|Year : 1967 | Volume
| Issue : 3 | Page : 111-113
Pseudomonas pyocyaneus as a cause of ophthalmia neonatorum
Department of Ophthalmology, Lady Hardinge Medical College and Hospital, New Delhi, India
|Date of Web Publication||21-Jan-2008|
Department of Ophthalmology, Lady Hardinge Medical College and Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathew M. Pseudomonas pyocyaneus as a cause of ophthalmia neonatorum. Indian J Ophthalmol 1967;15:111-3
The major cause of conjunctivitis in die new born is still infection. The incidence of gonorrhoeal ophthalmia is only 0.2% without silver nitrate prophylaxis and with it only 0.013% Mellin and Kent (1958). Staphylococcal conjunctivities on the other hand is on the increase especially in hospitals where antibiotic resistant staphylococci prevail -- Farrer et al (1959).
Pseudomonas as a cause of conjunctivitis in the new-born is known since Von Herff's report (1903). Burns et al (1961) indicate the gravity of Pseudomonas infection in the premature infants. In their report of 9 cases 4 are fatal and 5 non fatal. All fatal cases have eye infection ranging from conjunctivitis to orbital cellulitis invariably ending in septicemia. Bignell (1951), Ainslie and Smith (1952), Ainslie (1953) and MacDonald (1953) have published Pseudomonas eye infection in adults after use of eye medicines, following removal of foreign body from the eye. Forkner et al (1958) report 23 cases of Pseudomonas septicaemia and only one presents bilateral conjunctivitis. Epidemics of pseudomonas infection can take place in premature nurseries as seen by Hoffman and Finberg (1955); Neter and Weintraub (1955).
Pseudomonas pyocyaneus can be isolated from skin and faeces of human beings. In the eyes they abide in the conjunctival sac or Meibomian glands. They are also seen as free living organisms in soil and water.
There are over 100 species of the genus Pseudomonas and there is considerable variation in their morphology. The commonly recognised Pseudomonas pyocyaneus grows on blood agar and produces green to yellow colonies. Pyocyanin, the blue pigment is characteristically produced by Pseudomonas pyocyaneus. They survive and multiply without animal host or rich nutrient media. Therefore they can get access to solutions of germicides or antibiotics. The eyes of infants, especially premature and debilitated persons are more prone to pyocyaneus infection. Corneal epithelium once injured, can succumb to Pseudomonas infection quickly.
The onset of lesion in premature infants range from 5th to 41st day of life and infection is usually unilateral Burns et al (1961).
The following case of Pseudomonas ophthalmia is presented here because of the unusual destructive lesion of the lids and the rarity of the condition in a full term normal baby.
| Case Report|| |
A female Hindu girl, aged 5 days was admitted to the ophthalmic ward with red swollen eyes swelling and ulcer on the left pinna and fever for 2 days. The baby was of full term. The delivery was normal, conducted at home by an untrained person. The mother had no excessive discharge per vagina or leaking membrane. Birth weight of the baby was not recorded and no medicine was put in the eyes after delivery.
General condition was fair, weight 6 lbs. 3 ozs. and temperature 100°F. Systemic examination was normal. Eyelids of both eyes were swollen and the lid borders very hyperemic. Conjunctiva of both eyes were congested and chemotic and there was thick purulent discharge. Left cornea had a central corneal ulcer almost covering the pupillary area with circum corneal injection. External auditory meatus on both sides were filled with thick purulent discharge. Both pinna were swollen and there were small ulcers below the left ear lobule. Baby had swelling of the vulva with vaginal discharge.
After two days of admission, temperature rose to 102°-103°F. The baby developed otitis media on the right side with facial palsy. Lid margins on both sides were ulcerated and were detached.
| Investigations|| |
Hemoglobin - 12.4 Gm%
W.B.C. - 14,750 / cmm
Blood culture was negative.
| Smears and Cultures|| |
Smears from the right eye showed epithelial cells and gram-positive cocci; and from the left showed grampositive bacilli.
Similarly in the smears from both the ears could be seen pus cells and Gram-positive cocci, whereas Grampositive bacilli were found in the smear of the right ear and Gramnegative bacilli from that of the left ear.
From the cultures of materials taken from both the eyes and ears Pseudomonas pyocyaneus could be isolated.
Direct examination of the baby's vaginal swab showed only few pus cells, although culture showed Pseudomonas pyocaneus.
Thus P. pyocyaneus could be cultivated from both the eyes and cars and the vagina of the baby but not from the mother's vagina, a culture from which was also attempted.
| Treatment|| |
On admission before the result of the cultural examination, the baby was put on parenteral crystalline penicillin along with local treatment of Streptopenicillin eye drops and Terramycin eye ointment. In addition left eye had Atropine eye ointment. Third day onwards oral Chloromycetin and Streptomycin injection were also given. There was no improvement. When Pseudomonas was isolated from the eyes and ears, Framycetin was applied locally. Child's vulva was daily cleaned and painted with gentian violet. Very soon the corneal ulcer healed with minimum opacity. Detached lid margins healed with ankyoblepharon at the external canthus of the left eye. On the right eye, the medial half of the upper and lateral half of the lower lid had fallen off and healing took place without adhesion [Figure - 1]. The left ear lobule on healing was distorted and there was atresia of the external auditory meatus.
The baby could close the eyes easily [Figure - 2].
| Discussion|| |
Though Pseudomonas is not a common organism to cause ophthalmia neonatorum, such a possibility cannot be ruled out without laboratory aid. Burns et al (1961) do not wait for the report on the cultural examination but determine the anti-biotic sensitivity against material taken from the discharging eyes and ears. They state "If extra blood agar plates are streaked with material from the patient and antibiotic discs placed on the plates, antibiotic sensitivities can be determined in as little as 12 hours, even before a definite identification of the organism is made." Thus waiting for culture and sensitivity report for days can be avoided and correct choice of antibiotic treatment can be instituted within 12 hours.
None of the cases recorded so far have presented lid infection resulting in the destruction of the borders. The multiplicity of the lesion as seen in this case is characteristic of the Pseudomonas infection. The origin of the infection seems to arise from the articles used during the time of delivery at home.
| Summary|| |
A case of Pseudomonas ophthalmia neonalorum is presented with unusual picture, destruction of the eye lids leading to madarosis and ankyloblepharon; otitis externa, otitis media with facial palsy and atresia of the external auditory meatus in a full term baby. The importance of speedy laboratory diagnosis and early treatment is stressed.
| References|| |
Ainslie, D. and Smith, C. (1952). Brit. J. Ophth. 36, 352-361.
Ainslie, D. (1953), Brit. J. Ophth. 37, 336-342.
Allen, H. F. (1963), Infectious diseases of the Conjunctiva and Cornea. Symposium of the New Orleans Academy of Ophthalmology, p. 80, C. V. Mosby & Co., St. Louis.
Bignell. J. L. (1951), Brit. J. Ophth. 35, 419-423.
Burns R. P. and Rhodes. D. H. (1961) A. M. A. Arch. Ophth. 65, 517-525.
Forkner. C. E.. Frei. E. Ed-comb. J. H., and Utz, J. P. (1958) Am. J. Med. 25. 877-890.
Farrer, S. M.. Russo, R. Bavara. C. and Werthamer, S. (1959) J. A. M. A. 171, 1072-1079.
Hoffman, M. A.. and Fingberg. L. (1955) J. Pediat, 46, 626-630.
MacDonald, M. (1953) Brit. J. Ophth. 37, 370-373.
Mellin, G. W.. and Kent, M. P. (1958) Pediat. 22, 1006-1015.
Neter. E. and Weintraub, D. H. (1955) J. Pediat 46, 280-287.
Von Herff. Jahresberichte, Basel (1903) 34: cited by Axenfeld, T. (1908) Bacteriology of the eve translated by A. Macnab, P. 229. William Wood and Company, New York.
[Figure - 1], [Figure - 2]