**10. Neonatal inclusion conjunctivitis**

Approximately 5% of pregnant women have C. trachomatis infection of the cervix.which if left untreated has 50% chance of the infant developing conjunctivitis. Neonatal inclusion conjunctivitis is more common (about 10 times) than conjunctivitis resulting from N. gonor‐ rhoeae. The incubation period for chlamydial conjunctivitis is 1 to 3 weeks. Earlier infection can occur if there is evidence for rupture of membranes. If left untreated, the conjunctivitis can persist for 3 to 12 months. C. trachomatis is the leading cause of pneumonitis within the first 6 months of life. Rectal shedding of C. trachomatis does occur and is more common among infants with pneumonia. Onset of shedding does not usually occur before 6 to 12 weeks of age and can be as late as 12 months.

#### **10.1. Clinical features**

**9.2. Differential diagnosis**

244 Common Eye Infections

Adults develop a follicular conjunctivitis that can be indistinguishable from that of tracho‐ ma. The follicles may be present on both the lower conjunctiva and upper tarsus. The onset is usually acute with preauricular lymphadenopathy on the involved side and a serosangui‐ neous to mucopurulent discharge. After 2 weeks of infection, corneal involvement is more prominent and includes keratitis, subepithelial opacities, and infiltrates that are marginal and/or central. Occasionally there is mild scarring and corneal vascularization referred to as micropannus, but these are late findings, usually among cases that have not been treated.

Otitis media is a common complication of chlamydial conjunctivitis. Although there can be prompt resolution of the disease, In addition there can be a genital tract disease (which fail‐

Inclusion conjunctivitis is caused by serotypes D to K of Chlamydia tachomatis. The LGV strains (L1, L2, and L3) of C. trachomatis are responsible for a much more severe ocular dis‐ ease referred to as Parinaud's oculoglandular syndrome. This syndrome is comprised of an inflammatory conjunctival response with severe lymphadenopathy involving the preauricu‐ lar, cervical, and submandibular nodes. The LGV serovars are uncommon in developed countries with few reports in the literature but are very common in tropical and subtropical developing countries. Occasionally keratoconjunctivitis resulting from L2 has been reported

The best form of treatment for adult inclusion conjunctivitis is to prevent chlamydial sexual‐ ly transmitted diseases (STDs). Unfortunately, most chlamydial STDs are asymptomatic for males (approximately 40%) and females (approximately 70%) and usually go undetected be‐ cause routine diagnostic screening for C. trachomatis is not performed. Thus, it is important to recognize adult inclusion conjunctivitis that is caused by C. trachomatis and treat both the ocular and genital tract disease. Because chlamydial STDs cannot be resolved by topical ocu‐ lar antibiotics, systemic therapy is recommended. Most cases infected with non-LGV sero‐ vars will respond to oral tetracycline250mg four times a day for 3-4 weeks; Doxycycline100mg twice a day for 1-2 weeks or 200mg weekly for 3 weeks, or erythromycin 250mg four times a day for 3-4 weeks; when tetracycline is contraindicated as in pregnant

For LGV, the best treatment regimen for inclusion conjunctivitis caused by C. psittaci and C. pneumoniae is unknown, although 6 weeks of oral antibiotics has been successful in some

Improvement in personal hygiene and regular chlorination of swimming pool decrease the

ure to treat) resulting in the recurrence of the conjunctivitis.

as a consequence of laboratory accidents.

**9.3. Treatment**

and lactating females.

**9.4. Prophylaxis**

spread of disease.

cases for complete eradication.

Patient's sexual partner should be examined and treated.

Conjunctivitis in the neonate is characterized by swelling of lids, a purulent discharge, and hyperemia. If without treatment, neonates are at risk for conjunctival scarring, keratitis, and superficial vascularization of the cornea. In addition, these infants if up to 6 months of age are at risk for pneumonitis.

#### **10.2. Treatment**

Treating pregnant women is effective in preventing infants from acquiring conjunctival in‐ fection, although retreatment may be necessary in high-risk populations. In infants, systemic treatment is recommended for the fact that topical treatment of neonatal inclusion conjuncti‐ vitis does not eradicate nasopharyngeal carriage, which can result in pneumonia or recur‐ rent ocular infection. In addition, mothers should be treated for genital tract infection to prevent recurrence of chlamydial conjunctivitis in the neonate.
