Prickly-ash-like sore (trachoma) Chlamydia trachomatis (CT) infection is the most common sexually transmitted disease in Western countries. In developing countries, CT is one of the main causes of infertility and blindness. CT infections are often asymptomatic latent infections that can be activated during pregnancy and transmitted to newborns through intrauterine infection, birth canal infection, and puerperal infection. After infection, newborns primarily develop conjunctivitis, otitis media, pneumonia, and vaginitis.

bubble_chart Diagnosis

(1) The mother has a CT cervical infection. (2) Clinical Manifestations 1. Neonatal inclusion conjunctivitis is the most common condition, with an incubation period of 5–13 days. It typically develops within a few days after birth, rarely appearing after 2 weeks. The conjunctiva shows congestion, thickening, and papillae formation, particularly in the lower fornix and palpebral conjunctiva. Eye discharge is mucopurulent. In the early stages, the cornea remains clear, though pseudomembranes may form. After several weeks, microvascular nebula may appear on the cornea, and the eyelids may exhibit grade I edema. Concurrent bacterial infections may occur, and some infants may develop ocular sequelae. 2. Chlamydial pneumonia usually develops within days to weeks after birth, without fever or significant toxic symptoms. Initially, there is mild coughing, which gradually worsens over weeks, possibly accompanied by asthma or whooping cough-like spasmodic coughing. Severe cases may present with retractions, irregular breathing, or apnea. Lung auscultation is mostly normal, though fine crackles may be heard in the back. Chest X-rays often show more severe findings than clinical symptoms, with widespread interstitial and alveolar infiltrates of varying degrees, peribronchitis, and focal atelectasis. These radiographic changes may persist for weeks to months before resolving. (3) Laboratory Tests 1. Peripheral blood white cell differential and count are generally normal, with possible grade I eosinophilia. 2. Direct microscopy: Giemsa or PAS staining of conjunctival scrapings from the infant or cervical tissue from the mother may reveal intracytoplasmic inclusions. 3. Cell culture: Inoculation in 6–9-day-old chick egg yolk sacs or tissue culture using Hela 229, BHK-21, or other cell lines can identify intracellular inclusions. 4. Serological tests: A complement fixation titer >1:64 is diagnostically significant. ELISA is highly sensitive, while immunofluorescence is both specific and highly sensitive. Other methods, such as nucleic acid probe testing, polymerase chain reaction (PCR), and ligase chain reaction (LCR), can improve detection rates.

﹝Treatment﹞

Neonatal conjunctivitis should also be treated systemically. Erythromycin 40mg/(kg·d) can be used for 2 weeks to prevent concurrent pneumonia. Topical erythromycin, rifampicin, or chlortetracycline eye ointments may be applied. Additionally, sulfamethoxazole, ampicillin, and minocycline are also effective medications.

bubble_chart Prevention

Pregnant women should be tested for Chlamydia in cervical secretions, and if positive, prompt treatment should be provided to prevent neonatal CT infection. Antiviral eye drops such as 0.1% ribavirin can be administered.