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Pathology of Inclusion Conjunctivitis (Chlamydial Conjunctivitis)

Dr Sampurna Roy MD





Inclusion conjunctivitis is a self-limited suppurative conjunctivitis, acquired by newborns as they transit the birth canal. It is caused by Chlamydia trachomatis. 

In 1911, Lindner and colleagues identified intracytoplasmic inclusions in infants with a nongonococcal form of ophthalmia neonatorum called inclusion conjunctivitis of the newborn.

Mothers of affected infants were found to have inclusions  in their cervical epithelial cells, fathers of such infants had inclusions in their urethral cells, and the epidemiology of sexually transmitted chlamydial infections was revealed.

Fifty years later, chlamydial isolation procedures were developed, and studies again demonstrated Chlamydia trachomatis as an etiology of inclusion conjunctivitis of the newborn and the female birth canal as the reservoir.

Adults are infected by direct contamination of the eye with genital secretions containing Chlamydia trachomatis (subgroup groups D-K), although there are reports of infection after swimming in unchlorinated pools.

Inclusion conjunctivitis, known as neonatal inclusion conjunctivitis in the newborn and adult inclusion conjunctivitis in the adult, is also called inclusion blennorrhea, chlamydial conjunctivitis, or swimming pool conjunctivitis.

In the newborn, inclusion conjunctivitis appears between  the 2nd and 25th day of life, reaching a maximum intensity in 2 weeks, without pannus formation or scarring.

Inclusion conjunctivitis in adults is less acute.

After an incubation period of 4 to 12 days, patients present with unilateral or bilateral follicular conjunctivitis, with minimal suppuration, preauricular lymphadenopathy and conjunctival lymphoid follicles.

Symptoms include lacrimation, mild foreign body sensation, and lid fullness.

Histologically, an exudates of neutrophils and monocytes develop in one or both eyes, with edema and congestion of the lids.

The diagnosis is made by isolating the organism in tissue culture or by identifying intracytoplasmic inclusions in smears stained by Giemsa or by direct immunoflourescent techniques.

Tissue culture is more sensitive than microscopy but smears are faster and may be advantageous when evaluating neonatal disease.

Neonatal inclusion conjunctivitis must be differentiated from gonococcal conjunctivitis. 

Related posts: Gonococcal Infection (Gonorrhea) ; Trachoma ;  Chlamydial Infection  ; Chlamydial Infection of the Genital Tract  ; Psittacosis (Ornithosis,Parrot Fever)  ; Lymphogranuloma Venereum .


Further reading:

Chlamydia trachomatis infections in neonates and young children.

Chlamydia trachomatis

Chlamydia trachomatis infection in pregnancy

Chlamydia trachomatis and Neisseria gonorrhoeae

Chlamydia conjunctivitis and central retinal vein occlusion.  

The Relationship between chlamydia trachomatis and chlamydia pneumoniae as the cause of neonatal conjunctivitis (ophthalmia neonatorum).

Chlamydia trachomatis conjunctivitis in the newborn.

Evaluation of a new optical immunoassay for diagnosis of neonatal chlamydial conjunctivitis.

The role of Chlamydia trachomatis in the etiology of conjunctivitis.

Chlamydia trachomatisinfection in early neonatal period




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