opthalmia neonatorum
neonatal conjunctivits
- conjunctivitis within first 4 weeks after birth,
- most frequent causes s aureus, s epidermidis, s pneumonia and M catarrhalis
- can also be caused by c trachomatis, n gonorrhea and HSV
viral vs bacterial conjunctivitis
viral-unilateral, concurretn upper respi viral symptoms, awatery or serous discharge
bacterial: bilaterial, mucipurulent disscharge,
periorbital cellulitis vs orbital cellulitis
orbital cellulitis 2:1 male, mostly in winter months, associated with paranasal sinus and upper respiratory tract infections, unilateral
associated with blurred vision, opthalmoplegia, proptosis and chemosis–> signs of increased intraorbital pressure and not seen with periorbital infection
periorbital cellulitis: mosttly peds, and pts younger than 5,
differential diagnosis for pediatric pharyngitis
.
clinical signs of group A strep pharyngitis
sudden onset, sore throat, severe pain on swellin, fever, scalitiform rsh, headache, nausea, vomitting, abdominal pain, inflammation of pharynx and tonsils, patchy exudates
-tonsillopharyngeal erythema with or eithout exudates and tender enlarged anterior cervical lymph nodes
-beefy red swollen uvulae, petechiae on palate, excoriated nares and scarlitiniform rash
5-15 years old, winter/spring
diagnosis of group A strep pharyngitis
microbiologic confirmation is necessary for the diagnosis of GABH strep pharyngitis
- culture of a specimen obtained by throat swab on a sheep blood agar plate is the standard lab procedure
- sensitivity of 90-95% if performed correctly
- factors effecting the efficacy: manner in which swab was collected, should be from both tonsils and the posterior pharyngeal wall
- if antibiotics taken recently false negative results may be high
- anaerobic incubation increases sensitivity
- duration of incubation
- clinical algortihm can be used in adults only
- bacitracin disk test, can also use group specific cell wall carbohydrate antigen directly on isolated bacterial colonies but more expensive for little benefit over bacitracin
- rapid antigen detection tests are much quicker, (has increased the number of patients treated with GABS in comparison to throat culture) specificity more than 95%, sensitivity 80-90%, can make diagnosis with positive test
treatment of group A strep pharyngitis
for individuals with symptomatic positive culture GABS
- also is ther is a high suspicioin can start abx and d/c if cx -
- abx will shorten the clinical course the pharyngitis
- usually self limited adn wil psontaneously resolve in 3-4 days
- therapy can be started within 9 days to prevent rheumatic fever
- amoxicillin (erythromycin if allergic) 10 days
prognosis of group A strep pharyngitis
complications: peritonsillar abscess, retropharyngeal abscess, cervical lymphadenitis, sinusitis, otitis media and mastoiditis, (suppurative)
- rheumatic fever, post strep glomerulonephritis (not prevented by antimicrobials) 3 weeks after skin and 10 days after throat infection, post streptococcal reactive arthritis
severe, hyperpurulent discharge and pseudomembrane formation, marked conjunctival injection, frank subconjunctival hemorrhae, chemosis, eyelid edema and preauricular lymphadenopathy
suspicious for Neisseria gonorrhoeae or neisseria miningitidis
- rare but serious, hyperacute
- gram stain showing gram - diplococci
- may penetrate corneal epithelium within 24-48 hours and cause permanent vision loss
- need parenteral antibiotics like IM or IV ceftriaxone
- hospital admission
- topical may inclue fluroquinolone
- must consider concomitant chlamydia (if out of range for opthalmia neonatorium must consider sexual abuse)
common etiologic agents for acute bacterial conjunctivitis
s aureus, s epi, strep pneumo, moraxella catarrhalis, pseudomonas
chronic bacterial conjunctivits
staphylococcus, m catarrhalis and commonly chlamydia
-greater than 4 weeks duration
how is neonatal opthalmia chlyamidia diagnosed
nucleic acid amplification tests, including PCR also can use direct fluorscent antibody tests, or enzyme immunoassays
what percent of infants who have chlamydial conjunctivits have concomitant infection at other sitses (nasopharyns, genital tract, lungs?
more than 50%
treatment of chlamydia opthalmia neonatorum
oral erythromycin or ethylsuccinate for minimum of 14 days
how is n gonorrhoeae prevented in kids?
with antibiotic prophylaxis immediately after birth with topical .5% erythromycin ointment
-if mother known to have gonorrhea can use single 125mg dose of parenteral ceftriaxone bc topical prohpylaxis is insufficient
treatment of HSV opthalma neonatorum
acyclovir 60mg/kg in three doses for 14 days and topical antiviral (trifluridine drops)
white lumps in undersurface of upper lid (conjunctival follicles or lymphoid germinal centers), limbus leaving herbert pits arlt line abraosion resulting in chronic discomfort and scarring of the ocular surface leading to end stage trachome and blindness
c trachomatic trachome-serotypes a through c
-requires porlonged courses of oral azithromycin, erythromycin or doxyclicine or topical antibiotics
unilateral red eye with mucopurulent discharge, marked conjunctival hyperemia with follicles and preauricular lymphadenpathy
chlamydial inclusion conjunctivitis
- serotypes A and D-K
- oral antibiotics and topical antibiotics azitrho and erythro
unilateral granulomatous conjunctivits with visible swollen ipsilateral preauricular or submandibular lymphadenopathy
parinaud oculoglandular syndrome
- bartonella henselae (cat scratch disease)
- bacterial cultures and seologic tested may be indicated
- treatment is syndrome specific
what is the most common viral cause of acute conjunctivits?
adenovirus
singular or multiple dome-shaped, umbilicated, shiny papules on the eyelid or eyelid margin
molluscum contagiosum, pox virus
- results from viral shedding from the eyelid lesions onto the surface of the eye
- if immunocompromsied more lesions and less conjunctival reaction
- lesions may persist
- removal of lesions indicated in symptomatic patients
- removal by incision and curettage
kawasaki disease criteria
1-fever for at least 5 days and 4/5
2-conjunctivits, oropharyngeal changes (strawberry tongue, red fissured lips), cervical adenopathy (usually unilateral), extremity changes of the hands or feet, and a polymorphoius rash,
-conjunctivits is not purulent and bilateral , usually absence of conjunctival injection
-if there is dischrage or crusting you should send swabs
most common cause of acute pediatric conjunctivitis
bacterial
bilateral involvement, purulent ocular discharge, concurrent otitis
bacterial
