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Neonatal Conjunctivitis and Pneumonia Due to Chlamydia Infection

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Neonatal Conjunctivitis and Pneumonia Due to Chlamydia Infection SEXUALLY TRANSMITTED DISEASES © 2006 SNL All rights reserved Neonatal conjunctivitis and pneumonia due to chlamydia infection Genital chlamydia infection is the most commonly reported sexually transmitted infection in young adults and teenagers in the United Kingdom, particularly affecting those having unsafe sexual intercourse with multiple sexual partners. Infants born to women with untreated infection are at risk of chlamydial conjunctivitis and pneumonia. The prevalence, consequences, prevention and treatment of chlamydia infection and disease in both women and infants are described. Carol Pellowe hlamydiae are small Gram-negative which commenced in 10 areas of England EdD, RN Cbacteria, which like viruses, can only in September 2002. A further 16 areas were Deputy Director/Principal Lecturer replicate inside cells, i.e. they are obligate added in January 2004, covering 25% of all Richard Wells Research Centre intracellular parasites. However, unlike primary care trusts in England, and all Thames Valley University, London viruses, they are genuine cells being areas will be included in the national composed of both DNA and RNA, screening programme by 2008. The focus of Robert J. Pratt ribosomes and a cell wall, and dividing by this programme is an opportunistic CBE FRCN binary fission. Yet, in contrast to most screening of asymptomatic men and Director, Richard Wells Research Centre bacterial cells, chlamydiae lack the cellular women aged 16-24 years of age attending a Thames Valley University, London chemistry to produce their own energy and variety of healthcare settings, for example must invade and use a host cell to general practices, contraceptive clinics and reproduce. There are several different types young people’s services4. The screening (species) of chlamydiae, including method is simple and involves the collection Chlamydia trachomatis, a common cause of urine samples and self-collected vulvo- of sexually transmitted inflammatory vaginal swabs for diagnosis. genital disease, such as urethritis, cervicitis Data from the first year of screening Keywords and vaginitis. Infected women frequently shows a prevalence rate of 10.1% in chlamydial trachoma; neonatal transmit C. trachomatis infection to their women, over half of whom were under 20 conjunctivitis; chlamydial pneumonia infants during birth. years old4. Although this rate is less than Key points that seen in GUM clinics, it demonstrates a Prevalence significant prevalence among sexually Pellowe, C., Pratt, R.J. (2006) Neonatal Genital chlamydia is the most common active people. As women are not offered conjunctivitis and pneumonia due to sexually transmitted infection seen in screening for chlamydia infection during chlamydia infection. Infant 2(1): 16-17. genitourinary medicine (GUM) clinics in antenatal care, it is highly likely that many 1. Genital Chlamydia trachomatis is the England1. People most at risk are those infected women will be undiagnosed commonest STI in the United Kingdom, having unprotected sexual intercourse, during pregnancy. with 104,155 diagnoses in GUM clinics particularly those with multiple sexual in 2004. Consequences of chlamydia 2. About 75% of women and 50% of men partners. In 2004, a total of 103,932 with chlamydia have no symptoms of infections were diagnosed in GUM clinics, infection infection. representing an 8% increase compared In addition to inflammatory genital 3. In women, untreated genital chlamydia with 2003, and for the first time, women disease, the health consequences of C. infection can spread into the pelvic area aged 16-24 years exceeded 1000 cases per trachomatis infection can be serious. and infect the uterus, fallopian tubes, 100,0002. However, these cases only Infected women may develop an ascending and ovaries, leading to pelvic account for people diagnosed in GUM infection that can cause pelvic inflammatory disease. services and the national prevalence of inflammatory disease, infertility due to 4. Chlamydia infection can cause early genital chlamydia infection is unknown, damaged fallopian tubes and ectopic labour and delivery and can be but is clearly well in excess of those pregnancy5. Infected pregnant women are transmitted from mother to baby during diagnosed in GUM services. at increased risk of premature labour, birth. Four year ago, The National Strategy for premature rupture of membranes, low 5. Chlamydia infection in newborns can 3 5 cause neonatal conjunctivitis and HIV and Sexual Health outlined the birthweight infants and still births . pneumonia. Department of Health’s commitment to a Vaginal delivery is the usual route of national chlamydia screening programme transmission of C. trachomatis from 16 VOLUME 2 ISSUE 1 2006 infant SEXUALLY TRANSMITTED DISEASES neonatal chlamydia damage to neonate’s vision. In the infection is pneumonia industrially developing world, 1% silver caused by nasopharyngeal nitrate solution has been used but this is C. trachomatis infection or less effective in preventing conjunctivitis aspiration of infected caused by C. trachomatis6. genital secretions during During antenatal care in England, Agency: Dreamstime.com Agency: delivery. Pneumonia, pregnant women are routinely screened for © Photographer: Oleg Kozlov © Photographer: affecting as many as 10-20 gonorrhoea and the incidence is low. A percent of all infected number of studies concentrating on infants, typically occurs at prophylactic agents against chlamydia around six weeks of age, conjunctivitis comparing the topical use of although reports range erythromycin, tetracycline and silver from 1-19 weeks6. These nitrate solutions have proved inconclusive6. babies generally have a low- Povidone-iodine eye drops have been grade fever with an reported to have a broader spectrum of increased respiratory rate. activity with less side effects and no Often a persistent cough bacterial resistance, and in resource-poor interferes with feeding. A countries, also have the advantage of being chest X-ray will show cheaper to produce6. hyperinflation and diffuse An alternative option is to give systematic infiltrates6. Pneumonia in prophylaxis to all pregnant women. This FIGURE 1 Chlamydia infection can be pre-term babies is more serious, presenting has proved cost effective in countries with transmitted from infected mothers to their initially with respiratory distress followed prevalence rates of chlamydia greater than babies during birth. by worsening respiratory signs and 3%6. As the UK prevalence is far less than apnoea6. If left untreated, infants are at this, it is not current practice. infected mother to infant, as the eyes are increased risk of developing chronic coated with chlamydia as the baby passes pulmonary disease, including asthma6. Conclusions down the birth canal (FIGURE 1). Another species of chlamydia that also Chlamydial infection is a major cause of Approximately 50-70% of infants born to causes pneumonia in new-born infants is neonatal conjunctivitis in both developed women with genital chlamydia infection Chlamydia pneumoniae. and developing countries. A national will acquire chlamydia infection if no screening programme in England will not Treatment prophylaxis is given before or immediately be fully operational until 2008 and, even after birth6. A variety of antimicrobial drugs can be use when established, pregnant women may to effectively treat genital chlamydia still present with undiagnosed infection. Neonatal chlamydia infection infection in adults, including azithromycin, Neonatal nurses will need to be aware of doxycline, erythromycin and amoxicillin. Infants who become infected with the possibility of chlamydia as the cause of In order to prevent re-infection, current chlamydia during birth frequently develop conjunctivitis and pneumonia, as early sexual partners should also be screened a type of neonatal conjunctivitis of the treatment rather than prophylaxis remains and, if found infected, treated7. eyes, sometimes referred to as Ophthalmia the best strategy. In infants with chlamydia conjunctivitis Neonatorum. Maternally-acquired or chlamydia pneumonia, systemic therapy References infection with C. trachomatis is the with erythromycin is prescribed6. 1. Fenton K.A., Ward H. National chlamydia screening commonest cause of neonatal Erythromycin is generally well tolerated, programme in England: Making progress. Sex Trans conjunctivitis in industrially developed although it has been associated with the Infect 2004; 80(5): 331-33. 2. Health Protection Agency. Rates of increases in countries and it is a significant cause of development of hypertrophic pyloric 6 sexually transmitted infection slows. CDR Weekly. this condition in the developing world . 6 stenosis . Follow-up should be carried out 2005; 15(26): 2-5. Conjunctivitis develops between 5-14 days in all treated infants as subsequent courses 3. Department of Health. The national strategy for after delivery, usually in one eye but of therapy may be required6. sexual health and HIV. London: DoH. 2001. affecting the other after 2-7 days. Oedema 4. LaMontagne D.S., Fenton K.A., Randall S., Anderson and erythema of the eyelids is common, Preventing neonatal conjunctivitis S., Carter P. on behalf of the National Chlamydia Screening Steering Group. Establishing the National along with an eye discharge that may be Conjunctivitis can be prevented in Chlamydia Screening Programme in England: watery initially, but becoming purulent neonates by the topical use of various Results from the first full year of screening. Sex later6. Although chlamydia
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