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.].

Knowledge and practice of nursing professionals about prophylaxis of ophthalmia neonatorum / Conocimiento y la práctica de profesionales de enfermería sobre profilaxis de la oftalmía neonatal / Conhecimento e prática de profissionais de enfermagem sobre profilaxia da oftalmia neonatal

Abstract Objective: To analyze the knowledge and practice of nursing professionals about the prophylaxis of ophthalmia neonatorum. Method: Descriptive study, of qualitative approach, carried out in the first semester of 2018, in a city hall hospital located in the lake area of the Rio de Janeiro's state, through semi-structured interviews with 14 Nursing professionals participating in the care of the newborn, whose data were submitted to the Thematic Analysis. Results: From the three emerging thematic categories, there are gaps in knowledge related to ophthalmia neonatorum, silver nitrate and the instillation procedure of this prophylactic solution, as well as differences in care practice regarding care before, during and after the procedure. Conclusion and implications for practice: The data point to the importance of training the Nursing team in the prophylaxis of ophthalmia neonatorum, the revision of guidelines and procedures aimed at standardizing the procedure, as well as emphasizing the need for adequate follow-up of pregnant women in prenatal care.

Resumen Objetivo: Analizar el conocimiento y la práctica de los profesionales de Enfermería sobre la profilaxis de la oftalmía neonatal. Método: Estudio descriptivo, de naturaleza cualitativa, realizado en el primer semestre de 2018, en un hospital municipal ubicado en la bajada costera del estado de Río de Janeiro, a través de entrevistas semiestructuradas desarrolladas con 14 profesionales de Enfermería, que participan en la asistencia al recién nacido, cuyos datos se sometieron al análisis temático. Resultados: A partir de las tres categorías temáticas emergentes se evidencian lagunas en el conocimiento relacionadas a la oftalmía neonatal, al nitrato de plata y al procedimiento de instilación de esa solución profiláctica, además de divergencias en la práctica asistencial en cuanto a los cuidados antes, durante y después de la realización del procedimiento. Conclusión y las implicaciones para la práctica: Los datos apuntan a la importancia de la capacitación del equipo de Enfermería para la realización de la profilaxis de la oftalmia neonatal, de la revisión de directrices y conductas que visen la estandarización del procedimiento, además de resaltar la necesidad de un acompañamiento adecuado de las gestantes en el prenatal.

Resumo Objetivo: Analisar o conhecimento e a prática de profissionais de Enfermagem sobre profilaxia da oftalmia neonatal. Método: Estudo descritivo, de natureza qualitativa, realizado no primeiro semestre de 2018, em um hospital municipal localizado na baixada litorânea do estado do Rio de Janeiro, por meio de entrevistas semiestruturadas com 14 profissionais de Enfermagem, que participam da assistência ao recém-nascido, cujos dados foram submetidos à Análise Temática. Resultados: A partir das três categorias temáticas emergentes evidenciaram-se lacunas no conhecimento relacionadas à oftalmia neonatal, ao nitrato de prata e ao procedimento de instilação dessa solução profilática, além de divergências na prática assistencial quanto aos cuidados antes, durante e após a realização do procedimento. Conclusão e implicações para a prática: Os dados apontam para a importância da capacitação da equipe de Enfermagem para a realização da profilaxia da oftalmia neonatal, da revisão de diretrizes e condutas que visem a padronização do procedimento, além de ressaltar a necessidade de um acompanhamento adequado das gestantes no pré-natal.

Diagnosis of a neonatal ophthalmic discharge, Ophthalmia neonatorum, in the molecular age: investigation for a correct therapy.

An early double case of acute Ophthalmia neonatorum in 3-day-old twins is reported. Culture of eye swabs showed a wide bacterial polymorphism, in which common bacteria, such as Klebsiella pneumoniae, Streptococcus pneumoniae, Corynebacterium ulcerans and other Enterobacteriaceae, coexisted with atypical Mycoplasmataceae and Chlamydiaceae from resident cervical-vaginal maternal microbiota. The neonates were in an apparently healthy state, but showed red eyes with abundant greenish-yellow secretion, mild chemosis and lid edema. The maternal cervical-vaginal ecosystem resulted differently positive to the same common cultivable, atypical bacteria culturally and molecularly determined. This suggested a direct maternal-foetal transmission or a further foetal contamination before birth. An extended culture analysis for common bacteria to atypical ones was decisive to describe the involvement of Mycoplasmas (M. hominis and U. urealyticum) within the scenario of the Ophthalmia neonatorum in a Caucasian couple. The introduction of a routine PCR molecular analysis for Chlamydiaceae and N. gonorrhoeae allowed to establish which of these were present at birth, and contributed to determine the correct laboratory diagnosis and to define an adequate therapeutic protocol obtaining a complete resolution after one year for culture and atypical bacteria controls. This study suggests to improve the quality of laboratory diagnosis as unavoidable support to a correct clinical diagnosis and therapy, in a standardized modality both for swabbing and scraping, to check the new-born microbial programming starting in uterus, overtaking the cultural age to the molecular age, and to revise the WHO guidelines of SAFE Strategy for trachoma eye disease, transforming it into SAFES Strategy where the S letter is the acronym of Sexual ecosystem and behavioural valuation/education.

Efficacite de la polyvidone Iodee a 2;5 dans la prevention de l' ophtalmie neonatale a Yaounde; Cameroun

Objectif: Determiner l'efficacite de la polyvidone a 2;5 comparativement aux collyres usuels dans la prevention de l'ophtalmie neonatale a Yaounde. Materiels et methodes : Il s'agissait d'un essai clinique randomise realise dans deux formations sanitaires a Yaounde d'Octobre 2009 a Mars 2010. Cinq cent nouveau-nes dont les meres avaient donne leur consentement verbal etaient recrutes. Les donnees portaient sur les caracteristiques sociodemographiques; l'histoire obstetricale et les parametres anthropometriques du nouveau-ne. L'intervention consistait en une application oculaire a la naissance de polyvidone iodee a 2;5 ou de collyres usuels. Les nouveau-nes etaient suivis pendant trois jours a l'hopital puis par relance telephonique pour la survenue de conjonctivite. La clairance ethique etait obtenue du Comite National d'Ethique. L'analyse des donnees s'etait faite a l'aide du logiciel Epi-Info 3.5.1. Le seuil de significativite etait de 0;05. Resultats : Sur les 245 nouveau-nes du groupe polyvidone iodee a 2;5 et les 244 du groupe collyres usuels; le nombre d'ophtalmie neonatale etait identique soit 3 (1;2) respectivement (p=0;65). Le Klebsiella pneumoniae; l'Acinetobacter calcoaceticus et le Streptococcus pneumoniae etaient les germes isoles. Conclusion : L'efficacite de la polyvidone iodee a 2;5 a ete comparable a celle des collyres usuels dans la prevention de l'ophtalmie neonatale. Elle serait a recommander vu son faible prix

What have we learned from sexually transmitted infection research in sub-Saharan Africa?

Many of the most important research findings on STIs in the past 30 years have come from sub-Saharan Africa. African researchers and their international collaborators have led the way in the development and validation of syndromic STI management, in furthering our understanding of the interactions between HIV and other STIs, in the development of evidence-based strategies for the control of HIV and other STIs in high risk groups and in the general population, and in clinical, microbiological and epidemiological studies on syphilis, chancroid and ophthalmia neonatorum. This review summarises the major achievements of STI researchers in Africa in the past 30 years, and discusses the reasons underlying the success of STI research in Africa.

Conjuntivitis folicular crónica en el lactante / New born chronic follicular conjunctivitis

Caso clínico: Se presenta un caso de conjuntivitis folicular crónica del lactante que debuta como ptosis y dacriorragia. Mediante técnica de reacción en cadena de polimerasa (PCR) se diagnosticó Chlamydia trachomatis como agente etiológico y se trató con eritromicina tópica y sistémica. El contagio se produjo en el canal del parto. Discusión: La conjuntivitis de inclusión del lactante es muy infrecuente en nuestro medio. El método diagnóstico más sensible y específico es la PCR. Se debe identificar la fuente de contagio y hacer un tratamiento precoz y completo de todos los portadores para evitar las complicaciones de la cronicidad

Case report: A case of chronic follicular conjunctivitis in an infant presenting with ptosis and dacryorrhea is reported. Polymerase chain reaction (PCR) test identified Chlamydia trachomatis as the causative agent. The patient was treated with topic and systemic erythromycin. The infection was probably transmitted during delivery. Discussion: Chronic follicular conjunctivitis in infants is very uncommon in our environment. The most sensitive and specific diagnostic test is PCR. It is necessary to identify the original focus of infection and to provide specific treatment to all the carriers as soon as possible to avoid and prevent chronic complications (Arch Soc Esp Oftalmol 2008; 83: 559-562)

Gonococcal infections in newborns and in adolescents.

Gonococcal infections are now an uncommon problem in newborns in industrialized countries but remain a serious problem in developing countries due to ongoing high infection rates in pregnant women. Prompt diagnosis in the newborn with appropriate treatment can minimize sequelae. The mother and her partner(s) also require investigation and treatment. Adolescents are a core group fuelling the ongoing gonococcal epidemic in industrialized countries. This is unlikely going to change unless sexual behaviour changes substantially. Education is a critical step along with access to more youth friendly STI care. As noted in the 2001 Institute of Medicine Report, learning about sex, sexuality and prevention of STI is a basic human right of adolescents (DiClemente and Crosby 2006).

Eficacia y eficiencia clínica del Nitrato de Plata comparado con la tetraciclina en la profilaxis de la oftalmia neonatal / Efficacy and clinical efficiency of the nitrate of silver compared with the tetracycline in the prevention of the ophtalmology neonatal

El propósito del presente estudio clínico controlado a simple ciego fue conocer la eficacia y eficiencia del nitrato de plata comparado con la tetraciclina en las profilaxis de la oftalmía neonatal. Doscientos veinticuatro recién nacidos de parto vaginal, con Apgar igual o mayor de 7 al minuto y que no presentaron factores de riesgo para sepsis fueron asignados al azar a 2 grupos de tratamiento: el grupo A recibió nitrato de plata al 1 por ciento en solución 1 gota en cada saco conjuntival, dosis única de frasco gotero, el cuál luego fue descartado; el grupo B recibió tetraciclina oftálmica al 1 por ciento en ungüento 1/4 de pulgada en cada saco conjuntival, dosis única de tubo multidosis, el cuál luego fue descartado. Ambos grupos recibieron la profilaxis durante los 30 primeros minutos de edad. Ambos grupos fueron comparables en cuanto a las siguientes características perinatales: control prenatal, sexo, edad gestacional, peso al nacimiento y Apgar al 1´y a los 5´ (p > 0.05). La conjuntivitis química como efecto indeseable, se presentó 32.14 por ciento en el grupo A (p 0.05). Al evaluar el costo beneficio el nitrato de plata tuvo menor costo por neonato que la tetraciclina. Se concluye que el nitrato de plata al 1 por ciento y la tetraciclina oftálmica al 1 por ciento tienen la misma eficacia en la profilaxis de la oftalmología neonatal; además el nitrato de plata es tan eficiente como la tetraciclina en relación al menor costo igual beneficio: Recomendamos volver a utilizar el nitrato de plata al 1 por ciento en la profilxis de la oftalmía neonatal teniendo en cuenta que la población con escasos recursos económicos es la que acude con mayor frecuencia al hospital.

The management of common ocular infections.

Bacterial and viral infections involving the anterior segment of the eye and ocular adnexa present commonly in general practice, affecting patients of all ages. Careful assessment of the patient is necessary to distinguish between benign conditions and those with more serious complications. An understanding of the microbiology and pathogenesis of these conditions is helpful in rationalising current therapeutic approaches. This article focuses on the clinical presentation of common infections of the lids, conjunctiva and cornea, with a discussion of relevant therapeutic regimens for each condition.

The ocular manifestations of sexually transmitted diseases.

The problem of ocular involvement in sexually transmitted diseases is encountered by ophthalmologists in everyday practice. This paper reviews the ocular manifestations of some of the more common sexually transmitted diseases including AIDS, syphilis, gonorrhea and infections caused by herpes simplex, Chlamydia trachomatis and Phthirus pubis. Current methods of diagnosis and treatment are discussed. Neonatal infections associated with sexually transmitted diseases are also reviewed.

An approach to the management of gonorrhea in the pediatric age group.

Gonorrhea is becoming more important to the pediatrician. Not only is the incidence of this disease greatest in the adolescent group, but it has become more frequent in young children as well. The author outlines an approach to managing gonococcal disease in the pediatric and adolescent age groups.

[Extragenital gonococcal infections. A review]. / Extragenitale Gonokokken-Infektionen Eine Ubersicht.

In many cases gonorrhea is overlooked and not treated due to an unusual course of the disease. The longer this infection exists the greater is the danger of dissemination of the gonococci. Gonorrhea, if not diagnosed, may cause a series of local and general clinical manifestations, such as: the dermatitis-arthritis syndrome whose pathogenesis is not yet completely clarified: the Fitz-Hugh-Curtis syndrome which is often seen in females with chronic gonococcal adnexitis;gonococcal pharyngitis which nowadays occurs more often due to less conventional sexual practices of contemporary society; gonococcal conjunctivitis which represents the best known extragenital gonococcosis. This paper deals with the clinical manifestations and their treatment.