Vertical transmission of bacterial eye infections, Angola, 2011-2012

To determine transmission rates for neonatal conjunctivitis causative microorganisms in Angola, we analyzed 312 endocervical and 255 conjunctival samples from mothers and newborns, respectively, during 2011–2012. Transmission rates were 50% for Chlamydia trachomatis and Neisseria gonorrhoeae and 10.5% for Mycoplasma genitalium. Possible pathogenic effects of M. genitalium in children’s eyes are unknown.

Management strategies for acute infective conjunctivitis in primary care: a systematic review

A systematic review of the literature on all aspects of the management of acute infective conjunctivitis is undertaken. Acute infective conjunctivitis is a common presentation in primary healthcare. It is usually a mild condition and serious complications are rare. Clinical signs are a poor discriminator of bacterial and viral causes. Studies of treatment show that there is a high rate of clinical cure without any treatment (65% within 2-5 days). Treatment with topical antibiotics improves the rate of clinical recovery and this is more marked in the first 2-5 days after presentation (number needed to treat [NNT] = 6), but less by 6-10 days (NNT = 13). Studies comparing treatment with different antibiotics do not demonstrate that any one antibiotic is superior; the choice of antibiotic should be based on consideration of cost and bacterial resistance. The present practice of prescribing antibiotics to most cases is not necessary.

Experimental evidence for transmission of Mycoplasma gallisepticum in house finches by fomites

Ever since Mycoplasma gallisepticum emerged among house finches in North America, it has been suggested that bird aggregations at feeders are an important cause of the epidemic of mycoplasmal conjunctivitis because diseased birds could deposit droplets of pathogen onto the feeders and thereby promote indirect transmission by fomites. In this paper we bring the first experimental evidence that such transmission (bird-to-feeder-to-bird) does actually take place. House finches infected via this route, however, developed only mild disease and recovered much more rapidly than birds infected from the same source birds but directly into the conjunctiva. While it is certainly probable that house finch aggregations at artificial feeders enhance pathogen transmission, to some degree transmission of M. gallisepticum by fomites may serve to immunize birds against developing more severe infections. Some such birds develop M. gallisepticum antibodies, providing indication of an immune response, although no direct evidence of protection.

SPATIAL SPREAD OF AN EMERGING INFECTIOUS DISEASE: CONJUNCTIVITIS IN HOUSE FINCHES

In this paper we quantify the rate of spread of the newly emerged pathogen Mycoplasma gallisepticum of the House Finch, Carpodacus mexicanus, in its introduced range. We compare and contrast the rapid, yet decelerating, rate of spread of the pathogen with the slower, yet accelerating rate of spread of the introduced host. Comparing the rate of spread of this pathogen to pathogens in terrestrial mammalian hosts, we see that elevation and factors relating to host abundance restrict disease spread, rather than finding any major effects of discrete barriers or anthropogenic movement. We examine the role of seasonality in the rate of spread, finding that the rate and direction of disease spread relates more to seasonality in host movement than to seasonality in disease prevalence. We conclude that asymptomatic carriers are major transmitters of Mycoplasma gallisepticum into novel locations, a finding which may also be true for many other diseases, such as West Nile Virus and avian influenza.

Further Western Spread of Mycoplasma gallisepticum Infection of House Finches

Mycoplasma gallisepticum, an important pathogen of poultry, especially chickens and turkeys, emerged in 1994 as the cause of conjunctivitis in house finches (Carpodacus mexicanus) in their eastern range of North America. The resulting epidemic of M. gallisepticum conjunctivitis severely decreased house finch abundance and the continuing endemic disease in the eastern range has been associated with repeating seasonal peaks of conjunctivitis and limitation of host populations. Mycoplasma gallisepticum conjunctivitis was first confirmed in the western native range of house finches in 2002 in a Missoula, Montana, population. Herein, we report further western expansion of M. gallisepticum conjunctivitis in the native range of house finches based on positive polymerase chain reaction results with samples from birds captured in 2004 and 2005 near Portland, Oregon.

Controlling contagious bacterial conjunctivitis

BACKGROUND

Recent outbreaks (epidemics) of Streptococcus pneumoniae conjunctivitis, involving hundreds of patients, underscore the importance of following recommended guidelines to minimize disease transmission. These include the use of antimicrobial agents capable of minimizing patients' symptoms and the duration of the infectious period when disease can be transmitted to others.

PURPOSE

To compare the amount of time required forvarious antibiotic solutions to kill S. pneumoniae, a common cause of bacterial conjunctivitis.

MATERIALS AND METHODS

Isolates of S. pneumoniae from three patients were exposed to selected ophthalmic antibiotic products: moxifloxacin 0.5%, tobramycin 0.3%, gentamicin 0.3%, and polymyxin B 10,000 IU-trimethoprim 1.0%. The products were diluted 1:100 and 1:1000 for testing. At 15, 30, 60, 120, and 180 minutes after exposure, aliquots of broth were withdrawn, the cells were separated and cultured, and the viable cell count was determined.

RESULTS

Moxifloxacin killed actively growing S. pneumoniae faster and to a greater extent than did the other three antibiotic products when tested at concentrations corresponding to tear film concentrations 5 to 10 minutes and 30 to 60 minutes after instillation of the products.

CONCLUSIONS

Moxifloxacin killed S. pneumoniae in vitro faster than did the other antibiotics. Consequently, its use should complement other generally accepted measures for minimizing patients' symptoms and limiting the contagiousness of bacterial conjunctivitis. Also, this is consistent with the recommendations of other investigators to prescribe the most recent generation of fluoroquinolone antibiotics for the specific purpose of limiting the spread of bacterial resistance.

Is Chlamydophila felis a significant zoonotic pathogen?

PROBLEM

Chlamydophila felis is a common cause of conjunctivitis in cats and in some textbooks is listed as an important zoonotic pathogen. However, there are no published comprehensive reviews assessing the evidence supporting this. SEARCH AND ANALYSIS: Bibliographic databases and bibliographies of papers and textbooks were searched for all published cases of zoonotic disease associated with chlamydiosis in cats. All published case reports were reviewed to establish the quality of the evidence supporting the association between C. felis and zoonotic disease.

RESULTS

There are only seven case reports, most of which were published before the development of assays capable of distinguishing C. felis from other chlamydial species, implicating this organism in zoonotic disease. None of the three cases of pneumonia and systemic disease described, two of which occurred in immunocompromised patients, can be unambiguously attributed to C. felis. Of the four cases of follicular keratoconjunctivitis described, only one, in an immunocompromised patient, could be unambiguously attributed to C. felis.

CONCLUSION

While there is evidence that C. felis may occasionally cause keratoconjunctivitis in humans, there is little evidence to suggest it can cause serious systemic disease or pneumonia.

[Neonatal conjunctivitis in a hospital at Gran Buenos Aires. Last 5 years up-date]

Neonatal conjunctivitis is one of the most important consultation reasons in the first days of life. Causes may be chemical or infectious. Neonatal conjunctivitis study for common microorganisms and Chlamydia trachomatis is being performed at Posadas Hospital since 1995, in a progressive form. The objective of this study was to know the epidemiological situation in the last five years (1999-2003), and to describe the variations detected between two periods, 1995-1998, and 1999-2003. It was observed no change about C. trachomatis prevalence (8%), during all the time in the population studied. With regard to common microorganisms it was showed a decrease in the second period (36.6%) with respect to the first (52.4%). Likely, the causes may be due to changes about sample collection conditions, or to epidemiological variations. The most frequent microorganisms found were: Staphylococcus aureus 69 (27.6%), Streptococcus pneumoniae 68 (27.2%), and Haemophilus influenzae 64 (25.6%). We consider important to evaluate the kind of ocular secretions at the first consultation, which can lead to a symptomatic treatment that will be corroborated or not, according to microbiological results.

Seasonality and wildlife disease: how seasonal birth, aggregation and variation in immunity affect the dynamics of Mycoplasma gallisepticum in house finches

We examine the role of host seasonal breeding, host seasonal social aggregation and partial immunity in affecting wildlife disease dynamics, focusing on the dynamics of house finch conjunctivitis (Mycoplasma gallisepticum (MG) in Carpodacus mexicanus). This case study of an unmanaged emerging infectious disease provides useful insight into the important role of seasonal factors in driving ongoing disease dynamics. Seasonal breeding can force recurrent epidemics through the input of fresh susceptibles, which will clearly affect a wide variety of wildlife disease dynamics. Seasonal patterns of social aggregation and foraging behaviour could change transmission dynamics. We use latitudinal variation in the timing of breeding, and social systems to model seasonal dynamics of house finch conjunctivitis across eastern North America. We quantify the patterns of seasonal breeding, and social aggregation across a latitudinal gradient in the eastern range of the house finch, supplemented with known field and laboratory information on immunity to MG in finches. We then examine the interactions of these factors in a theoretical model of disease dynamics. We find that both forms of seasonality could explain the dynamics of the house finch-MG system, and that these factors could have important effects on the dynamics of wildlife diseases generally. In particular, while either alone is sufficient to create recurrent cycles of prevalence in a population with an endemic disease, both are required to produce the specific semi-annual pattern of disease prevalence seen in the house finch conjunctivitis system.

An outbreak of conjunctivitis due to atypical Streptococcus pneumoniae

BACKGROUND

In February 2002, clinicians at the Dartmouth College Health Service recognized an outbreak of conjunctivitis; cultures of conjunctival swabs implicated Streptococcus pneumoniae. An investigation was begun to determine the extent of the outbreak, confirm the cause, identify modes of transmission, and implement control measures.

METHODS

Investigators reviewed the health service's data base for diagnoses of conjunctivitis. Viral and bacterial cultures were obtained from ill students. Bile-soluble isolates that were susceptible to ethylhydrocupreine (optochin) and therefore were presumed to be pneumococci underwent serotyping, capsular staining, pulsed-field gel electrophoresis, a DNA probe, and multilocus sequence typing. A cohort study of risk factors was conducted with the use of the Internet. Control measures included distribution of alcohol-based hand gel and messages about prevention.

RESULTS

Among 5060 students, 698 (13.8 percent) received a diagnosis of conjunctivitis from January 1, 2002, through April 12, 2002, including 22 percent of first-year students. Presumed pneumococci were isolated from 43.3 percent of conjunctival swabs (110 of 254); viral cultures performed on 85 specimens were negative. DNA probes and multilocus sequence typing confirmed that the organisms were pneumococci, although the bacteria did not have the characteristic capsule. On pulsed-field gel electrophoresis, strains were found to be identical to pneumococci that caused outbreaks of conjunctivitis in other parts of the country in 1980. Analysis of survey data from 1832 students indicated that close contact with a student with conjunctivitis, wearing contact lenses, membership on a sports team, and attending parties at or living in a fraternity or sorority house were associated with conjunctivitis. The rate of diagnosis of conjunctivitis declined after the implementation of control measures and after spring break.

CONCLUSIONS

This large outbreak of conjunctivitis on a college campus was caused by an atypical, unencapsulated strain of S. pneumoniae that was identical to strains that had caused outbreaks two decades earlier.

Conjunctivitis due to Chlamydophila felis (Chlamydia psittaci feline pneumonitis agent) acquired from a cat: case report with molecular characterization of isolates from the patient and cat

Conjunctivitis due to Chlamydiaceae other than Chlamydia trachomatis is rarely reported because of infrequent occurrence or inadequate investigation. A case of chronic non-trachomatis chlamydial conjunctivitis is described. After full clinical information was supplied to the laboratory, a non-trachomatis chlamydia was recovered from the patient's eye. This organism, and a subsequent isolate from one of the patient's cats, were shown to be indistinguishable examples of the recently described species Chlamydophila felis. The infection was most likely acquired from the patient's cats. A prolonged course of doxycycline was required to eradicate the infection.

Mycoplasmal conjunctivitis in wild songbirds: the spread of a new contagious disease in a mobile host population

A new mycoplasmal conjunctivitis was first reported in wild house finches (Carpodacus mexicanus) in early 1994. The causative agent was identified as Mycoplasma gallisepticum (MG), a nonzoonotic pathogen of poultry that had not been associated with disease in wild songbirds. Since the initial observations of affected house finches in the mid-Atlantic region, the disease has become widespread and has been reported throughout the eastern United States and Canada. By late 1995, mycoplasmal conjunctivitis had spread to an additional species, the American goldfinch (Carduelis tristis). This new disease exemplifies the rapid spread of a pathogen following introduction into a mobile wildlife population and provides lessons that may apply to emerging human diseases.

[Effect of tonometry and nasolacrimal duct irrigation on bacterial flora of the conjunctiva]

This study was undertaken to assess the influence of preoperative ophthalmological examinations on the microbial flora of the conjunctiva. For this purpose, 112 patients awaiting ocular surgery were included in the study. Conjunctival swabs for microbiological investigation were taken by nurses on the day of admission. In addition, specimens were taken before an ophthalmological examination, after applanation and impression tonometry, after irrigation of the lacrimal duct and 2 h after the end of all examinations. A last swab was taken preoperatively. Comparison of the microbiological results of the first two specimens only showed an agreement in 53% of the cases. The increase after tonometry and irrigation of the lacrimal duct in the number of swabs that were positive was not permanent. Swabs that were primarily germ-free and those that were mostly contaminated also showed strong bacterial fluctuation. Based on the present results, there is no strong evidence that the microorganisms found at the preoperative examinations correlate with a higher risk of postoperative infection. Disinfection of the conjunctival sac and the application of antibiotic drops are necessary on the day before the operation and immediately before it.

Epidemic gonococcal conjunctivitis in central Australia

OBJECTIVES

To describe an epidemic of gonococcal conjunctivitis in central Australian Aboriginal children, the responsible phenotypes of Neisseria gonorrhoeae, factors facilitating spread and treatment efficacy.

DESIGN

Prospective study of patients with laboratory confirmed or clinical gonococcal conjunctivitis diagnosed from January to July 1991.

SETTING

The Alice Springs and Barkly Tablelands Health Districts of the Northern Territory, the Anangu Pitjantjatjara Lands of South Australia and the Ngaanyatjarra Homelands of Western Australia.

METHODS

Cases were identified from surveillance data and laboratory notifications, and by active case finding. A community survey explored risk factors.

MAIN OUTCOME MEASURES

Age-specific attack rates, auxotype/serovar characterisation of isolates, and clinical response to single dose treatment.

RESULTS

We identified 432 cases. The highest attack rate was in the 0-4 year age group (86 per 1000), and the risk of conjunctivitis decreased with age. The odds ratio of secondary infection in household compared with community contacts was 14.5 (P < 0.002; 95% CI, 1.8-120.0). Disease was less common in children with clean faces and hands. The outbreak occurred after unseasonable rains and large community gatherings. Isolates were predominantly IA serovars, less common among central Australian serovars.

CONCLUSIONS

The trigger for nonsexually transmitted gonococcal conjunctivitis epidemics remains obscure. Age is a significant risk factor and social and ecological factors may also contribute. Active case finding within affected households and treatment with a suitable penicillin is effective in stopping transmission.

Atopic disease, rhinitis and conjunctivitis, upper respiratory tract infections, and insect stings and snake bites

In this section we review four broad topics in pediatrics: atopic disease, rhinitis and conjunctivitis, upper respiratory tract infections, and insect stings and snake bites. The first three topics comprise three of the most commonly encountered problems in pediatric practice. Although the fourth topic accounts for a relatively small number of office visits, it generates a great deal of concern among our patients and their parents. There have been significant contributions to the pediatric literature in each of these areas over the past year and we review those of particular interest here. The papers that we have chosen to review were selected for both their scientific significance and practicality. Both review articles and original research are included, but all should be relevant to the care of your patients.

[Extra-urogenital detection of Chlamydia trachomatis--perinatal transmission]

Infections produced by Chlamydia trachomatis reach an epidemic scale worldwide. Examination of 1,333 women with suspected cervicitis and other clinical symptoms revealed positive findings in 355 (27.5%). Of 72 examined men 25 (34.7%) were positive. Perinatal infection is confirmed also by positive evidence of Ch. t. in 28.9% neonates with conjunctivitis and 19% positive smears from the nasopharynx. The authors used the direct immunofluorescent method, Chlamyset of Orion Co., Finland.

Neonatal meningococcal conjunctivitis associated with meningococcal meningitis

Two infants are described in whom identical strains of meningococcus were isolated from both the eyes and the cerebrospinal fluid. This suggests that the eye may be a portal of entry in at least some cases of perinatally acquired neonatal meningococcal disease and has important implications for the management of purulent conjunctivitis in the newborn.

Gonococcal conjunctivitis in prepubertal children

Four prepubertal children had confirmed gonococcal conjunctivitis. All were febrile and had hyperpurulent conjunctival discharge with periorbital inflammation. Cultures of pharyngeal, rectal, and genital specimens on selective media excluded infection at other sites. Detailed social evaluation revealed no evidence or suspicion of sexual abuse. Isolated gonococcal conjunctivitis occurs in prepubertal children. Unlike gonococcal infections at other locations, a nonsexual mode of transmission may exist. However, a careful physical examination and detailed social evaluation, looking for signs of sexual abuse, must be obtained in any prepubertal child with a gonococcal infection.

Outbreak of erythromycin-resistant staphylococcal conjunctivitis in a newborn nursery

We investigated an outbreak of erythromycin-resistant Staphylococcus aureus conjunctivitis in a hospital newborn nursery that used erythromycin eye ointment to prevent ophthalmia neonatorum. Cases occurred in 2 clusters; 20 (14%) of 146 infants in the nursery developed conjunctivitis from July through October, 1987; and 5 (7%) of 69 infants in the nursery developed conjunctivitis during April and May, 1988. A case-control study of the first cluster demonstrated that culture-confirmed cases were more likely than controls to have received prophylactic erythromycin eye ointment or their initial bath from one nurse (odds ratio, 9.0; P = 0.01) or to have been delivered by one physician (odds ratio, 12.7; P = 0.03). The nurse was the only staff person to have a nasopharyngeal culture which yielded erythromycin-resistant S. aureus. Control measures, instituted in October, 1987, included using silver nitrate drops instead of erythromycin eye ointment for prophylaxis; however, in January, 1988, the hospital resumed use of erythromycin eye ointment. No additional cases were identified until mid-April, 1988, when the second cluster of cases occurred. At that time the hospital reinstituted the use of silver nitrate and no additional cases were identified. This investigation illustrates the potential for conjunctival infection with an antimicrobial-resistant pathogen when antimicrobials are used to prevent ophthalmia neonatorum.