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Year : 2015 Month : July Volume : 4 Issue : 53 Page : 9276-9278

GONOCOCCAL OPHTHALMIA NEONATORUM: A RARE CASE REPORT IN THIS ANTIBIOTIC ERA.

Pooja Jain1, Naveen Saxena2

1. Assistant Professor, Department of Microbiology, Kota Medical College, Rajasthan.
2. Associate Professor, Department of Microbiology, Kota Medical College, Rajasthan.

CORRESPONDING AUTHOR

Naveen Saxena,
Email : poojajain3985@gmail.com

ABSTRACT

CORRESPONDING AUTHOR:
Naveen Saxena,
House No. 622,
Main Road, Dadabari,
Kota, Rajasthan.
E-mail:poojajain3985@gmail.com

ABSTRACT: This is the first case report on gonococcal ophthalmia neonatorum at, MBS (Maharao Bhim Singh) Hospital, Kota. Apart from N. gonorrhoea, a variety of organisms are implicated inophthalmia neonatorum-Chlamydia trachomatis, Staphylococci, Streptococci, Gram negative coliforms, Candida spp. and herpes simplex virus. The incidence of gonococcal ophthalmia neonatorum in this antibiotic era is less than 1%(1,2) So it is one of the rare cases for this institution in this antibiotic era.

KEYWORDS: Gonococcal, Conjunctivitis.

INTRODUCTION:

CASE REPORT: A two day old female infant presented with history of bilateral mucopurulent discharge from eyes, redness, and severe periorbital swelling with oedematous eyelids.

Her mother a 30yr old female delivered via normal vaginal delivery. As per antenatal protocol TORCH, HIV, HBsAg, VDRL test were done. Results were negative. Her delivery and post-partum course was also uncomplicated.

Conjunctival swab from baby was taken for microbiological investigations. Gram staining and culture was performed. This was requested urgently as there was suspicion of gonococcal conjunctivitis. Diagnosis of ocular infection with N. gonorrhoeae was made following identification of intracellular gram negative, diplococci on gram stain confirmed by culture of Conjunctival swabs on Chocolate agar and a selective medium like modified Thayer Martin medium. Culture was incubated at 35-36oc under 5-10% CO2. N. gonorrhoeae was confirmed by oxidase positivity. It also ferments glucose with acid only. It does not ferment maltose.

Findings were cross checked by taking the endocervical swab of mother sent for Gram staining and culture examination with antibiotic sensitivity. As the findings from cervical swab of mother were similar to Conjunctival swab of baby, it was confirmed that baby had acquired infection from birth canal. The baby was treated with 1% silver nitrate solution and she showed improvement in two days. Mother was found sensitive to ceftriaxone, doxycycline and ciprofloxacin.

 

 

Fig.b

 

DISCUSSION: Ophthalmia neonatorum is the most common ocular disease in the newborn, occurring in 2-12%(3,4,5) of neonates. The mode of infectious transmission is believed to be acquisition during passage through a colonized or infected birth canal.(4,5) While nearly every bacterial species has been implicated, ocular infection with Neisseria gonorrhoeae is felt to be one of the most serious because of its potential to damage vision and cause blindness.(4,3) The incubation period for N. gonorrhoeae is 2-5 days (Sometimes longer) with the appearance of symptoms seen from birth to beyond 5 days of age. Beginning with a mild inflammation and serosanguinous drainage, gonococcal ophthalmia soon results in thick, profuse purulent discharge and tense eyelid edema with marked chemosis (Swelling of the conjunctiva).(5,6) Shortly after birth, ophthalmic prophylaxis for gonorrhea should be administered to all infants, including those delivered by cesarean section since ascending infection can occur. Two drops of a 1% silver nitrate solution or a 1 cm ribbon of antibiotic ointment (0.5% erythromycin or 1 % tetracycline) are applied to each lower conjunctival sac. The eyes should not be flushed or irrigated.(7) Without prompt treatment, N. gonorrhoeae ocular infection may spread to the deeper layers of the conjunctiva and cornea.(5,6) Corneal ulceration and perforation, iridocyclitis, anterior synechiae, and panophthalmitis from untreated gonococcal ophthalmitis may result in permanent vision loss and blindness.(4,8,9)

 

REFERENCES:

1.    Recommendations for the prevention of neonatal ophthalmia; Canadian Paediatric Society;
2.    Denniston AKO, Murray PI; Oxford Handbook of Ophthalmology (OUP), 2009.
3.    Chlamydial Infections. In: Pickering LK (ed). 2000 Red Book: Report of the Committee on Infectious Diseases, 25th edition. 2000, Elk Grove Village, IL: American Academy of Pediatrics, pp.
4.    Hammerschlag MR. Neonatal Conjunctivitis. Pediatr Ann 1993; 22 (6): 346351.
5.    Overall JC. Chapter 9 he Fetus and the Neonatal Infant. In: Behrman RE, et al (eds). Nelson Textbook of Pediatrics, 14th edition. 1992, Philadelphia: W.B. Saunders Company, pp. 504505.
6.    Wagner RS. Eye infections and abnormalities: Issues for the pediatrician. Contemp Pediatr 1997;14 (6): 137153.
7.    Prevention of Neonatal Ophthalmia. In: Pickering LK (ed). 2000 Red Book: Report of the Committee on Infectious Diseases, 25th edition. 2000, Elk Grove Village, IL: American Academy of Pediatrics, pp. 735742
8.    Schachter J. Why we need a program for the control of Chlamydia trachomatis (editorial). New Engl J Med 1989;320 (12): 802803
9.    Hammerschlag MR. Neonatal ocular prophylaxis. Pediatr Infect Dis J 1988; 7: 8182.

 

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