Conjunctivitis In Children Research Articles

Isolamento de Haemophiliis aegyptius associado à Febre Purpúrica Brasileira, de cloropídeos (Diptera) dos gêneros Hippelates e Liohippelates

The recognition of the Brazilian purpuric fever (BPF) in 1984 led to a number of studies which showed a relation between this disease and conjunctivitis caused by Haemophilus aegyptius. The increase in cases of conjunctivitis in children associated with higher population density of eye gnats (Chloropidae: Hippelates) has been reported since last century. This phenomenon is related to the attraction that those flies show for the eyes, secretions and wounds, from where they feed on. Although there are evidences on the role of these flies in the mechanical transmission of seasonal bacterial conjunctivitis, the isolation of Haemophilus aegyptius from them in their natural habitat had not been demonstrated yet. In this study Haemophilus aegyptius associated to BPF was isolated from two pools of chloropids collected around the eyes of children with conjunctivitis which were identified as Liohippelates peruanus (Becker) and a new species Hippelates neoproboscideus.

Acute conjunctivitis in childhood

We obtained specimens for culture from the lids and conjunctivae of 95 patients with acute conjunctivitis and 91 control children of similar age and, in addition, stained the conjunctival scrapings with Giemsa and Gram stains. The conjunctivitis was attributed to bacterial infection in 76 patients, viral infection in 12 children, and al lergy in 2 patients; no cause was identified in the remaining 5 patients. In most cases the etiologic diagnosis was based on the results of laboratory studies. By separately culturing microorganisms in specimens from the lids and conjunctivae of patients and control subjects, we could distinguish normal flora from pathogens, and blepharitis from conjunctivitis. Staphylococci, corynebacteria, and =-hemolytic streptococci were the predominant organisms recovered from the lids of control subjects. In contrast, Haemophilus Influenzae, Streptococcus pneumoniae, and Moraxella catarrhalls were the major pathogens cultured from the conjunctival specimens from patients with bacterial conjunctivitis. Gram stains of conjunctival scrapings provided a rapid means of predicting the pathogen in 51 of 55 cases of bacterial conjunctivitis. Giemsa stains of conjunctival scraplngs provided etiologic information in 81 of 84 cases, showing neutrophilia in bacterial infections, lymphocytosis in viral infections, and eosinophilia in allergic disease. These results indicate that most cases of acute conjunctivitis in children can be diagnosed on the basis of differential cultures of microorganisms from the lid and conJunctiva, together with Glemsa stains of conjunctival scrapings. (J PEDIAI'R 1993;122:10-4)

PRIMARY MENINGOCOCCAL CONJUNCTIVITIS IN CHILDREN

SUMMARY Four cases of primary meningococcal conjunctivitis in children are reported. This represents an incidence of 2% of patients presenting with conjunctivitis to a paediatric A&E department. All were initially treated with topical chloramphenicol, followed by systemic rifampicin once the diagnosis had been established. No ocular or systemic complications developed, nor recolonisation of the conjunctiva or colonisation of the nasopharynx at follow‐up (1–2 years).

Incidência do gênero Haemophilus nas conjuntivites purulentas em crianças na região de Campinas, SP

The study of 354 purulent conjunctivitis in children under 10 years old in the region of Campinas, SP, had the aim of finding the presence of Haemophilus influenzae biogroup aegyptius, the etiologic agent of the Brazilian Purpuric Fever in this population. Among the 264 bacteria identified, this organism was shown in 16,29%, Haemophilus influenzae in 34,09%, Staphylococcus aureus in 10,61%, and Staphylococcus sp in 14,39%. Most of these cases occurred between the age groups from 0 (zero) to 2 years (60,27%). The seasonal distribution showed a prevalence of Haemophilus influenzae in cold season and of Haemophilus influenzae biogroup aegyptius in warm season.

Branhamella (Moraxella) catarrhalis Endophthalmitis

Branhamella (Moraxella) catarrhalis is a gram-negative diplococcus that is morphologically indistinguishable from Neisseria . 1 In 1970, M catarrhalis was transferred to a new genus, Branhamella , and separated from other species of Moraxella. Branhamella catarrhalis principally colonizes the upper respiratory tract. It is a common cause of otitis media and sinusitis and has become an increasingly important pathogen for lower respiratory tract infections in patients with chronic obstructive pul monary disease. Approximately 75% of strains of B catarrhalis produce β-lactamase and are therefore resistant to penicillin and penicillin derivatives. Branhamella catarrhalis may also exhibit resistance to vancomycin or clindamycin. It remains sensitive to most other oral or intravenous antibiotics. The related Moraxella organisms are principally associated with external eye disease, especially corneal ulcers in debilitated patients. Outbreaks of Moraxella conjunctivitis in children have also been reported. To our knowledge, Moraxella species have been reported as the etiologic agent in three cases

Acute conjunctivitis in childhood

We obtained specimens for culture from the lids and conjunctivae of 95 patients with acute conjunctivitis and 91 control children of similar age and, in addition, stained the conjunctival scrapings with Giemsa and Gram stains. The conjunctivitis was attributed to bacterial infection in 76 patients, viral infection in 12 children, and allergy in 2 patients; no cause was identified in the remaining 5 patients. In most cases the etiologic diagnosis was based on the results of laboratory studies. By separately culturing microorganisms in specimens from the lids and conjunctivae of patients and control subjects, we could distinguish normal flora from pathogens, and blepharitis from conjunctivitis. Staphylococci, corynebacteria, and alpha-hemolytic streptococci were the predominant organisms recovered from the lids of control subjects. In contrast, Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were the major pathogens cultured from the conjunctival specimens from patients with bacterial conjunctivitis. Gram stains of conjunctival scrapings provided a rapid means of predicting the pathogen in 51 of 55 cases of bacterial conjunctivitis. Giemsa stains of conjunctival scrapings provided etiologic information in 81 of 84 cases, showing neutrophilia in bacterial infections, lymphocytosis in viral infections, and eosinophilia in allergic disease. These results indicate that most cases of acute conjunctivitis in children can be diagnosed on the basis of differential cultures of microorganisms from the lid and conjunctiva, together with Giemsa stains of conjunctival scrapings.

Levocabastine eyedrops in comparison with cromoglycate in the treatment of conjunctivitis in children with birch pollinosis

During the season 65 children, 7–19) yours old, with conjunctivitis due to birch pollinosis were treated with eyedrops, either levocabastine b. i. d. (+ placebo b. i. d.) (n=32), or cromoglycate q. i. d. (n= 33). Beclomethasone was given to children with rhinitis. Symptoms of conjunctivitis and sedation as well as pollen counts were assessed daily. Blood was drawn before and at the end of the treatment. When mean weekly scores for symptoms of conjunctivitis or sedation were evaluated there were no significant differences between the treatments. A dynamic statistical method correlating symptoms with pollen counts on the same and previous days was applied showing that the children treated with levocabastine had a quicker reduction of their conjunctivis symptoms after a pollen peak (p < 0.05) but were tired for a longer period (p < 0.01). Other side effects were few and similar in the groups. No significant changes were seen in the blood safety data. The differences between the groups were small, and from a clinical point of view the conclusion is that levocabastine taken twice daily is as effective and as free of side effects as cromoglycate taken 4 times a day.

Conjunctivitis in Children

Conjunctivitis is a common, usually mild, self-limited problem. Pathogens vary at different ages. Conjunctivitis occurs alone or as a manifestation of a systemic infection or a systemic disease. Diagnosis can usually be established by the combination of clinical and laboratory findings. Topical, systemic or combination therapy is used, depending on the agent and extent of infection.

A microbiological study of conjunctivitis with emphasis on Chlamydia trachomatis, in northern Norway.

To determine the microbiological agents in conjunctivitis in children and young adults, physicians outside hospitals were asked to obtain samples from the conjunctiva in patients presenting with conjunctivitis. Specimens from 194 patients and 177 healthy controls were cultivated for Chlamydia trachomatis. In 12 cases Chlamydia trachomatis was isolated (i.e. 4 neonates, 1 three-year-old child and 7 adults, aged 17 to 39 years), but in none of the controls. Of the specimens from patients 168 and all of the healthy controls were cultivated for both bacteria (including Chlamydia trachomatis) and viruses. The main micro-organisms, regarded as infectious, were Haemophilus influenzae (20), Streptococcus pneumoniae (18), Staphylococcus aureus (14) and Chlamydia trachomatis (9). Haemophilus influenzae (non-typable strains) were isolated more frequently in the age group below 5 years of age than in the age group 5-50 years. Herpes simplex virus (type II) was isolated in one neonate. Chlamydia trachomatis is among the most important infectious agents in conjunctivitis treated outside hospitals. As chlamydial infections need special attention regarding treatment and follow-up, physicians should be encouraged to obtain specimens for microbiological examination, including chlamydia, from the population at risk.

Efficacy of topical antibiotic therapy in acute conjunctivitis in children: Gigliotti F, Hendley JO, Morgan J, et al. J Pediatr 1984; 104:623–626

Efficacy of topical antibiotic therapy in acute conjunctivitis in children: Gigliotti F, Hendley JO, Morgan J, et al. J Pediatr 1984; 104:623–626

Efficacy of topical antibiotic therapy in acute conjunctivitis in children

We studied 102 children aged 1 month to 18 years in a randomized, double-blind trial designed to determine both the natural history of bacterial conjunctivitis and whether topical antibiotic therapy is beneficial. Affected eyes were treated four times a day for 7 days with drug (polymyxin-bacitracin ophthalmic ointment) or placebo. Eighty-four patients had proved bacterial conjunctivitis (Haemophilus influenzae 61, Streptococcus pneumoniae 22, both one); 66 of these received only topical therapy. By 3 to 5 days, 21 of 34 (62%) patients receiving topical antibiotic were clinically cured, whereas only nine of 32 (28%) patients given placebo were cured (P less than 0.02). By 8 to 10 days, 31 (91%) of the patients given antibiotic and 23 (72%) of the placebo group were cured (P = NS). The bacterial pathogen was eradicated by day 3 to 5 in 71% and by day 8 to 10 in 79% of patients given antibiotic, compared to 19% and 31% of the placebo group (P less than 0.001). Acute bacterial conjunctivitis is a self-limited disease, but topical antibiotic therapy with polymyxin-bacitracin shortens the duration of clinical disease and enhances eradication of the causative organism from the conjunctiva.

Conjunctivitis in Infancy and Childhood

Conjunctivitis is one of the most common afflictions affecting the eyes. Practically every microorganism, from viruses to bacteria have been implicated as causes of conjunctivitis. Depending upon the etiologic agent, conjunctivitis may range from a mild self-limited infection to one that can destroy vision and even be life-threatening. This review will be divided into two sections covering conjunctivitis in older infants and children and ophthalmia neonatorum, which has a different epidemiology. CONJUNCTIVITIS BEYOND THE NEONATAL PERIOD Epidemiology and Etiology Bacterial infection probably accounts for most of acute conjunctivitis in children. The organisms thought to be most common are Staphylococcus aureus, Haemophilus species including H influenzae and H aegyptius, and Streptococcus pneumoniae (Table I). Bacterial infection is frequently characterized by a purulent or mucopurulent discharge which is usually the source of transmission of infection. Towels and other commonly used articles may spread the infection from one person to another. Although Staph aureus has traditionally been assumed to be a pathogen, the organism is frequently isolated from the conjunctivae of individuals without conjunctivitis.1,2 In a recent prospective study of acute conjunctivitis in children,1 Staph aureus was isolated from 24% of the children with acute conjunctivitis and 16% of the control subjects, a nonsignificant difference. It has been hypothesized that the increased isolation rate of Staph aureus seen in conjunctivitis may be secondary to the wetter environment of the infected eye rather than a direct cause of the infection.

Conjunctivitis in Infancy and Childhood

Conjunctivitis is one of the most common afflictions affecting the eyes. Practically every microorganism, from viruses to bacteria have been implicated as causes of conjunctivitis. Depending upon the etiologic agent, conjunctivitis may range from a mild self-limited infection to one that can destroy vision and even be life-threatening.This review will be divided into two sections covering conjunctivitis in older infants and children and ophthalmia neonatorum, which has a different epidemiology.CONJUNCTIVITIS BEYOND THE NEONATAL PERIODEpidemiology and EtiologyBacterial infection probably accounts for most of acute conjunctivitis in children. The organisms thought to be most common are Staphylococcus aureus, Haemophilus species including H influenzae and H aegyptius, and Streptococcus pneumoniae (Table I). Bacterial infection is frequently characterized by a purulent or mucopurulent discharge which is usually the source of transmission of infection. Towels and other commonly used articles may spread the infection from one person to another.Although Staph aureus has traditionally been assumed to be a pathogen, the organism is frequently isolated from the conjunctivae of individuals without conjunctivitis.1,2 In a recent prospective study of acute conjunctivitis in children,1 Staph aureus was isolated from 24% of the children with acute conjunctivitis and 16% of the control subjects, a nonsignificant difference. It has been hypothesized that the increased isolation rate of Staph aureus seen in conjunctivitis may be secondary to the wetter environment of the infected eye rather than a direct cause of the infection.

Etiology of acute conjunctivitis in children: Gigliotti F, Williams WT, Hayden FG, et al J Pediatr 98:531–536 Apr 1981

Etiology of acute conjunctivitis in children: Gigliotti F, Williams WT, Hayden FG, et al J Pediatr 98:531–536 Apr 1981

Etiology of acute conjunctivitis in children: Gigliotti, F., Williams, W. T., Hayden, F. G. and Hendley, J.O. (1981). Journal of Pediatrics, 98, 531

Etiology of acute conjunctivitis in children: Gigliotti, F., Williams, W. T., Hayden, F. G. and Hendley, J.O. (1981). Journal of Pediatrics, 98, 531

Etiology of acute conjunctivitis in children

To determine the etiology of acute conjunctivitis in children seen in pediatric practice, 99 patients with conjunctivitis and 102 age-and season-matched controls were cultured for aerobic bacteria including Haemophilus influenzae, and for viruses, Chlamydia trachomatis, and mycoplasmas. Agents statistically associated with conjunctivitis included H. influenzae (42% vs 0%), Streptococcus pneumoniae (12% vs 3%), and adenoviruses (20% vs 0%). One of these three etiologic agents was isolated from 71 (72%) of the patients. Simultaneous infection with two pathogens was uncommon. Staphylococcus aureus was equally prevalent in diseased and control eyes; one strain of C. trachomatis was isolated from a control eye. Although there were variations in the clinical features of viral and bacterial conjunctivitis, differentiation in an individual patient was difficult. An adenovirus was isolated from 11 (65%) of 17 patients who had pharyngitis in addition to conjunctivitis. H. influenzae was isolated from 14 (74%) of 19 children who had both otitis and conjunctivitis. Adenovirus conjunctivitis was common in the fall and H. influenzae in winter.

Anaerobic and aerobic bacterial flora of acute conjunctivitis in children.

Aerobic and anaerobic cultures and clinical data were obtained from 126 pediatric patients with acute conjunctivitis. Similar cultures were obtained from 66 persons who did not have a conjunctival inflammation. Anaerobes were isolated from 47 patients (37.3%). In 26 cases (20.6%), they were in mixed cultures with aerobes, and in 21 cases (16.7%), they were the only isolates. Aerobes alone were recovered in 72 patients (57.1%). No bacterial growth was noted in seven patients (5.6%). The organisms recovered from eyes with conjunctivitis in statistically significant numbers were Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and anaerobic Gram-postive cocci.

Clinical Review : Conjunctivitis in Children

The management of acute conjunctivitis need not be confusing. In the newborn period the common etiologic agents are chemical, TRIC, and bacterial. The latter two causes are effectively treated with sulfacetamide ophthalmic preparations. Dacryostenosis should be suspected in any child with recurrent conjunctivitis in the first six months of life. With older children the major causes can be classified as viral, allergic, foreign bodies, and bacterial. Bacterial conjunctivitis almost always responds to sulfacetamide ophthalmic preparations.

The eye gnat Hippelates pusio as a vector of bacterial conjunctivitis using rabbits as an animal model.

Eye gnats ( Hippelates pusio Loew) have been considered possible vectors for the bacterium Haemophilus aegyptius , which causes conjunctivitis in children. After exposure to a culture of H. aegyptius , the eye gnat retained viable organisms for a maximum of 10 hr. A severe conjunctivitis was produced in rabbits which had been treated by irradiation with a cobalt-60 source and ultraviolet light, and then inoculated with H. aegyptius . This bacterium was then transmitted by the eye gnat from the eyes of the experimentally infected rabbits to irradiated rabbits, producing infection. Pathologic changes observed in the eyes of rabbits with conjunctivitis were attributed to infection with H. aegyptius . Results of these experiments indicate that eye gnats can act as mechanical vectors of H. aegyptius , with production of conjunctivitis. A conjunctivitis was also produced in irradiated rabbits by inoculation and gnat transmission of Escherichia coli and Staphylococcus sp.

Trachoma and follicular conjunctivitis in children.

Until sulfanilamide was first used, in 1938, the treatment of trachoma was limited to such nonspecific and partially effective measures as cauterization with copper sulphate or silver nitrate. Except in our Indian population, however, the disease was on the wane in the United States before 1938, probably as a result of improved economic and sanitary conditions and a consequent elevation of personal hygiene in the subject populations. It is now generally accepted that trachoma is a disease of the family, and that infection usually occurs in preschool life by transfer from parents or siblings. Treatment programs limited to school children alone usually fail in the long run, since reinfection in the family almost invariably occurs. In the United States trachoma is limited almost entirely, except for sporadic cases, to populations in whom a low level of personal hygiene is complicated by desert conditions, as in our southwestern Indian tribes, or