Comparative diagnosis of neonatal chlamydial conjunctivitis by polymerase chain reaction and McCoy cell culture

A Newborn with a Purulent Ocular Discharge

An 11-day-old girl, who was diagnosed with Neisseria gonorrhoeae ophthalmia neonatorum, presents with a purulent ocular discharge. Although rare in regions with high implementation rates of ocular prophylaxis, ophthalmia neonatorum remains an important diagnostic consideration, especially in developing countries and areas of low socioeconomic status. In this article, we review the evolving epidemiology, diagnostic considerations, prevention, and treatment of ophthalmia neonatorum. [Pediatr Ann. 2022;51(5):e206-e208.].

Chlamydial conjunctivitis (in adults), uveitis, and reactive arthritis, including SARA. Sexually acquired reactive arthritis

This chapter deals with Chlamydia -induced ocular and rheumatic diseases of the adult. All of these may follow a primary urogenital infection with Chlamydia trachomatis in genetically predisposed patients. Besides the infection with Chlamydia trachomatis, infections with Chlamydia pneumoniae and Chlamydia psittaci are also discussed as possible causative agents. Chlamydial conjunctivitis is frequently a secondary infection, and the organism is transferred from the urogenital tract to the eye by autoinoculation. Uveitis and reactive arthritis are believed to be triggered - among other infections - by a preceding urogenital infection. Both of them are closely associated with HLA-B27 positivity. The simultaneous occurrence of uveitis and reactive arthritis is termed Reiter's syndrome. We report on clinical characteristics, diagnosis and the role of Chlamydia in the pathogenesis of chlamydial conjunctivitis, uveitis and reactive arthritis as well as on the currently recommended treatment regimens.

Use of polymerase chain reaction for the detection of Chlamydia trachomatis in ocular and nasopharyngeal specimens from infants with conjunctivitis

BACKGROUND

Chlamydia trachomatis is the most common identifiable infectious cause of neonatal conjunctivitis. Nonculture tests including enzyme immunoassays and direct fluorescent antibody tests have been shown to perform well for the diagnosis of chlamydial conjunctivitis with sensitivities and specificities > or = 90%. However, the performance with respiratory specimens has been less than satisfactory.

METHODS

We compared a new, commercially available polymerase chain reaction (PCR) assay, Roche AMPLICOR (Roche Diagnostic Systems, Branchburg, NJ) with culture for the detection of C. trachomatis in conjunctival and nasopharyngeal specimens from infants with conjunctivitis. We also evaluated AMPLICOR for the detection of C. trachomatis in the urine of mothers of positive infants.

RESULTS

Ocular and nasopharyngeal specimens from 75 infants with conjunctivitis were obtained for culture and PCR. AMPLICOR was equivalent to culture for eye specimens and more sensitive than culture for nasopharyngeal specimens. The sensitivity, specificity and positive and negative predictive values of PCR compared with culture for conjunctival specimens were 92.3, 100, 100 and 98.4%, respectively. The sensitivity, specificity and positive and negative predictive values for nasopharyngeal specimens were 100, 97.2, 60 and 100%, respectively. We also detected C. trachomatis by PCR in the urine of 12 mothers of culture positive infants.

CONCLUSIONS

PCR performed comparably to culture for detection of C. trachomatis in conjunctival and nasopharyngeal specimens from infants with conjunctivitis.

Chlamydia trachomatis-associated respiratory disease in the very early neonatal period

Of 103 preterm neonates admitted consecutively to the neonatal intensive care unit soon after birth for respiratory distress, 8 were found to be Chlamydia trachomatis-positive as early as within the first 24 h of life. All these patients required mechanical ventilation and supplemental oxygen. Six infants had evidence on chest radiographs of hyaline membrane disease, one of pneumonia, and one of slight bilateral parenchymal changes. Our results suggest that the presence of C. trachomatis in preterm infants with neonatal respiratory distress is probably not an infrequent event.