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Bacteriology of Ophthalmic Infections
Published in K. Balamurugan, U. Prithika, Pocket Guide to Bacterial Infections, 2019
Arumugam Priya, Shunmugiah Karutha Pandian
Conjunctivitis can be classified as hyperacute, acute, and chronic (Morrow and Abbott, 1998). Neisseria gonorrhoeae is the common cause of hyperacute conjunctivitis with the characteristic symptoms of abrupt onset, yellow-green purulent secretion, redness, and irritation of the conjunctiva, tenderness and palpation, conjunctival chemosis, conjunctival injection, lid swelling and so on. If hyperacute gonococcal conjunctivitis is left untreated, the corneal involvement and endophthalmitis is inevitable. N. meningitis is the second-most common cause for hyperacute bacterial conjunctivitis (Hovding, 2008). Acute bacterial conjunctivitis lasts for 3–4 weeks with burning and irritating sensation obviously followed by purulent discharge. The common bacterial pathogens involved in acute conjunctivitis are S. aureus, S. pneumoniae, and Haemophilus influenza. Prompt medication will lower the contagiousness and reduces further complications like corneal ulceration. The chronic conjunctivitis last for at least 4 weeks with similar signs of itching and burning sensation along with flaky debris, erythema, and bulbar conjunctival injection. The chronic conjunctivitis is commonly caused by Staphylococcus species and Moraxella lacunata with occasional involvement of other bacteria (Thielen et al., 2000).
Infections of the Eye
Published in Keith Struthers, Clinical Microbiology, 2017
In most instances topical eye drops or ointment can be used to treat acute bacterial conjunctivitis. In the UK chloramphenicol is widely used; it has broad-spectrum activity and is useful for most of the common bacteria considered, with the exception of Pseudomonas. The opinion that chloramphenicol should be avoided because of the risk of aplastic anaemia is not considered to be well founded. Aminoglycosides are also useful and have activity against Pseudomonas, as do quinolones, for example ciprofloxacin and ofloxacin. The aminoglycosides and these quinolones are considered to have equivocal activity against streptococci, but with topical application the concentration of these agents is considered high enough to be effective. In Ophthalmology departments, topical cefuroxime and gentamicin can be used as these cover most of the common bacterial pathogens. In the adult, gonococcal conjunctivitis can be treated with systemic antibiotics and a single 500 mg dose of intramuscular ceftriaxone plus 1 g oral azithromycin is used. Regular saline washes of the eye are used to remove purulent exudate.
Neisseria gonorrhoeae
Published in Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward, Case Studies in Infectious Disease, 2010
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward
In neonates vertical transmission may occur from an infected mother to her neonate during vaginal delivery. This results in bilateral conjunctivitis (ophthalmia neonatorum). The symptoms of gonococcal conjunctivitis are pain, redness, and a purulent discharge. Corneal ulceration, perforation, and blindness can occur if treatment is not given promptly. Blindness from neonatal gonococcal infection is a serious problem in developing countries but is uncommon in the United States and Europe where neonatal prophylaxis is routine.
Neonatal ocular prophylaxis in the United States: is it still necessary?
Published in Expert Review of Anti-infective Therapy, 2023
Susannah Franco, Margaret R. Hammerschlag
Very little data exist on the pharmacokinetics of erythromycin and other macrolides in neonates. Both drugs exhibit concentration-dependent activity [28,37]. Importantly, the MICs of antibiotics can vary by body site. Erythromycin reaches high concentrations in the eye when administered via ophthalmic ointment, but the concentration reached in the conjunctiva, how long it remains, and (for gonococci) if the concentration can overcome resistance is unknown [15,19,21]. A case report of two adults with gonococcal conjunctivitis describes the AST of five N. gonorrhoeae strains between 2003 and 2013 in Japan performed using Etest. Susceptibility to erythromycin decreased over the 10-year period; the maximum MICs to erythromycin and azithromycin were 1 mg/L and 0.25 mg/L, respectively. The authors concluded that the erythromycin concentrations reached in the conjunctiva may not surpass the MIC [38].
Challenges in treating ophthalmia neonatorum
Published in Expert Review of Ophthalmology, 2021
Faith Uche Ukachukwu, Afshan Rafiq, Lori A. S. Snyder
Whilst the treatment recommendations for reproductive tract N. gonorrhoeae infections have changed several times over the last few years to address the growing threat of extensively drug-resistant gonorrhea, there has been little change in treatment recommendations for ophthalmia neonatorum. The shortcomings of guidance in the light of N. gonorrhoeae resistance, the clinical consequences of corneal perforation, and the need for prompt treatment and follow-up has been highlighted by clinicians [162]. The CDC recommendation for adult cases of gonococcal conjunctivitis is both a single 1 g dose of ceftriaxone given intramuscularly and a single 1 g oral dose of azithromycin [72]; however, this is theoretical and consultation with an infectious-disease specialist is recommended. When these antibiotics are ineffective, as in a case of gonococcal STI in 2018 [78], it is unclear what treatment options remain. Silver nitrate was highly effective in the past at preventing ophthalmia neonatorum, but it is clear that even if we are willing to accept the risk of chemical conjunctivitis and toxicity as have clinicians of the past [163], it was never effective in the treatment of established infections. In 10–17% of infants receiving silver nitrate prophylaxis, ophthalmia neonatorum still developed [164] requiring treatment, which may not be possible if the bacteria are fully resistant to antibiotics.