Neonatal Chlamydial Infection Research Articles

Chlamydial and Gonococcal Infections in Infants and Children

The recommendations for the 2010 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines in regard to diagnosis and treatment of gonococcal and Chlamydia trachomatis infections in infants and children are essentially the same as the 2006 guidelines. There are no new data on the diagnosis or treatment of neonatal chlamydial or gonococcal infections. New data on the efficacy of neonatal ocular prophylaxis are limited. Two recent studies from Iran and Brazil suggest that povidone-iodine may not be effective for prevention of chlamydial or gonococcal ophthalmia. Prenatal screening and treatment of pregnant women, which has been demonstrated to be very effective for the prevention of neonatal gonococcal ophthalmia, is the most effective strategy for preventing neonatal chlamydial infection.

Prophylaxis, screening and treatment all have a place in the management of neonatal chlamydial infections

Prophylaxis, screening and treatment all have a place in the management of neonatal chlamydial infections

Neonatal Chlamydial Infections

Neonatal chlamydial infection, which manifests principally as ophthalmia neonatorum (ON) or pneumonia, is a significant cause of neonatal morbidity. Widespread use of silver nitrate drops resulted in a dramatic decline in the incidence of gonococcal ophthalmia but had much less impact on the incidence of neonatal chlamydial infection. Chlamydia trachomatis has become the most common infectious cause of ON in developed countries.A number of prophylactic antibiotic or antiseptic agents have been used to prevent ON. Prophylaxis with 1% silver nitrate ophthalmic drops, 0.5% erythromycin ophthalmic ointment, or 1% tetracycline ointment has comparable efficacy for the prevention of chlamydial ophthalmia but does not offer protection against nasopharyngeal colonization or the development of pneumonia. Erythromycin or tetracycline topically have been used as prophylactic agents because of their allegedly superior activity for the prevention of ON and because they produced less chemical conjunctivitis compared with silver nitrate. However, the relative efficacy of these agents for chlamydial infection and the emergence of beta-lactamase-producing Neisseria gonorrheae has raised questions regarding their effectiveness when applied topically for prophylaxis of ON. Compared with these agents, a 2.5% povidone-iodine ophthalmic solution has been found to have greater efficacy for the prevention of ON generally, and chlamydial ophthalmia specifically. In countries where the incidence of ON is very low, an alternative strategy is to institute prenatal screening and treatment of infected mothers, forgo routine neonatal prophylaxis, and follow-up infants after birth for the possible development of infection. For the treatment of chlamydial ophthalmia or pneumonia, oral erythromycin for 2 weeks is recommended; additional topical therapy is unnecessary. However, in approximately 20-30% of infants, therapy will not eradicate the organism and the infant may require a repeat oral course of antibiotics. The few published studies on the use of the new oral macrolide antibiotics, such as azithromycin, roxithromycin, or clarithromycin for chlamydial infections in neonates suggest that these agents may be effective; however, more data on their tolerability and efficacy in this patient group are warranted.

Chlamydia trachomatis infection in early neonatal period.

BackgroundThe clinical characteristics of Chlamydia trachomatis respiratory tract infections in Japanese neonates were investigated.MethodsClinical, laboratory and microbiological characteristics of five infants with pneumonia due to C. trachomatis in early neonatal period were analyzed.ResultsOnly C. trachomatis was identified in 4 infants. Both C. trachomatis and cytomegalovirus was identified in one. Wheezing, tachypnea and cyanosis were common in infants. Mothers of five infants had negative chlamydial EIAs at 20 weeks of gestation.ConclusionsWe identified five cases of C. trachomatis respiratory tract infections in early neonatal period with the possibility of intrauterine infection. Targeted screening, early diagnosis, and effective treatment of perinatal and neonatal chlamydial infections seems to be necessary

Influence of infection with Chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring

This chapter deals with genital chlamydial infections in pregnancy and postpartum. There is increasing evidence that Chlamydia trachomatis infection may result in a number of adverse pregnancy outcomes, including early and late abortion, intrauterine infections of the fetus, stillbirth, prematurity, premature rupture of the membranes (PROM) and postpartum endometritis. Ectopic pregnancy is commonly associated with a previous tubal chlamydial infection where immunological reactions seem to play a role. C. trachomatis infection may be acquired as an intrauterine infection, as well as during transit through the birth channel, and this may result in neonatal conjunctivitis and/or pneumonia. The role of chlamydial infection in the sudden death syndrome has also been considered, but evidence so far is minimal. Neonatal chlamydial infection may cause life-long sequelae, such as obstructive lung disease. Genital chlamydial infections have been associated with problems in insemination and attempts at in vitro fertilization. The chapter also deals with screening of pregnant women for C. trachomatis and the treatment of infected mothers and their offspring.

Chlamydial and mycoplasmal infections

Chlamydial and mycoplasmal infections of newborn infants are not uncommon, but often remain unrecognized. <i>Chlamydia trachomatis</i> is an important sexually transmissible pathogen and neonatal infection causes specific, usually focal manifestations in the infant which are not usually difficult to diagnose and treat if appropriate investigations are performed. Neonatal chlamydial infection is an important marker of maternal infection, which may otherwise be overlooked. <i>Mycoplasma hominis</i> and <i>Ureaplasma urealyticum</i> are part of the normal genital flora and opportunistic pathogens. <i>M. hominis</i> is an uncommon neonatal pathogen but occasionally causes invasive, often chronic, infection, especially of the nervous system. The role of <i>U. urealyticum</i> in perinatal morbidity and mortality remains incompletely defined. It is a well-documented cause of congenital pneumonia particularly, but not exclusively, in premature infants and it can also cause invasive infection and meningitis. It is strongly associated with preterm delivery, respiratory distress and increased perinatal mortality and there is strong evidence of a significant independent role in the development of chronic neonatal lung disease. Prospective studies are needed to determine the role of antibiotic therapy in reducing the morbidity associated with perinatal respiratory infection due to <i>U. urealyticum</i>.

Immune status of newborns in perinatal chlamydial infection.

Thirty newborns, delivered by mothers with urogenital chlamydiosis, diagnosed on the 35th-36th weeks of gestation, and 10 newborns of healthy mothers were studied immunologically. CD3 (T-lymphocytes), CD19 (B-lymphocytes), CD4 (T-helpers-inductors), CD8 (T-suppressor-cytotoxic), T-lymphocyte response to PHA, levels of Ig G, A, M in umbilical blood were detected. Chlamydia trachomatis antibody's titers in umbilical blood were determined by indirect immunofluorescent method (with antigen C. trachomatis, serovar L2). Antibody titers found in umbilical blood were in 50% of cases higher than antibody level in mother's blood serum, and they later varied from 1:64 to 1:256. It was established that newborns delivered by mothers with urogenital chlamydiosis had imbalance of T-lymphocyte subsets, decrease in the numbers of T- and B- lymphocytes, and increased level of Ig M, while the level of Ig G did not change significantly. The exposed disproportion in immune status neonatal, born from mothers with urogenital chlamydiosis, in combination with high C. trachomatis antibody titers in umbilical blood may be prognostic of the development of neonatal chlamydial infections.

Chlamydial Infections in Obstetrics and Gynecology

Although Chlamydia trachomatis causes important diseases in both men and women, this review focuses on the genital tract disease associated with chlamydial infection in women and on neonatal chlamydial infection. 8 of the 15 serotypes of C. trachomatis are sexually transmitted agents. The unique growth cycle which distinguishes the chlamydiae from all other organisms is described and they are compared to bacteria and viruses. The prevalence and risk factors for chlamydial infections are then discussed. The symptoms, complications, prevalence, diagnosis, and treatment of male genital tract infections are outlined. Experimental and clinical evidence of the role of chlamydiae in lower genital tract diseases of women including Bartholinitis, cervicitis, endometritis, and acute urethral syndrome; in acute salpingitis; and in the Fitz-Hugh-Curtis syndrome is presented and discussed, followed by a discussion of the incidence and prevalence, diagnosis, prognosis, and treatment of neonatal inclusion conjunctivitis and pneumonia due to C. trachomatis. Some possible control measures for neonatal chlamydial infections are recommended and the relative costs and benefits for populations with different incidences are evaluated. Other possible neonatal clinical manifestations and a possible role in preterm labor and delivery, low birth weight, and perinatal mortality are noted. The diagnosis of chlamydial infections by cytology, serology, and culture are discussed, and recommended therapy is outlined.

PROSPECTIVE STUDY OF CHLAMYDIAL INFECTION IN NEONATES

Chlamydia trachomatis was recovered from the cervices of 4% (36/900) of pregnant women tested. 20 infants born through chlamydia-infected cervices were followed up for a year, as were 18 infants born to chlamydia-negative mothers. A statistically significant excess of conjunctivitis and pneumonia was found in infants exposed to chlamydia. The attack-rate for inclusion conjunctivitis was 35% (7/20) and for chlamydial pneumonia it was 20% (4/20). Chlamydiæ were recovered from 10 of the 20 (50%) exposed infants, and seroconversion was demonstrated in 14 (70%). None of the 18 unexposed infants showed evidence of chlamydial infection. Thus in our clinic 2·8% of all newborns acquired chlamydial infection, with incidence-rates of 14 cases of conjunctivitis and 8 cases of pneumonia per 1000 live births. Neonatal chlamydial infection is thus a major public-health problem warranting a preventive programme based on the fuller provision of diagnostic services and the treatment of infected pregnant women.