**6.2. Bacterial keratitis**

Diagnosis is based on the detection of IgM, IgG and IgA antibodies to these bacteria in the blood serum by ELISA method and confirmation with W-blot test. Classical method is a detection of Chlamydia basophilic intracytoplasmic inclusions in primary cells from the conjunctival swab or conjunctival scraping using DFA (direct immunofluorescence stain‐ ing) method, DNA hybridization tests or PCR (polymerase chain reaction and LCR (Ligas

Treatment of chlamydial conjunctivitis infection in the course of reactive arthritis consists of systemic antibiotic therapy and topical use of tetracycline, erythromycin or fluorochino‐ lones. In systemic treatment effectiveness of macrolides (azithromycin), tetracyclines and quinolones has been shown [82,83, 84]. Single dose of azithromycin (1000mg) showed effica‐ cy in eradication of C. trachomatis infection [85] It's vital to stress that chlamydia infection is still the main cause of blindness on the African Continent. In the case of trachoma present

Because C.trachomatis infection is sexually transsmitted, other similarly transmitted co- in‐

Significantly higher incidence of fungal conjunctivitis is observed in patients with rheumatic diseases treated with systemic glucocorticoids (eg, RA) and in patients with primary Sjögren's syndrome. The most common pathogens are Candida albicans and Candida parapsilosis [87].

It has been shown that in patients with scleral inflammation lasting over 12 years, 7.5% of them had infectious complications, usually caused by herpes zoster virus [88]. Infectious complications can be even more frequent in patients with rheumatic diseases who are chron‐ ically treated with immunosuppressive drugs. The use of immunosuppressive drugs can cause reactivation of latent Mycobacterium tuberculosis infection which, in the form of nod‐ ular scleritis may occur in the eye [89]. There are reports of the occurrence of tuberculosis

In RA patients inflammatory corneal ulceration may occur as a symptom of this disease. How‐ ever, any such changes require the differentiation from herpes simplex infection, which presents the same clinical picture. The differentiation is important from the point of imple‐ mented treatment, because corneal ulceration in course of RA requires a very intensive immu‐ nosuppressive therapy, which exacerbates an inflammation caused by herpes simplex

uveitis during treatment with etanercept (soluble anti TNF inhibitor) [90].

chain reaction).

222 Common Eye Infections

drug of choice is azithromycin [86].

*4.1.2. Fungal conjunctivitis*

**6.1. Viral keratitis**

infection [91].

fections should be considered, most commonly gonococcal.

**5. Infectious scleritis in rheumatic diseases**

**6. Infectious keratitis in rheumatic diseases**

Bacterial keratitis in rheumatic diseases often is a complicated by erosive lesions of the cor‐ nea. Such changes are most commonly associated with primary and secondary Sjögren's syndrome. Most frequently - up to 73.9% - patients suffer from Gram-positive bacterial in‐ fections of as coagulase-negative Staphylococci, Staph. aureus and Spreptococcus pneumo‐ niae. 0.3% of patients suffer from infections of Gram-negative Moraxella spp. Infections with Gram-positive bacteria are present in 17.4% of patients; most common are : Propionibacteri‐ um acnes, Corynebacterium spp. 6.5% patients reveal infections caused by Pseudomonas aeruginosa and Proteus spp [92,93].

#### **6.3. Fungal keratitis**

The fungal infections of the cornea may also develop in the primary and secondary Sjogren's syndrome due to improper hydration of the eye – both because of the composition of tears and rupture in the tear film. In 45.8% of patients with fungal infection of the cornea Candida albi‐ cans is the major pathogen, while Fusarium spp accouns for approximately 25% of the infec‐ tions.
