[To the detection rate of Chlamydia infection in regmatogenous retinal detachment].

Regmatogenous, or primary, retinal detachment is a vision-threatening condition resulting from retinal rupture. Inflammation and autoimmune processes are of great importance in the pathogenesis of this disease. In this connection, the purpose of the study was to reveal the incidence of Chlamydia infection in regmatogenous retinal detachment. Subretinal fluid (SRF) aspirates and conjunctival scrapes from 50 patients with regmatogenous retinal detachment were studied by direct immunofluorescence test and polymerase chain reaction for Chlamydia trachomatis. The latter was found in 74% of SRF samples and in 90% of conjunctival scapes (in a total of 47 (94%) patients). The findings suggest that regmatogenous retinal detachment is associated with Ch. trachomatis contamination of the organ of vision in most cases. In retinal detachment, it is expedient to include tests for Ch. trachomatis into a complex of diagnostic methods and, when detected, to consider whether antichlamydial therapy is performed.

Combination of adult inclusion conjunctivitis and mucosa-associated lymphoid tissue (MALT) lymphoma in a young adult.

PURPOSE: To report a patient who was diagnosed with combined adult inclusion conjunctivitis (AIC) and mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: This is a case report. RESULTS: An 18-year-old male patient presented with chronic conjunctivitis and giant follicles. Evaluation by chlamydial antigen assay was positive. Conjunctival biopsy for the immunohistochemical stain and polymerase chain reaction of the left eye showed MALT lymphoma. CONCLUSIONS: MALT lymphoma can masquerade as other ocular surface diseases. Chlamydial infection causes chronic inflammation of the conjunctiva. Both of these diseases should be considered as a differential diagnosis of refractory follicular conjunctivitis. It is worthy of further study to determine whether chronic inflammation resulting from chlamydial infection increases the risk of MALT lymphoma or it is coincidental.

Infecçäo por Chlamydia trachomatis no período neonatal: aspectos clínicos e laboratoriais. Experiência de uma década: 1987-1998 / Chlamydia trachomatis infection in neonatal period: clinical and laboratorial aspects. Experience of a decade: 1987-1998

A infecção por C. trachomatis é adquirida pelo recém-nascido (RN) principalmente durante sua passagem pelo canal parto; 25 por cento a 50 por cento destes deverão desenvolver conjuntivite e 10 por cento a 20 por cento pneumonia. Objetivos. Verificar a incidência de infecção ocular por C. trachomatis nos RN internados com diagnóstico de conjuntivite, num período de 10 anos. - Observar a associação entre infecção ocular é pneumonia intersticial - Estudar os aspectos epidemiológicos e os métodos utilizados para o diagnóstico laboratorial. Casuística e Metodologia. Foram analisados os RN internados com diagnóstico de conjuntivite e/ ou pneumonia interticial internados na UCINE no período de 1987-1998. Os métodos de diagnóstico utilizados foram: a pesquisa direta do agente etiológico em raspado de conjuntiva, radiografia de tórax, sorologia para C. trachomatis no sangue pelo método de imunofluorescência para anticorpos IgG e IgM. Resultados. Estudamos as características de 20 RN que apresentaram infecção por C. trachomatis: 15 eram de termo (75 por cento) e cinco, pré-termos (25 por cento); houve predominância da infecção no sexo feminino (60 por cento); a pneumonia esteve presente em 15 dos 20 RN (75 por cento) e 12 apresentaram associação de conjuntivite e pneumonia. Não houve relação significante entre tipo de parto, idade materna, número de parceiros e a infecção, sendo que o antecedente materno de leucorreia esteve presente em 50 por cento dos casos. O diagnóstico sorológico esteve relacionado com a presença de pneumonia e a pesquisa direita com a conjuntivite. A incidência de conjuntivite por C. trachomatis entre os RN internados com esse diagnóstico durante o período de estudo foi de 17/100 (17 por cento). Conclusões. A. C. trachomatis é um importante agente patogênico e sua pesquisa é muito importante em RN com conjuntivite e/ou pneumonia intersticial mesmo na ausência de fatores de risco para doença sexualmente transmissível. A pesquisa direta em raspado de conjuntiva e o exame sorológico se mostraram importantes como métodos auxiliares do diagnóstico.

Incidence of adenoviral and chlamydial coinfection in acute follicular conjunctivitis.

PURPOSE/METHODS: After we studied a case of chlamydial and adenoviral coinfection in a 20-year-old woman, we determined the incidence of chlamydial infection in patients with acute adenoviral conjunctivitis. In a randomized retrospective study, we evaluated 100 specimens of patients with culture-proven adenoviral conjunctivitis. RESULTS/CONCLUSIONS: Three of 100 (3%) specimens tested positive for chlamydial DNA using polymerase chain reaction. Adenoviral and chlamydial coinfection is rare, yet should be considered in patients with prolonged follicular keratoconjunctivitis.

Comparison of two enzyme immunoassays to culture for the diagnosis of chlamydial conjunctivitis and respiratory infections in infants.

Data are limited for the performance of enzyme immunoassays for the detection of Chlamydia trachomatis in conjunctival and nasopharyngeal specimens from infants. The only available data are for one assay, Chlamydiazyme (Abbott Diagnostics). The purpose of this study was to compare a new enzyme immunoassay, Pathfinder (Kallestad Diagnostics), with Chlamydiazyme and culture for the diagnosis of chlamydial conjunctivitis and pneumonia in infants. Pathfinder differs from Chlamydiazyme in that it uses a monoclonal antibody directed against the chlamydial lipopolysaccharide in addition to a polyclonal antichlamydial antibody. Triplicate conjunctival and nasopharyngeal specimens were obtained from 97 infants with conjunctivitis, and additional nasopharyngeal specimens were obtained from 14 infants with suspected chlamydial pneumonia (total, 111 nasopharyngeal specimens). Twenty-nine (30%) of the conjunctival specimens from infants with conjunctivitis and four (28.6%) of the nasopharyngeal specimens from the infants with pneumonia were positive for C. trachomatis by cell culture. The sensitivities, specificities, and positive and negative predictive values for Pathfinder for conjunctival specimens were 96.6, 98.5, 96.6, and 98.5%, respectively. The results for Chlamydiazyme were 96.6, 100, 100, and 98.6%, respectively. For nasopharyngeal specimens, the results for Pathfinder were 77.8, 94.6, 73.7, and 95.7%, respectively. The results for Chlamydiazyme were 66.7, 95.7, 75, and 93%, respectively. Pathfinder and Chlamydiazyme appeared to perform equivalently for the detection of C. trachomatis in both eye and nasopharyngeal specimens from infants with chlamydial conjunctivitis and pneumonia.

Sexually transmitted diseases profile of patients with chlamydial conjunctivitis.

During 1980-85, 1648 patients with conjunctivitis attended an Eye Hospital in Liverpool. Of these, 195 had proven chlamydial infection. On referral, only 68 adults and 27 children of this group, and 66 adults as 'contacts' attended the Sexually Transmitted Diseases Clinic. Screening tests detected a significant number of STD's among the adults. Though asymptomatic, a large proportion of them had chlamydia a potential pathogen, in their genital tract. The need for such a referral, full S.T.D. screening and appropriate systemic treatment to prevent some of the sequele of untreated chlamydial infection are emphasised.

Marginal corneal abscess associated with adult chlamydial ophthalmia.

In four patients with an adult chlamydial ophthalmia small, marginal corneal abscesses were detected. These corneal abscesses were associated with unilateral papillary and follicular conjunctivitis and punctate keratitis. In these patients no bacteria was isolated from the abscesses, but Chlamydia trachomatis was isolated from materials collected from the abscesses and from the conjunctival swabbings. In addition all patients had microbiologically proved concomitant chlamydial genital infections. The clinical signs resolved after topical treatment with rifampicin or tetracycline eye ointment for six weeks or systemic treatment with tetracycline for two weeks. Because of concomitant chlamydial genital infection it is advisable to treat patients with adult chlamydial ophthalmia with systemic tetracycline and to refer these patients and their consorts for investigation and treatment of their genital infection.

Dual infection of the conjunctiva with herpes simplex virus and Chlamydia trachomatis.

We describe a homosexual man with simultaneous infection of the conjunctiva by Herpes simplex virus and Chlamydia trachomatis. This dual infection was associated with a genital and disseminated Herpes simplex virus infection as well as asymptomatic chlamydial infection of the rectum and "nonspecific" urethritis. The findings in this case show the importance of laboratory investigation in cases of conjunctivitis associated with genital infection.

Latent oculogenital infection with Chlamydia trachomatis.

Thirty patients attending a sexually transmitted disease clinic were evaluated for genital and ocular infection with chlamydia. Eight patients had positive conjunctival immunofluorescent staining. This represents an asymptomatic, latent carrier state with important epidemiologic considerations.

Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis.

Among 149 consecutive infants with ophthalmia neonatorum in Nairobi, Neisseria gonorrhoeae was recovered from 43%, Chlamydia trachomatis from 13%, and both microorganisms from 4%. Three of five isolates of C. trachomatis belonged to trachoma serovars. The sensitivity and specificity of a gram-stained smear for the diagnosis of gonococcal conjunctivitis were 86% and 90%, respectively. Patients with gonococcal conjunctivitis had more purulent discharge, a higher clinical severity score, and a younger age at onset of disease. Corneal epithelial edema with superficial keratitis was present in four (16%) of 25 patients with gonococcal conjunctivitis but in none of 22 other patients (P = .07). N. gonorrhoeae or C. trachomatis was isolated from the pharynx in 11 (15%) and six (23%) cases, respectively. Oropharyngeal gonococcal infection was associated with coughing (P = .007).

Otitis media and the Australian aboriginal.

Australia's aboriginal population, which numbers 150,000 persons, suffers much more from otitis media than does the nonaboriginal population, which numbers 15,000,000. Moreover, the clinical presentation, course, and pathology of otitis media in aboriginals have features that differ from what are considered usual. Problems of isolation, communication, and socioeconomic circumstances require that specially designed treatment projects be set up. Debate continues as to why aboriginal otitis media behaves so differently, and theories cover the full range: genetic factors, environment, protein-calorie malnutrition and immunity mechanisms, allergies, different microbiology, and so on. Current research may point up a link to ocular trachoma. The process of spontaneous healing of drum perforations is being studied in an attempt to identify those factors that may delay or prevent such healing.

Prevalence of chlamydial eye infection in patients attending an eye clinic, a VD clinic, and in healthy persons.

Chlamydial eye infection was detected in 28 of 983 ophthalmological patients with conjunctivitis or keratoconjunctivitis, with a peak frequency of over 9% in patients aged 16-20 years and with decreasing frequency thereafter. In patients aged 1 to 15 years chlamydial conjunctivitis was not observed. Chlamydial eye infection could not be detected in patients at a venereal diseases clinic, though chlamydial genital infection was rather frequent in these patients. Nor was Chlamydia trachomatis found in the eyes of healthy young adults. In patients with proved chlamydial conjunctivitis unilateral symptoms were the rule. Pseudoptosis was the most conspicuous presentation in two cases. A prolonged course can be expected in chlamydial eye infection if the condition is unrecognised and effective treatment delayed. The venereal background of the condition must also influence the management.

Ophthalmia neonatorum.

Although many types of conjunctival infections in neonates are relatively inconsequential, chlamydial, gonococcal, and herpes simplex infections can cause permanent ocular damage and serious systemic complications. These specific causes are discussed along with silver nitrate conjunctivitis, staphylococcal infections, and nasolacrimal duct obstructions.

Adult inclusion conjunctivitis. Clinical characteristics and corneal changes.

Twenty-five consecutive cases of adult inclusion conjunctivitis were studied. Diagnosis was based on the finding of typical Halberstaedter-Prowazek inclusion bodies on conjunctival scrapings. Corneal involvement was common (20/25 patients); most frequent was superficial epithelial keratitis (15/25). Other changes seen included subepithelial nummular keratitis (6/25), marginal keratitis (2/25), (4/25). There seemed to be a predilection for involvement of the upper half of the cornea. Conjunctival scarring occurred in one patient only. Associated genitourinary symptoms were spontaneously reported in three patients only; however, on careful questioning, an additional 12 patients were found to have a history of urethritis or cervicitis. A comparison with viral follicular conjunctivitis is made. The location and pattern of keratopathy, associated genitourinary complaints, mucopurulent nature of discharge, and lack of response to standard topical therapy would seem to suggest chlamydial cause. Conjunctival scrapings are very helpful in differential diagnosis between viral and chlamydial conjunctivitis.