|Year : 1987 | Volume
| Issue : 4 | Page : 186-189
Chlamydial Conjunctivitis - An Outbreak in Neonatal Ward
UD Hardas, SV Jalgaonkar, SJ Sharma
|Date of Web Publication||20-Dec-2008|
U D Hardas
Source of Support: None, Conflict of Interest: None
A short outbreak of conjunctivitis in a neonatal ward was investigated to find out the etiological agent and source of infection. Giemsa stained smears were examined. Chalamydia as an etiological agent was detected in seven cases and source of infection was found to be cervical secretions of mothers.
|How to cite this article:|
Hardas U D, Jalgaonkar S V, Sharma S J. Chlamydial Conjunctivitis - An Outbreak in Neonatal Ward. Indian J Ophthalmol 1987;35:186-9
|How to cite this URL:|
Hardas U D, Jalgaonkar S V, Sharma S J. Chlamydial Conjunctivitis - An Outbreak in Neonatal Ward. Indian J Ophthalmol [serial online] 1987 [cited 2020 Feb 17];35:186-9. Available from: http://www.ijo.in/text.asp?1987/35/4/186/26181
| Introduction|| |
In man, infection caused by chlamydia trachoma-s tis falls into three groups (i) Ophthalmic trachoma caused by serotypes A B, BA and C (i) Oculogenital infections caused by serotypes D to K (iii) Lymphogranuloma Venereum by serotypes L 1, L2 & L3.
Chlamydia have been long recognised as a major cause of blindness affecting eyes primarily and passing through various stages of cicatrization, scarring, recurrent infections ultimately leading to blindness Conjunctivitis in neonatology ward is rather unusual We experienced such an outbreak of conjunctivitis in a neonatal ward in the period of one month from October to November 85.
| Material and Methods|| |
i) 37 newborn babies with clinical symptoms of mucopurulent discharge, swelling of eyelids and redness of conjunctiva in both eyes
ii) Respective mothers of infected babies.
iii) Ten patients in the same ward having conjunctivits
iv) 35 staff members - medical, paramedical and nursing staff with or without symptoms
v) Fathers of the infected babies refused examination Thus a total of 119 persons were studied, as detailed above.
Collection of Materials
i) Conjunctival swabs in duplicate were collected from the lower conjunctival fomix One of the swabs was immediately placed in bacteriological saline with streptomycin for isolation of chlamydiae. The second swab collected in sterile container was used for isolation of bacterial agents
ii) With a sterile blunt spatula, conjunctival scrapings from lower conjunctiva were collected and spread on a clean glass microscopic slide taking care to minimise heaping of cells and to get a single smear layer for examination.
iii) Cervical scraping at the time of speculum examination were collected from endocervix of mothers. Material was spread in a thin layer on a glass slide.
Isolation aetiological agent
a) Bacteria - On receipt in the laboratory, the material was immediately processed for isolation and identification of organisms by standard bacteriological techniques  .
b) Clamydia - Material collected in streptomycin broth was inoculated in embryonated eggs  .
Examination of smears for inclusion bodies
Conjunctival/cervical smears were numbered and then stained by Giemsa stain  ., mounted in DPX and examined under oil immersion.
| Results|| |
A total of 119 persons consisting of 84 cases and 35 hospital staff were investigated. All the 84 patients had same presenting symptoms of acute mucopurulent conjunctivitis The staff members did not have any acute symptoms but one doctor and two other paramedical persons had little redness of eyes.
All the neonates developed symptoms within 24 hours to 72 hours after birth. The respective mothers had conjunctivitis at the time of investigation and of these only 31 could be investigated for chlamydial cervicitis. The rest of the ten cases in the ward were awaiting gynecological treatment.
Thirty one cervical scrapings were examined which showed epithelial cells, smudged cells, a few basal cells and plenty of red blood cells Basophilic cytoplasmic inclusions were seen in four cervical smears [Table 1].
Out of 199,90 (75.63%) showed no growth, only 29 were positive on bacterial culture Gram negative bacilli were present in 3 (2.52%) and Gram positive cocci in 26 (21.84%) of which 12 (10.08%) were coagulase positive and 14 (11.76%) were coagulase negative
None of the samples processed showed chlamydial isolate.
Smears for inclusion bodies
(Cytological finding - conjunctival smear)
I. Neutrophilic polymorpho-nuclear cells were seen in 71 cases In addition there were numerous large epithelial cells either single or in sheets, characteristic basophilic cytoplasmic inclusion bodies of'Halberstaelter- Prowazek' seen capping the nucleus of epithelial cells in 17 cases.
II. Mixed population of neutrophils and lymphacytes was seen in 13 cases. These smears showed epithelial cells, few smudged cells and inclusions were seen in 5 cases Conjunctival smears of staff members showed a few lymphocytes, mononuclear cells and occasional epithelial cells All were negative for inclusion bodies [Table 1].
Source of infection was detected in seven neonates as seen from [Table 2]. Source of infection in seven index cases was mother's conjunctiva in five, mothers cervical canal in one and either conjunctiva or cervix in one case.
| Discussion|| |
There are three naturally occuring chlamydial agents (i) lymphogranuloma venereum (ii) trachoma and (iii) inclusion conjunctivitis Chalamydial intections in neonates are attributed to the infected parents having either conjunctivitis or genital infection such as urethritis or cervicitis.
In this study the outbreak of conjunctivitis in neonates was investigated to find out the source of infection. Bacteriological investigation indicates that majority of cases (75.63%) were bacteriologically sterile. Bacterial growth was seen in 24.37% of cases Such findings have been reported as due to secondary infection  . In one of our study from this department, we have reported presence of similar bacterial isolates from 14.67%, 763 healthy conjunctival swabs.
There is an epidemiological association of genital infection and conjunctivitis In a previous study  genitourinary complaints were present in 15 of 25 cases or their partners In another study  , 4 of 16(25%) mothers showed presence of inclusion bodies and of these chlamydial agent was isolated in three In our study, it was rather difficult to get proper history and specific symptoms as all the mothers were examined during 6-7 days after delivery. However 4 cervical smears were positive for inclusion bodies and one was the mother of an index case. Further by direct and detailed questioning, 11 cases were detected as having cervicitis or urethritis.
We feel that this small outbreak of neonatal conjuncivitis was of chlamydial origin because
In one of the studies from India  , using Giemsa staining technique, presence of chlamydial agent was reported in25 of 57 (44%) casesand40 of 57 (70%) when examined by fluoresceine stain.
The present study is also based on Giemsa stained conjunctival and cervical smears for diagnosis of chlamydial infection Out of 37 paired samples of neonates & respective mothers, mother as a source of infection could be proved in 7 neonates Six mothers showed conjunctival scrapings positive and seven mothers showed cervical scraping positive for typical intracytoplasmic basophilic inclusion. In one case all the smears (mother's cervical and conjunctival and neonates conjunctival) were positive for inclusion. [Table 2].
I. 75.63% of cases were bacteriologically steril
II. Percentage of bacteriological positive finding is comparable to that seen in healthy conjunctiva
III. 7 neonates and 6 mothers of these showed, positive intracytoplasmic basophilic inclusion bodies typical of Chlamydia
IV. The cellular reaction in the smear was also in favour of chlamydial conjunctivitis
V. Source of infection was the mothers as proved by conjunctival and cervical smear examinations
| Acknowledgement|| |
We are thankful to the Dean, for permitting us to publish this work We are also thankful to Prof. & Head Deots of Ophthalmology and Gynaecology & Obstetrics for their co-operation.[Figure 1],[Figure 2]
| References|| |
Cruickshank R 1975. Medical Microbiology. Twelth Edition. Vol. IL Churchill Livingstone.
Lennette E FL & Schmidt N.J. 1979. Diagnostic procedures for viral, rickettsial and chlamydial infections. American Public Health Association. 5th Edition.
Dowson CR and Schachter J. 1967. TRIC - agent infection of the eve and genital tract Amm. J. of Ophthalmology. 63, 128E
Kher MM Jalgaonkar S.V. & Hardas U. D. 1985. Bacteriological study of healthy conjunctival flora. Indian Medical Gazette. Vol CXIX, 53.
Mahajan V.M et al 1981. Persistance of chlamydal agent in conjunctival infection and lacrimol sac of monkeys. Indian J. of Ophthalmology. 29, 257.
Susan Stenson 1981 - Adult inclusion conjunctivitis. Arch. Ophthalmology 99, 605.
Mordhorst H and Dowson C 1971. Sequck of neonatal inclusion conjunctivitis and associated disease in parents Amm. J. of Ophthalmology. 71, 861.
[Figure 1], [Figure 2]
[Table 1], [Table 2]