuntivitis clamidial, conjuntivitis crónica por Chlamydia trachomatis, conjuntivitis de inclusión (trastorno), conjuntivitis de inclusión por Chlamydia trachomatis, conjuntivitis de inclusión, conjuntivitis por clamidia (trastorno), conjuntivitis por clamidia, conjuntivitis por inclusión (concepto no activo), paratracoma, Conjuntivitis por clamidia, Conjuntivitis de inclusión, Blenorrea de Inclusión, Conjuntivitis de Inclusión |
| Japanese | クラミジア性結膜炎, ﾌｳﾆｭｳﾀｲｾｲﾉｳﾛｳ, ｸﾗﾐｼﾞｱｾｲｹﾂﾏｸｴﾝ, ﾌｳﾆｭｳﾀｲｹﾂﾏｸｴﾝ, 結膜炎-封入体, 封入体性結膜炎, 封入体性膿漏, 封入体結膜炎, 結膜炎-封入体性, 膿漏-封入体性 |
| Swedish | Konjunktivit, inklusion |
| Czech | konjunktivitida inkluzní, Paratrachom, Chlamydiová konjunktivitida, Inkluzní blenorea, Inkluzní konjunktivitida, paratrachom, konjunktivitida inkluzorní |
| Finnish | Inkluusiokonjunktiviitti |
| Russian | KON"IUNKTIVIT S VKLIUCHENIIAMI, BLENNOREIA S VKLIUCHENIIAMI, БЛЕННОРЕЯ С ВКЛЮЧЕНИЯМИ, КОНЪЮНКТИВИТ С ВКЛЮЧЕНИЯМИ |
| Korean | 클라미디아 결막염 |
| Polish | Zapalenie spojówek wtrętowe |
| Hungarian | inclusiós conjunctivitis, Inclusiós blenorrhoea, chlamydiás conjunctivitis, Zárványtestes blenorrhoea |
| Norwegian | Konjunktivitt, inklusjons-, Inklusjonskonjunktivitt |
Ontology: Inclusion conjunctivitis of the adult (C0392644)
| Concepts | Disease or Syndrome (T047) |
| ICD10 | B30.1 |
| SnomedCT | 56009001, 186674002 |
| English | ADULT INCLUSION CONJUNCTIVITIS, Adult chlamydial keratoconjunctivitis, Adult chlamydial keratoconjuntivitis, swimming pool conjunctivitis, swimming pool conjunctivitis (diagnosis), Swimming-pool conjunctivitis, Inclusion conjunctivitis of the adult, Swimming pool conjunctivitis, Inclusion conjunctivitis of the adult (disorder) |
| Dutch | zwembadconjunctivitis |
| French | Conjonctivite des piscines |
| German | Swimmingpool-Konjunktivitis |
| Italian | Congiuntivite da piscina |
| Portuguese | Conjuntivite das piscinas |
| Spanish | Conjuntivitis por piscina, queratoconjuntivitis clamidial del adulto, conjuntivitis de inclusión del adulto (trastorno), conjuntivitis de inclusión del adulto, conjuntivitis de las piscinas |
| Japanese | プール結膜炎, ﾌﾟｰﾙｹﾂﾏｸｴﾝ |
| Czech | Bazénová konjunktivitida |
| Hungarian | Uszoda conjunctivitis |
Ontology: Inclusion conjunctivitis neonatal (C1096186)
| Concepts | Disease or Syndrome (T047) |
| Italian | Congiuntivite neonatale da inclusione |
| Japanese | 新生児封入体結膜炎, ｼﾝｾｲｼﾞﾌｳﾆｭｳﾀｲｹﾂﾏｸｴﾝ |
| Czech | Novorozenecká inkluzní konjunktivitida |
| Hungarian | újszülöttkori inclusiós conjunctivitis |
| English | Inclusion conjunctivitis neonatal |
| Portuguese | Conjuntivite por inclusão neonatal |
| Spanish | Conjuntivitis neonatal por inclusión |
| Dutch | inclusie-conjunctivitis neonataal |
| French | Conjonctivite à inclusions du nouveau-né |
| German | Einschlusskonjunktivitis Neugeborenes |
