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In 1911,
Lindner and colleagues identified intracytoplasmic inclusions in
infants with a nongonococcal form of ophthalmia neonatorum called
inclusion conjunctivitis of the newborn (ICN). 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 ICN and the female birth canal as the reservoir.
Adults are infected by direct
contamination of the eye with genital secretions containing C.
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.
Visit:
Gonococcal Infection (Gonorrhea)
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