AKHALILIAN Farabi Hospital Drkhaliliancom Bacterial Conjunctivitis in Children and Adults Bacterial conjunctivitis is less common than viral conjunctivitis in adults In an adult with unilateral ID: 780036
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Slide1
Bacterial Conjunctivitis in Children and Adults
A.KHALILIAN
Farabi
Hospital
Drkhalilian.com
Slide2Bacterial Conjunctivitis in Children and Adults
Bacterial conjunctivitis is less common than viral conjunctivitis in
adults
In an adult with unilateral bacterial conjunctivitis >>> NLDO (R/O)
Slide3Slide4Acute purulent conjunctivitis
P
urulent
discharge < 3 weeks’ durationS pneumoniae
,
Streptococcus
viridans
,
S
aureus
,
(
acute
blepharoconjunctivitis
)
H
influenzae
(
biotype III previously called H
aegyptius
)
Slide5Slide6H influenzae conjunctivitis
Y
oung
children, sometimes with otitis
media
,
A
dults
,
particularly those chronically colonized with H
influenzae
(
smokers, COPD
).
Conjunctival
membranes
do not develop,
peripheral
corneal epithelial ulcers
and
stromal infiltrates
occur more
commonly
.
H
influenzae
preseptal
cellulitis may be associated with fulminant
Haemophilus
Meningitis (up
to 20%
long-term
neurologic
sequelae
)
Slide7Gram-stained smears and culture of the
conjunctiva in:
N
eonates or
debilitated
or
immunocompromised
individuals
, to
assess the risk of local and systemic complications
S
evere
cases
of
purulent conjunctivitis
, to differentiate it from
hyperpurulent
conjunctivitis,which
generally requires systemic therapy
U
nresponsive
to initial therapy
Slide8Rx acute bacterial conjunctivitis
Delaying
treatment until day 3 or 4 would significantly
reduce the unnecessary use of antibiotics and would not affect outcomes
If
the conjunctivitis
is improving on day 4,
then
antibiotics may not be necessary at
all.(limited benefit)
Slide9P
olymyxin
B/trimethoprim (Haemophilus species) Aminoglycosides
or
fluoroquinolone
drops,
B
acitracin
or ciprofloxacin ointment
.
4–6
times daily for approximately
5–7 days
Slide10Supplemental
oral antibiotics are recommended for patients with
A
cute
purulent
conjunctivitis associated
with pharyngitis,
C
onjunctivitis-otitis
syndrome,
Haemophilus
conjunctivitis
in children
.
Slide11Cultures of the nose or throat:
A
ssociated
sinusitis or pharyngitis
R
elapsing conjunctivitis
B
ecause organisms
persisting in and colonizing the respiratory mucosa may be the source of infection
.
Slide12Hyperacute
gonococcal
conjunctivitis
Slide13Hyperacute
gonococcal
conjunctivitisExplosive onset and very rapid progression of
severe purulent
conjunctivitis
Massive
exudation; severe
chemosis
; eyelid edema; marked
conjunctival
hyperemia,corneal
involment
N
gonorrhoeae
(
STD
,
maternal–neonate
transmission in NVD)
Slide14N gonorrhoeae
conjectivitis
P
reauricular
lymphadenopathy
C
onjunctival
membranes
.
Keratitis
,the
principal cause of sight-threatening
complications
(15
%–40
%):
D
iffuse epithelial haze,
Epith
defects
,
M
arginal
infiltrates
,
U
lcerative keratitis Corneal melting &perforation
Slide15N
gonorrhoeae
grows well
on chocolate agar and Thayer-Martin media
Slide16gonococcal
conjunctivitis without corneal ulceration:
gonococcal
conjunctivitis with
corneal ulceration:
Outpatient basis
1 (
IM
) ceftriaxone (1 g) injection
admitted
intravenous (
IV
) ceftriaxone (1 g IV every 12 hours) for
3 consecutive days.
copious, frequent(every 30–60 minutes) irrigation of the
conjunctival
sac with normal saline
copious, frequent(every 30–60 minutes) irrigation of the
conjunctival
sac with normal saline
Erythromycin, bacitracin or gentamicin ointment, and ciprofloxacin solution
Erythromycin bacitracin
or
gentamicin
ointment, and ciprofloxacin solution
supplemental oral antibiotics for treatment of
chlamydial infection
.(2/3)
supplemental oral antibiotics for treatment of
chlamydial infection
.
Slide17Rx
Patients
with
penicillin allergy can be given spectinomycin (2 g IM)
O
ral
fluoroquinolones
(ciprofloxacin
500 mg or
ofloxacin
400 mg orally twice daily for 5 days)
Patients should be instructed to refer their sex partners for evaluation and treatment.
Slide18Slide19Bacterial conjunctivitis in
neonates
ophthalmia
neonatrum
Chlamydia
trachomatis
S
viridans
S
aureus
H
influenzae
group D Streptococcus
Moraxella
catarrhalis
E coli and other gram-negative rods
N
gonorrhoeae
Slide20Neonatal
gognococcal
conjectivitis
1%
Bilateral
conjunctival
discharge typically develops
3–5 days after parturition
.
The discharge may
be
serosanguinous
during the first several days, with a
copious purulent exudate
,
severe
corneal complications
, and
endophthalmitis
developing
later
Disseminated
gonococcal
infection with arthritis, meningitis, pneumonia, and sepsis
Slide21Rx
For
nondisseminated
infections, a single IM or IV ceftriaxone injection (up to 125 mg or a dose of 25–50 mg/kg) or
cefotaxime
at
a single
dose of 100 mg/kg IV or IM
For disseminated infection
, treatment should
be augmented
according to infectious disease consultation.
Slide22H
ourly
saline irrigation
of the conjunctiva until discharge is eliminated. If corneal involvement
is suspected
, application of
topical erythromycin
or
gentamicin
ointment or frequent application of
a
topical
fluoroquinolone
should be considered.
Topical
cycloplegia
Neonatal chlamydia
conjectivitis
There
is no follicular response in newborns.
The
gretaer
amount of
mucopurulent
discharge
Pseudomembranes
Intracytoplasmic
inclusions
The
infection in newborns is more likely to respond to topical medications
.
Slide24Gram
and
Giemsa stains of conjunctival scrapings are recommended in neonates with conjunctivitis to
identify C trachomatis and N
gonorrhoeae
, as well as other
bacteria
Slide25Rx of Neonatal chlamydia
conjectivitis
Other Chlamydia-associated infections, such as
pneumonitis and otitis media
, can accompany inclusion conjunctivitis in the newborn.
1- Topical erythromycin or
sulacetamide
+
2- Systemic
erythromycin (12.5 mg/kg oral or IV 4 times daily for 14 days
)
Slide26Chlamydial conjunctivitis
Chlamydia trachomatis:
T
rachoma: serotypes A–C
A
dult
and neonatal inclusion conjunctivitis: serotypes
D–K
L
ymphogranuloma
venereum
: serotypes L1, L2, and L3
Slide27Adult
chlamydial
conjunctivitis
Adult chlamydial conjunctivitis
is a sexually transmitted disease
often found
in
conjunction with chlamydial urethritis
or cervicitis
.( systemic disease)
Other modes
of transmission may include
shared eye
cosmetics
and
swimming
pools.
Slide28Scant
mucopurulent
discharge
Follicular conjunctival response that is most prominent in the lower
palpebral conjunctiva
and
fornix,
P
reauricular
adenopathy
.
Follicles in the bulbar conjunctiva and semilunar
fold( specific sign)
Slide29F
ine
or coarse epithelial infiltrates, occasionally associated with
subepithelial infiltrates.( sup)
Micropannus
( < 3mm. Sup)
Slide30Rx
A
dult
chlamydial conjunctivitis often resolves spontaneously in 6–18 months.
A
zithromycin
1000 mg single
dose
D
oxycycline
100 mg twice daily for 7 days
T
etracycline
250 mg 4 times daily for 7 days
E
rythromycin
500 mg 4 times daily for 7 days
Slide31Patients
and
their sexual contacts should
be evaluated for coinfection with other sexually transmitted diseases, such as syphilis or gonorrhea
Slide32