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]
