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PubMed1987

Comparison of enzyme immunoassay and culture for diagnosis of chlamydial conjunctivitis and respiratory infections in infants.

The efficacy of Chlamydiazyme (Abbott Laboratories, North Chicago, Ill.) in detecting neonatal conjunctival and respiratory infections caused by Chlamydia trachomatis was determined by comparison of this enzyme immunoassay (EIA) with the method of isolation of chlamydiae in tissue culture. The sensitivity and specificity of Chlamydiazyme for detecting C. trachomatis in conjunctival specimens from infants with conjunctivitis were 98 and 94%, respectively. For nasopharyngeal infection in infants with conjunctivitis, the sensitivity and specificity were 87 and 92%, respectively. There were nine nasopharyngeal specimens that were Chlamydiazyme positive and culture negative. All of these specimens demonstrated the presence of typical fluorescing chlamydial elementary bodies when pellets of the original specimens were examined with a fluorescein-conjugated monoclonal antibody. When the EIA was performed on nasopharyngeal specimens from infants with suspected chlamydial pneumonia, 6 culture-positive and 10 culture-negative specimens were correctly identified.

Chlamydia Infections↗
PubMed1990

Comparison of two enzyme immunoassays to culture for the diagnosis of chlamydial conjunctivitis and respiratory infections in infants.

Data are limited for the performance of enzyme immunoassays for the detection of Chlamydia trachomatis in conjunctival and nasopharyngeal specimens from infants. The only available data are for one assay, Chlamydiazyme (Abbott Diagnostics). The purpose of this study was to compare a new enzyme immunoassay, Pathfinder (Kallestad Diagnostics), with Chlamydiazyme and culture for the diagnosis of chlamydial conjunctivitis and pneumonia in infants. Pathfinder differs from Chlamydiazyme in that it uses a monoclonal antibody directed against the chlamydial lipopolysaccharide in addition to a polyclonal antichlamydial antibody. Triplicate conjunctival and nasopharyngeal specimens were obtained from 97 infants with conjunctivitis, and additional nasopharyngeal specimens were obtained from 14 infants with suspected chlamydial pneumonia (total, 111 nasopharyngeal specimens). Twenty-nine (30%) of the conjunctival specimens from infants with conjunctivitis and four (28.6%) of the nasopharyngeal specimens from the infants with pneumonia were positive for C. trachomatis by cell culture. The sensitivities, specificities, and positive and negative predictive values for Pathfinder for conjunctival specimens were 96.6, 98.5, 96.6, and 98.5%, respectively. The results for Chlamydiazyme were 96.6, 100, 100, and 98.6%, respectively. For nasopharyngeal specimens, the results for Pathfinder were 77.8, 94.6, 73.7, and 95.7%, respectively. The results for Chlamydiazyme were 66.7, 95.7, 75, and 93%, respectively. Pathfinder and Chlamydiazyme appeared to perform equivalently for the detection of C. trachomatis in both eye and nasopharyngeal specimens from infants with chlamydial conjunctivitis and pneumonia.

Antibodies, Monoclonal↗
PubMed1997

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

The BioStar OIA Chlamydia test (BioStar, Inc., Boulder, Colo.) is a novel immunoassay system that uses changes in reflection of light to directly detect chlamydial antigen in clinical specimens. We compared the optical immunoassay (OIA) with culture for detecting Chlamydia trachomatis in ocular specimens from infants with suspected chlamydial conjunctivitis. We initially performed a retrospective evaluation, testing 152 ocular specimens previously collected for culture with the OIA. The sensitivity and specificity were 94.2 and 97%, respectively. A subsequent prospective study evaluating 37 ocular specimens from infants with suspected C. trachomatis conjunctivitis revealed a sensitivity and specificity of 100 and 92.6%, respectively.

Antigens, Bacterial↗
PubMed1984

A prospective study of chlamydial, mycoplasmal, and viral infections in a neonatal intensive care unit.

In a prospective study of non-bacterial infection in a neonatal intensive care unit in north west London, Chlamydia trachomatis infection was identified in 4 of 280 babies (1.4%) and was the most common cause of neonatal ophthalmia. One of the four developed pneumonitis. Ureaplasma urealyticum was found to colonise the nasopharynx in 53 of 235 babies (22.6%), with Mycoplasma hominis present in 6 of 235 babies (2.6%). There was a statistically significant association between U urealyticum colonisation and preterm birth or prolonged rupture of membranes. Colonisation occurred more commonly in babies with apnoea. Viral infection was detected in 16 of 280 babies (5.7%). Rotavirus was identified in 5 of 170 babies (2.9%) and was associated with necrotising enterocolitis in two infants and with bloody diarrhoea in another. Respiratory syncytial virus, which was identified in 4 of 280 babies (1.4%), was not associated with lower respiratory tract infection.

Chlamydia trachomatis↗
PubMed1986

Neonatal chlamydial conjunctivitis.

Maternal chlamydial antibodies were determined in cord sera of 41 infants who developed neonatal chlamydial conjunctivitis and compared with the antibody profile of infants who had been exposed to Chlamydia trachomatis at birth by their isolation positive mothers but in whom conjunctivitis did not develop. No protective effect could be attributed to maternal antibodies transferred to the infants. Paired sera samples were collected from 18 infants with chlamydial conjunctivitis. Chlamydial IgM antibodies were detected in four of these 18 cases at the time diagnosis was established by isolation. An additional eight cases had developed chlamydial IgM at the time the convalescent sera samples were taken, on average on day 40. At that time symptoms had disappeared after systemic treatment had been given. Thus chlamydial IgM antibodies were eventually shown in two thirds of infants with chlamydial conjunctivitis who were all systemically treated and clinically healed. These data suggest a cautious assessment of chlamydial IgM in the diagnosis of chlamydial pneumonia.

Adult↗
PubMed1986

Chlamydia trachomatis as a cause of neonatal conjunctivitis.

Chlamydia trachomatis was identified in 37 of 73 consecutive neonates with purulent conjunctivitis, including four delivered by caesarean section with intact membranes. Most (28/37) presented in the first week. Infection was significantly associated with referral from the community. Genital C. trachomatis infection was present in 13 of 35 parents of affected infants.

Chlamydia trachomatis↗
PubMed1989

Chlamydia trachomatis infection in infants: a prospective study.

In a prospective study of Chlamydia trachomatis infection in pregnancy, 198 mothers positive for chlamydial antigen were identified; the infants of 174 were followed for up to six months and C trachomatis was recovered in cell culture from 43 infants (25%). Conjunctivitis occurred in significantly more infants who were positive for C trachomatis (20 of 43, 47%) than in those who were negative (18 of 131, 14%). There were also significantly more lower respiratory tract infections among infants with positive cultures (six of 43, 14%, compared with three of 131, 2%). The chlamydial antigen enzyme linked immunosorbent assay (ELISA) was positive in 61 of 131 infants from whom C trachomatis was not recovered in cell culture. False positive results were usually associated with the isolation of Staphylococcus aureus from samples of pharyngeal aspirate. Our results confirm that C trachomatis infection is a common cause of neonatal conjunctivitis, and respiratory infection in the first few months of life, with an incidence of 8.2/1000 live births. Because the infection is easily treated by oral erythromycin, however, screening during pregnancy is not warranted.

Chlamydia Infections↗
PubMed1990

Diagnosis of neonatal chlamydial conjunctivitis.

Fifty seven babies with ophthalmia neonatorum had conjunctival smears examined by microscopy and bacterial culture, and by immunofluorescence, to find out which was the best method of diagnosing chlamydial conjunctivitis. The positive (33%) and negative (70%) predictive values of microscopy and culture were too low for us to accept it as an adequate method of detecting the presence of Chlamydia trachomatis.

Bacteriological Techniques↗
PubMed1981

A double-blind comparison of topical therapy of chlamydial ocular infection (TRIC infection) with rifampicin or chlortetracycline.

A double-blind stratified trial was carried out on 85 patients to assess the efficacy of topical therapy with 1% chlortetracycline eye ointment in comparison with 1% rifampicin eye ointment in the treatment of chlamydial ocular infection of sexually transmitted origin (paratrachoma). Patients included were selected on the basis of positive culture for Chlamydia trachomatis. A 6-week course of treatment with chlortetracycline or rifampicin 3 times daily gave a clinical cure rate of 80% and 75% and a microbiological cure rate of 93% and 86% respectively. In patients who were not cured the intensity of inflammatory responses was considerably reduced.

Administration, Topical↗
PubMed1983

Neonatal chlamydial eye infection: an epidemiological and clinical study.

Neonatal chlamydial eye infection was detected in 39 cases of 281 infants with purulent conjunctivitis seen at the Department of Ophthalmology. Most cases of neonatal chlamydial eye infection (90%) were detected during the first month of life, and no case was found after 2 months of age. C. trachomatis was not isolated from any of 161 healthy control infants at 3-4 weeks of age. Genital chlamydial infection was demonstrated in 50% of the mothers to infected infants. Two of these women developed post-partum complications possibly due to chlamydial infection. Mothers of infected infants tended to be younger than average. Of 23 cases examined 2 years later, late sequelae were identified in 3.

Adolescent↗
PubMed1984

Prevalence of acute conjunctivitis caused by chlamydia, adenovirus, and herpes simplex virus in an ophthalmic casualty department.

The causes of acute conjunctivitis in 140 consecutive patients attending an ophthalmic casualty department in London were investigated. Laboratory evidence of infection with Chlamydia trachomatis, adenovirus, or herpes simplex virus was found in 52 (37%) cases. In 70 cases (50%) no evidence of infection with these agents was found. In the remaining 18 cases (13%) laboratory results were inconclusive. The importance of these findings, the role of laboratory investigations in the differential diagnosis of acute conjunctivitis, and their cost-benefit are discussed.

Acute Disease↗
PubMed1985

Prevalence of chlamydial eye infection in patients attending an eye clinic, a VD clinic, and in healthy persons.

Chlamydial eye infection was detected in 28 of 983 ophthalmological patients with conjunctivitis or keratoconjunctivitis, with a peak frequency of over 9% in patients aged 16-20 years and with decreasing frequency thereafter. In patients aged 1 to 15 years chlamydial conjunctivitis was not observed. Chlamydial eye infection could not be detected in patients at a venereal diseases clinic, though chlamydial genital infection was rather frequent in these patients. Nor was Chlamydia trachomatis found in the eyes of healthy young adults. In patients with proved chlamydial conjunctivitis unilateral symptoms were the rule. Pseudoptosis was the most conspicuous presentation in two cases. A prolonged course can be expected in chlamydial eye infection if the condition is unrecognised and effective treatment delayed. The venereal background of the condition must also influence the management.

Adolescent↗
PubMed1985

Rapid, reliable diagnosis of chlamydial ophthalmia by means of monoclonal antibodies.

The use of fluorescein-conjugated monoclonal antibody (Syva, UK) provided a rapid reliable diagnostic test for Chlamydia trachomatis in conjunctival samples from 100 adults with acute follicular conjunctivitis and seven babies with suspected chlamydial ophthalmia neonatorum. Elementary bodies (EBs) were seen in smears from 11 of the adults, and culture confirmed C. trachomatis infection in nine of them. Both tests were positive with specimens from four of the neonates. No specimens from either group of patients produced a negative result in the smear test but a positive result by culture. However, the two adult patients with chlamydial ophthalmia who had negative cultures but were EB-positive had both had prior topical tetracycline therapy.

Adult↗
PubMed1986

Oral doxycycline in the treatment of adult chlamydial ophthalmia.

Ninety-three consecutive patients with adult chlamydial ophthalmia were treated with four different regimens of oral doxycycline. In patients treated with a single dose of 5 mg/kg of body weight (300 mg) of doxycycline the severity of clinical signs was reduced, and in half of the patients shedding of the infective agent was stopped. Treatment with a weekly dose of 300 mg of doxycycline for three weeks or a daily dose of 1.5 mg/kg of body weight (100 mg) for one week produced a clinical and microbiological cure in 100% of patients. However, in some of these patients mild to moderate papillary responses were present up to six months from completion of the treatment. The best results were obtained with a daily dose of 100 mg for two weeks, which produced rapid clinical and microbiological cure in all patients.

Administration, Oral↗
PubMed1988

Marginal corneal abscess associated with adult chlamydial ophthalmia.

In four patients with an adult chlamydial ophthalmia small, marginal corneal abscesses were detected. These corneal abscesses were associated with unilateral papillary and follicular conjunctivitis and punctate keratitis. In these patients no bacteria was isolated from the abscesses, but Chlamydia trachomatis was isolated from materials collected from the abscesses and from the conjunctival swabbings. In addition all patients had microbiologically proved concomitant chlamydial genital infections. The clinical signs resolved after topical treatment with rifampicin or tetracycline eye ointment for six weeks or systemic treatment with tetracycline for two weeks. Because of concomitant chlamydial genital infection it is advisable to treat patients with adult chlamydial ophthalmia with systemic tetracycline and to refer these patients and their consorts for investigation and treatment of their genital infection.

Abscess↗