PEDBASE.org - The Pediatric Database - Detailed information of GONOCCOCAL CONJUNCTIVITIS

GONOCCOCAL CONJUNCTIVITIS

DEFINITION:

Inflammation of the conjunctiva by Neisseria gonorrhoeae resulting in a conjunctivitis.

EPIDEMIOLOGY:

incidence: 4/10,000 live births
age of onset:
- newborn period with peak between 2-5 days
risk factors:
- infected mothers or health-care workers
- prematurity, prolonged rupture of membranes

PATHOGENESIS:

3 major infectious causes of conjunctivitis in the newborn period
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Staphylococcus aureus
incubation period for N. gonorrhoeae conjunctivitis is 2-5 days

CLINICAL FEATURES:

1. Initial Presentation

peak onset between 2-5 days but can be present at birth or beyond 5 days
mild inflammation with a serosanguineous discharge
unilateral or bilateral

2. Later Presentation

after 24 hours
discharge now thick and purulent
tense edema of the eyelids with marked chemosis

3. Complications

may spread to deeper layers of the conjunctivae and cornea
- corneal ulceration and perforation
- anterior synechiae
- anterior uveitis (iridocyclitis)
- panophthalmitis
- permanent eye damage and blindness

INVESTIGATIONS:

1. Infectious

gram stain of discharge - intracellular gram negative diplococci
culture and sensitivity of discharge

MANAGEMENT:

1. Acute Infection

irrigate eyes with saline q10-30m initially then q2h
IV Ceftriaxone x 7 days
may also use a single IM dose of Kanamycin with Gentamicin eye ointment for 3 days

2. Prophylaxis

0.5% Erythromycin drops
if mother positive but untreated, infant should receive a single dose of IV or IM Ceftriaxone

Pediatric Database - GONOCCOCAL CONJUNCTIVITIS

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