Chlamydia Conjunctivitis

This presentation describes one of the common ocular infections which is chlamydia conjunctivitis

1. Chlamydia
ConjunCtivitis
presentation by:
yassmeen Zein al-abdien Khalil
supervised by:
dr. amr mounir
sohag ophthalmology department

2. What is Chlamydia?
Chlamydia infection is a common sexually
transmitted disease. It is caused by bacteria
called Chlamydia trachomatis.
 Chlamydia is one of the most common sexually
transmitted infections worldwide affecting
about 4.2% of women and 2.7% of men.
Chlamydia can be spread during vaginal, anal,
or oral sex, and can be passed from an infected
mother to her baby during childbirth.

3. Chlamydia the Bacteria
C. trachomatis is responsible for the human
forms of chlamydial ocular infections inclusion
conjunctivitis and trachoma.
Testing of polyclonal and monoclonal
antibodies with major outer-membrane protein
has identified 19 different human serotypes
and several variants of C. trachomatis.
Serotypes D, Da, E, F, G, H, I, Ia, J, and K are
associated with inclusion conjunctivitis (as well
as genital infections), while serotypes A, B, Ba,
and C are usually isolated from trachoma.

4. Chlamydia trachomatis
Obligate
intracellular human
pathogen.
gram-negative
coccied bacterium
that typically
infects columnar
epithelial cells.

5. Chlamydial Conjunctivitis
Adult inclusion conjunctivitis.
Neonatal inclusion conjunctivitis
Trachoma

6. Adult inclusion conjunctivitis
Adult chlamydial conjunctivitis is an
oculogenital infection usually caused by
serovars D–K of C. trachomatis.
Affects 5–20% of sexually active young
adults in Western countries.
Transmission is by autoinoculation from
genital secretions,although eye-to-eye
spread probably accounts for about 10%.
The incubation period is about a week.

7. Signs and symptoms of adult inclusion conjunctivitis
mucopurulent discharge.
lid swelling.
Irritation.
foreign body sensation.
Redness.
an enlarged preauricular lymph node and
diffuse mixed papillary follicular conjunctivitis.
Superficial vascularization.
peripheral scarringsuperficial punctate epithelial
defects and peripheral subepithelial infiltrates
can occur if the disease is left untreated.

12. Neonatal inclusion conjunctivitis
Chlamydia-infected mothers can pass the
infection on to their newborns during
parturition.
the rate of chlamydial infections among
infants born per vaginum appears to be
decreasing, as more women are screened
and treated.
Neonatal inclusion conjunctivitis due to C.
trachomatis presents within the first three
weeks of life and is usually self-limiting.

13. Signs of Neonatal inclusion
conjunctivitis
Mucous discharge
Redness
lid swelling
diffuse papillary conjunctivitis
Newborns don't present with follicles
Persistent or untreated disease will result in the
occasional corneal micropannus and palpebral
conjunctival scarring
the infection can spread to the nasopharynx
and lower respiratory tract and lead to
pneumonia if untreated.

17. Diagnosis and treatment of inclusion conjunctivitis
Chlamydial conjunctivitis is detectable by a
cytological examination of stained smears
from tissue.
Trachoma and acute chlamydial conjunctivitis
can be detected by Giemsa staining of
conjunctival cells, which also reveals
intracellular inclusion bodies.
Immunofluorescent antibody staining of
chlamydial antigen and nucleic acid
amplification of conjunctival smears are
newer and more accurate techniques.

18. Recommended treatment for inclusion
conjunctivitis includes both topical and
systemic antibiotics.
A two-to-three week regimen of
erythromycin or tetracycline ointment with
systemic tetracycline, doxycycline or
erythromycin is the usual treatment for adult
chlamydial conjunctivitis.
Infected mothers and their partners should
take systemic tetracyclines, macrolides or
azolides.
Infants are usually treated with
erythromycin ophthalmic ointment for one
week and erythromycin or azithromycin
elixir for two to three weeks.

19. Trachoma
Definition:
Repeated infection with gram negative C.
trachomatis results in trachoma, a chronic,
inflammatory, follicular form of
keratoconjunctivitis.
Aetiology:
Caused by A, B, Ba and C of Chlamydia
trachomatis.
Any age but mainly affects children at early
age.
Bad environment,flies&bad general health.
Endemic in Egypt 80%-90%of
population(trachoma was previously known as
Egyptian ophthalmia)

21. Life cycle of Trachoma

22. pathophysiology of Trachoma

24. Clinical features of Trachoma
Incubation period 5 to 21days.
Onset –subacute
Symptoms:
F.b senseation(gritty senseation of sand)
mucopurulent discharge.
Watering .
Redness.
Photophobia.
Blurring.
Mild pain

25. Signs:
I.Conjunctival signs:
According to Mac Callen’s Classification, there
are 4 stages:

27. WHO classification:

29. II. corneal signs:
(1)Superficial punctuate keratitis:

30. )2(Corneal follicles:

31. )3(Trachomatous pannus:
Infltration of cornea associated with
vascularization in the upper limbal area.
Stages:progressive ,regressive &healing
stage.

32. :types

33. )4(Trachomatous ulcers:

34. Complication of trachoma
Lid:
trichiasis,entropion,tylois,ptosis&madarosis
Conjunctiva:
Concretions,pseudocyst,xerosis&symblephar
on.
Cornea:
Opacity,ectasia,xerosis,total corneal
pannus.
Lacrimal:
Punctal stenosis,fibrosis of canaliculi

35. Management of Trachoma

36. Prevention of Trachoma
WHO’s SAFE stategy for the globtal elimination of
Trachoma:

38. Treatment of Trachoma
(1)Medical:
Systemic:A single dose of azithromycin (20 mg/kg up to 1 g)-
Erythromycin 500 mg twice daily for 14 days-doxycycline 100
mg twice daily for 10 days.
Local: sulphacetamide drops 10-30%5times/day for 2 months-
Topical 1% tetracycline ointment.

39. )2(surgical:
is aimed at relieving entropion and trichiasis and
maintaining complete lid closure, principally with
bilamellar tarsal rotation.
(3)Treatment of complications:

40. Differential diagnosis of Trachoma

41. Thank you