**6. Clinical presentation**

#### **6.1 Conjunctivitis**

Neonates exposed to C. trachomatis in an infected birth canal may develop conjunctivitis, sometimes referred to as "ophthalmia neonatorum", with transmission rate from 30%–50% [25]. Neonatal conjunctivitis caused by C. trachomatis has been reported as the most common infectious cause of neonatal conjunctivitis worldwide.

Conjunctivitis typically occurs between 5–14 days after delivery and can be unilateral or bilateral. It has a variety of clinical presentations in the infant. It is characterized by palpebral erythema and oedema, as well as eye discharge. Initially, the eye discharge is watery and later becomes purulent and copious. Moderate eye drainage and redness is common. Corneal opacification, chemosis and pseudomembranes may be present. Topical prophylaxis with erythromycin does not prevent but reduces the incidence of the chlamydial conjunctivitis [29–31].

Moreover, the 10%–20% of the infants with chlamydial conjunctivitis will develop pneumonia [25].

#### **6.2 Pneumonia**

The species C. psittaci, C. trachomatis and C. pneumoniae can all cause pneumonia in humans. Perinatal transmission of C. trachomatis has been reported to cause neonatal pneumonia with potentially a life-threatening severity. Usual age of presentation is at 3 weeks to 3 months of life [32]. In half of the cases concurrent or previous conjunctivitis is present and in one third of the cases otitis media is co-existing [33]. When C. pneumoniae is the cause, infection is predominantly asymptomatic or mild but can result in the development of acute upper and lower respiratory illness [34].

Upper and lower respiratory tracts may be directly infected intrapartum. C. trachomatis, which is the most common though, has been documented to be pathogen causing lower respiratory tract infection in children less than 6 months of age. Infants may present moderate symptoms, such as rhinitis, mucoid rhinorrhea together with cough and increased respiratory rate for 3 or more weeks before

#### *Chlamydial Infection DOI: http://dx.doi.org/10.5772/intechopen.96501*

pneumonia. Most cases are afebrile. When pneumonia occurs, tachypnea, nasal obstruction and/or discharge, interstitial and peribronchiolar inflammation may exist, leading to significant morbidity manifested as low grade fever and paroxysmal staccato cough. Crepitant inspiratory rales often are heard on auscultation of the lungs, in contrast with expiratory wheezes which are distinctly uncommon. Hyperinflation of the lungs usually accompanies the diffused infiltrates observed on chest X-rays. Reticulonodular patterns and atelectasis have also been described. Eosinophilia may be also present [33, 35, 36].

In premature infants chlamydial pneumonia can be more serious. In the beginning, respiratory distress is observed which is followed later by worsening respiratory signs [37]. Apnea spells and respiratory failure may present as well [33, 38]. If chlamydial pneumonia is left untreated, infants are at high risk of developing later pulmonary dysfunction and possibly chronic respiratory disease, including mild to severe asthma [36]. Prophylaxis does not eliminate nasopharyngeal colonization or pneumonia.

It should be taken into consideration that C. trachomatis and C. pneumoniae are agents associated with community-acquired pneumonia in children and adolescents. They have not been associated with specific clinical syndromes among children and adolescents. Nevertheless, pharyngitis, bronchitis, and sinusitis may be present [38, 39].

### **6.3 Other clinical presentations in children and adolescents**

In prepubertal girls, vaginitis may present, while in postpubertal girls, urethritis, bartholinitis, cervicitis, endometritis, salpingitis, proctitis, perihepatitis, are possible manifestations of the disease. Long-lasting infections may result in ectopic pregnancy, infertility or pelvic inflammatory disease [11, 13, 35]. In males, chlamydial infection may cause epididymitis, proctitis, prostatitis, urethritis and reactive arthritis. Lymphogranuloma venereum is extremely rare in children and adolescents below the age of 18 years old and is usually confined to HIV positive and homosexual men [35, 40].

Repeated and chronic chlamydial infection that affects eyes can lead to trachoma, a chronic follicular keratoconjunctivitis that causes scarring and neovascularization of the cornea and can even result in irreversible blindness [9]. It can be spread through contact with the eyes, eyelids, nose or throat secretions of infected people. Chlamydiae can be transmitted by contaminated handkerchiefs, towels, clothes or bed linen as well. Signs and symptoms of trachoma usually affect both eyes and may include: mild itching and irritation of the eyes and eyelids, eye discharge containing mucus or pus, eyelid swelling, light sensitivity (photophobia), eye pain, eye redness and vision loss. In areas where trachoma is endemic, usually poor and rural, active (inflammatory) trachoma is common among preschool-aged children, with prevalence rates which can be as high as 60–90% [8, 41].
