Friday, June 10, 2016

Step 2 CK: Conjunctivitis in newborn

Hello! 

These are some points that I felt are high yield while studying conjunctivitis in newborn =)

Chlamydial conjunctivitis:
Neonatal C. trachomatis infection may present with conjunctivitis between 5 and 14 days of life.

Symptoms include mucopurulent discharge, swelling of the eyelids with red and thickened conjunctivae (chemosis).

Neonatal C. trachomatis pneumonia presents with cough, tachypnea, rales (Fever and wheezing is rare) between 4 and 12 weeks of age.

Oral erythromycin is the recommended treatment (50 mg/kg per day given orally in four divided doses) for 14 days for either chlamydial conjunctivitis or pneumonia.

Topical therapy for chlamydial conjunctivitis is not effective and there is a high failure rate compared with oral therapy in eradicating conjunctival infection.

The "gold standard" for diagnosis of neonatal C. trachomatis is culture. Nucleic acid amplification tests are non-culture diagnostic tools with a high sensitivity and specificity compared with culture.

Gonococcal conjunctivitis:
In the newborn, gonococcal infection is typically characterized by a purulent conjunctivitis with profuse exudate and swelling of the eyelids within 2-12 days of birth.

The diagnosis is confirmed by culture of the exudate.

Empirical antibiotic therapy of a single dose of ceftriaxone (25 to 50 mg/kg, not to exceed 125 mg, intravenously or intramuscularly) is administered in any infant with suspected gonococcal ophthalmia neonatorum.

How to differentiate the two in exams?
Gonococcal infections present earlier than Chlamydial infections.
Gonoccocal conjunctivitis is extremely purulent.
Chlamydial infections may have a respiratory component to it.

Adenoviral conjunctivitis:
Serous discharge
URTI symptoms

That's all!
Push yourself, because no one else is going to do it for you :)
-IkaN

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