Acute Purulent Conjunctivitis Research Articles

1433. Association Between Impact of Pneumococcal Conjugate Vaccines (PCVs) on Acute Respiratory Infections Rates and Impact on Antibiotic Consumption Rates in Young Children

BackgroundAcute respiratory infections (ARIs) are the main reason for prescribing antibiotics in young children. The impact of PCVs on ARIs is well documented. We attempted to assess the post 7- and 13-valent PCVs (PCV7/PCV13) temporal relationship of reduction in ARI rates vs. reduction in rates of dispensed antibiotic prescriptions (DAPs) in community clinics for children <2 years old.MethodsMost children in the Southern Israel district belong to the Clalit Health Maintenance Organization (Clalit-HMO), where all dispensed antibiotics are computerized. We enrolled all Clalit-HMO pediatric clinics in southern Israel that: (1) had ≥50 insured children <2 years; and (2) were active both before and after PCV implementation. In the years 2005–2009, an average of 22,187 children <2 years were insured yearly by the Clalit-HMO. PCV7/PCV13 were implemented in July 2009/November 2010, respectively, and rapidly reached ≥90% coverage. To associate post-PCV DAP to ARI rate dynamics, we used three separate population-based databases on ARIs (table). Over 95% of births and medical services in the southern Israel district take place at the only medical center in the district, enabling incidence calculation. Dynamics of incidences and incidence rate ratios (IRRs) were calculated, using the population at risk for each year.ResultsIncidence rates (Figure 1) and IRRs (Figure 2) for otitis media, acute purulent conjunctivitis, chest radiographies for ARI in pediatric emergency room showed similar, but not identical trends compared with DAP rate trends: All incidences were significantly reduced, especially after PCV13 implementation. This resulted in a 25.6% reduction of DAPs. Extrapolated to a cohort of 100,000 births, translates into a saving of 140,419 (95% CI 133,837–146,453) prescriptions through the first 2 years of life.ConclusionThe temporal association between ARI and DAP rate dynamics suggests a causative relationship. We speculate that reduction of ARIs led to reduced clinic visits and hence decline in antibiotic prescriptions. Disclosures R. Dagan, Pfizer: Consultant, Grant Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee, Grant recipient, Research grant and Speaker honorarium; MeMed: Consultant, Consulting fee; MSD: Consultant, Grant Investigator and Scientific Advisor, Consulting fee and Research grant. S. Ben-Shimol, Pfizer: Grant Investigator and Speaker’s Bureau, Research grant and Speaker honorarium. D. Greenberg, Pfizer: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium.

Escherichia hermannii as the Sole Isolate from a Patient with Purulent Conjunctivitis

Escherichia hermannii was isolated in pure culture from a patient with acute purulent conjunctivitis after a minor ocular injury. This is the first report of E. hermannii isolated as the sole pathogen from an infected site without prior antibiotic exposure, confirming the pathogenic potential of the microorganism.

Haemophilus influenzae causing conjunctivitis in day-care children

The role of Haemophilus influenzae in acute purulent conjunctivitis was studied during an outbreak among children in day care. Five day-care centers contributed 20 cases and 35 controls. All the children were subjected to culture of the nasopharynx and the eyes. H. influenzae was carried in the nasopharynx of 53% of the children (range between day care centers, 20 to 91%). Of the 20 children with acute conjunctivitis 8 had eye cultures positive for H. influenzae, 2 had Moraxella and the remaining were culture-negative. Ten colonies of H. influenzae were isolated from each positive culture and identified by capsular type, biotype and multi-locus enzyme electrophoresis. All but one of the isolates were nonencapsulated. They belonged to 4 biotypes and 8 electrophoretic types. The same strain was recovered from the eyes and nasopharynx of the symptomatic children, suggesting that the H. influenzae in the eyes originated from the nasopharynx. There was no evidence for spread of the same H. influenzae strains between day-care centers. Even within each center the Haemophilus strains recovered from the eyes varied among the symptomatic children. The in vitro capacity to attach to oropharyngeal epithelial cells was not increased among the H. influenzae recovered from the eyes. The results question if the majority of conjunctivitis cases were caused by H. influenzae and suggested that eyes were colonized with the nasopharyngeal carrier strain rather than infected by an isolate with special virulence for the eye.

A study of inclusion conjunctivitis in newborn and young adults. Clinical picture, culture, conjunctival scrapings and cytology of the tear fluid in 12 cases.

Chlamydia trachomatis were cultured from the conjunctiva of 8 newborn babies and 4 young adults' (age 20-30 years) affected with acute or therapy-resistant chronic conjunctivitis. The newborn had acute purulent conjunctivitis noticed 4 to 12 days after birth. Five of them had been treated with topical chloramphenicol without effect before the diagnosis was made. They responded well to topical tetracycline ointment, but 3 relapsed. Two developed chronic conjunctivitis and respiratory tract infection, one under long time topical chloramphenicol treatment. The adults had a chronic, in 3 unilateral, conjunctivitis with pronounced follicularly (3) or papillary (1) conjunctival hypertrophy. Different degrees of pseudoptosis, micropannus and corneal infiltrates (in 3) were noticed. In the tear fluid, the quantitative pipette method revealed inflammation shown by neutrophilic granulocytes and lymphocytes with an appreciable predominance of the former in the newborn, while less so in the adults. In the newborn the diagnosis was easily made by culture and by demonstrating inclusions bodies in Giemsa-stained conjunctival scrapings. In the adults the methods were less sensitive. A negative response to one culture does not preclude chlamydial infection.

Acute Purulent Conjunctivitis in Nigerian Children in Zaria

A prospective study of 61 acute purulent conjunctivitis seen in children up to 10 years of age at the Ahmadu Bello University Hospital, Zaria, Nigeria, between October 1975 and September 1976 showed H influenzae as the most common etiologic agent (26.2%), followed by S aureus (16.4%), N gonorrhoeae (14.8), and D pneumoniae (9.8%). N gonorrhoeae was the most common cause of conjunctivitis in the first month of life (43.8%) followed by S aureus (37.5%). Conjunctivitis from H influenzae occurred in older children, was more often bilateral, and had a male predilection. Gonococcal conjunctivitis occurred mostly in neonates and was largely unilateral. A good response to treatment with parenteral penicillin and topical Neosporin or chloramphenicol was noted in all the cases of gonococcal infection.

Eye survey—Mrewa Trust Lands

Summary In a remote area of Rhodesia, 4051 rural Africans were examined. Emphasis was placed on examination of the eye although attention was also devoted to any other complaints. The main finding was of a follicular conjunctivitis, two-thirds of these cases being judged to be due to trachoma. Pathology was found more frequently in the younger patients, in whom there was a high incidence of acute purulent conjunctivitis. In older patients cataract and conjunctival growths were found to be common. Many patients had multiple disorders. Malnutrition and vitamin deficiencies were also seen and treated, and many other medical disorders were recorded. The major weapon in combating general infection and eye disease would be a basic education in hygiene, and this is being put into practice.

ACUTE PURULENT CONJUNCTIVITIS DUE TO THE MENINGOCOCCUS

The occurrence of acute purulent conjunctivitis due to the meningococcus in an otherwise healthy person is exceedingly rare. Its occasional occurrence, however, and that of conjunctivitis due to Micrococcus catarrhalis illustrate the value of culture in certain cases in which differentiation from gonorrheal ophthalmia is important and would be otherwise impossible. REPORT OF CASE George G., aged 7 years, the son of a physician, was seen in April 1933 with chronic bilateral conjunctivitis. A few gram-negative diplococci were found in conjunctival scrapings, but on account of the mildness of the subjective and objective symptoms no complete bacteriologic study was made, and the organism was considered as probably M. catarrhalis. The symptoms subsided within a few weeks with the use of a mild antiseptic, though some enlarged follicles remained. On Dec. 11, 1934, during a moderately severe cold, the boy complained of a sudden pain in the left

CARELESS METHODS IN FITTING ARTIFICIAL EYES

To the Editor: —It may not have occurred to the readers ofThe Journal, as it had not to me until recently, how insanitary are the methods employed by the dealers in artificial eyes. Many surgeons in order to avoid the commercial element of selling something to a patient have been in the habit of referring those requiring ocular prostheses to opticians who keep artificial eyes in large quantities. This has seemed the more reasonable, moreover, because almost invariably after the first eye is fitted our patients go directly to these dealers to have them replaced. In a case recently referred to one of the best of these, an acute purulent conjunctivitis was developed within twenty-four hours. An examination of the discharge revealed the presence of streptococci, staphylococci and pus cells. While the condition was rapidly controlled, it emphasized the careless methods employed. The shells, having been tried in many