Gonococus Cases Reports and Literature Review

Gonococcal Conjunctivitis and Treatment

1. Cases Report
and Literature
Review
Prepared By Year2 Resident Sim Molika

2. Review
Gonococcal Conjunctivitis
Literature
Prepared By R2 Sim Molika

3. Introduction
●Acute bacterial conjunctivitis is a common and usually self limitingcondition caused by direct
contact with infected secretion
●Bacterial Cause : Streptococcus pneumoniae, Staphylococcus aureus, Hemophilus influenzae
and Moraxella catarrhalis, sexually transmitted organism Neisseria gonorrhoeae

5. Introduction
●Acute Bacterial Conjunctivitis discharge purulent Occur in Two form :
1 , Adult : Gonococcal Conjunctivitis cause by Neisseria gonorrhea
2, New Born : Ophthalmia Neonatorum

6. Introduction
●Gonococcal Conjunctivitis Cause By Neisseria gonorrhoeae also known as gonococcal
ophthalmia neonatorum ,
Neisseria gonorrhoeaeis a gram-negative diplococcus :
●Mode of Transmission from mother to children during birth or Via STD
●GC also present without evidence of concomitant genital infection
●If Left untreated it might cause Life Threatening or Might lead to blindness

7. Risk factor
●Adult ,Sexual active
●Cause Agent Gonococcus (Neisseria gonorrhoeae )
●Contact of the eyes with infected genital secretions from a person with genital gonorrhea
infection

8. Etiology
●N gonorrhoeae :
•Transmit through STI , Mother to children
•Gram-Negative Diplococci
•Host : Human , Cannot survive out side the host ( pilli> adhersionepithelial cells )
•Mucosa of the cervix and urethra of infected mothers can act as bacterial reservoirs.
•Even with delivery via cesarean section, vertical transmission ofN gonorrhoeaeis still possible. Approximately 10%
of neonates exposed to gonorrheal exudates during delivery may go on to develop GC
* An interprofessional team of clinicians, epidemiologists, infectious disease specialists

9. Epidemiology
●Gonococcal infection in newborns is less than 1 In Developed Country
●Pregnancy nears 5% in some parts of Africa
●GC was 0.19 cases per 1000 patients evaluated for eye emergencies with the majority
presenting in young adult males in Ireland .

10. Pathophysiology
●N gonorrhoeae> penetrate > epithelial cells of mucosal surfaces such cervix ,
conjunctiva .
●Bacteriacanproliferate andinduce pro-inflammatory
●N gonorrhoeaehave developed methods forevading and even modulating immune
responses
●It can penetrate in epithelium> corneal ulceration if left untreated > Numerous papillae
may form ( Over growth of epithelium )

11. Clinical Feature
●Neonatal GC: Confirm when mother had infected with Gonorrhea , After First Days of life
Symptom May presented : ( Timing Onset one week )
•Conjunctival injection, chemosis
•Edema of the eyelids
•Mucopurulent discharge
•Tenderness of the globe
•Lymphadenopathy, preauricular

12. Clinical Feature
●In non-neonatal populationConjunctival injection chemosis:
•Edema of the eyelids
•Mucopurulent discharge
•Tenderness of the globe
•Lymphadenopathy, preauricular
•Sexual Active Individual Present with Conjunctivitis without Genital Sign
Severe purulent discharge, hyperacute onset (classically within 12 to 24 hours)

13. Clinical Feature
●1,StageInfiltration:
-Painandtendernessofeyesball
-BrightredonConjunctiva
-Waterydischarge
-Pseudomembranous
-LidSwollen
●3, stage of heeling :
-Pain less
-Swelling decrease
-Papillary formation on tarsus of conjunctiva
-Hyperemic remain but discharge decrease ( virulent gonococcus still remain )
●2, Blenorrheastage :
-5
th
Days After infection
-Discharge with mucopurulent
-Onset conjunctiva hyperemia
*Bacterial Conjunctivitis more than 4 weeks is considered chronic

14. Clinical Feature

15. Investigation
●Diagnosis : identification of Gram-negative intracellular diplococci on conjunctival smears
( Gram stain )
●Cultured on chocolate agar ,Thayer Martin agar
●PCR may be required for less severe cases that fail to respond to treatment
●Screening for other STIs : human immunodeficiency virus (HIV)

16. Management
Systemic Treatment
Gonococcal infection treated with a third generation cephalosporin
●Ceftriaxone 1 g (IM) + azithromycin 1 g p.o.both in a single dose is recommended
●If corneal involvement and Chemosis : hospitalize Ceftriaxone IV every 12, 24hour
( duration depend on clinical responded )
If Allergic to ceftriaxone Consider
-Gemifloxacin 320 mg p.oplus azhtrithromycine2g P.O in single Dose
-Gentamicin 240 mg i.m. in a single dose PLUS azithromycin 2 g p.o. in a single dose
( Fluroqinolone not recommed in pregnancy women )
* Increase resistance monotherapy not recommed

17. Management

18. Management
●Topical ED Treatment :
-Fluoroquinolone ointment *
-Fluoroquinolone drop 2hourly ( Cornea involved 1Hourly )*
●Saline irrigation until the discharge resolves
●Treat Partner by antibiotic
●Treat for possible chlamydial coinfection (e.g., azithromycin 1 g p.o.single dose or
doxycycline 100 mg p.o.b.i.d. for 7 days)
*Gatifloxacin, moxifloxacin, besifloxacin, levofloxacin, or ciprofloxacin

19. Management

20. Management

21. Differential Diagnosis

22. Prognosis
●If Left untreated if might cause
-Orbital Cellulitis
-Corneal Ulcer
-Perforation When Cornea Evolve

23. Reference

24. Case report
Section

25. Case Presented
●Patient Name : MRM
●Age : 17Years
●From : Phnom Penh
●Arrival at Our OPD : 15/05/2024

26. Chief Complain
BE redness, irritated & had some discharge
Additional History ??

27. History of presenting illness
●Her BE started redness & had some purulent discharge about 20 days
post prior arrival treated with unknown eye-drop from the clinic &
pharmacy still didn’t get any better => came to see us.

28. ●Past History :
NKA
DM (-)
HTN (-)
●Social History :
Alcohol (-)
Sexual active (+)

29. Full eyes examination
●VA
RE: 6/15LE: 6/9 (Snellen chart)
IOP:RE: 11mmHg , LE:13mmHg (I-care)

30. Slit Lamp examination
RE LE
Eyelid Mild swollen mike swollen
Conjunctival Moderate injections +
a little bit discharge
Severe injections + a
little bit discharge
Cornea erosion erosion
Anterior chamber Deep, Cell + Deep, Cell +
Lens Clear Clear
Posterior WML WML

31. Slit Lamp examination

33. Investigation

34. Diagnosis
●We Diagnosis Her as Gonococcus Conjunctivitis

35. Management
We Admit her for hospitalize
●PIV Ceftriaxone 2g/day : 3 days
●Fortified ceftriaxone: 1hourly
●Optamoxeyedrop : 1 hourly
●T mycinplus ointment : 1x 2

36. 21/06/2024 3Days After PIV

37. 21/06/2024 3Days After PIV
RE LE
Eyelid Decrease swollen Decraseswollen
Conjunctival Moderate injections +
a little bit discharge
Severe injections + a
little bit discharge
Cornea Clear Clear
Anterior chamber Deep, Cell (-) Deep, Cell (-)
Lens Clear Clear
Posterior WML WML

38. 1st follow up 29/06/2024

39. 21/06/2024 3Days After PIV
RE LE
Eyelid No Edema No edema
Conjunctival No injection No injection
Cornea Clear Clear
Anterior chamber Deep, Cell (-) Deep, Cell (-)
Lens Clear Clear
Posterior WML WML

40. Management
●Fortified Ceftriaxone drop 2hourly
●Optamox2 hourly
●AFM 1X4
Follow Up back 2weeks

41. Disclaimer
●Neisseria Gonorrhea is an interracial professional , Early Treatment and diagnosis
not only save sight but save life