Etiology and pattern of neonatal conjunctivitis

Abstract

A prospective case study was carried out at Kenyarta National Hospital and Pumwani Maternity Hospital. The study aimed to determine the infective spectrum in cases of neonatal conjunctivitis. This included detection of C. trachomatis, and bacterial spectrum along with the drug sensitivity patterns of the detected ocular bacterial pathogens. A total of 120 patients (neonates) with neonatal conjunctivitis were studied, between August 2001 and April 2002, amongst whom 10 were pre-term. Consecutive sampling method was used for the selection of cases under study. The ratio of Male: Female =0.7: 1. Conjunctival swabs of all the newborns with a clinical diagnosis of neonatal conjunctivitis were taken for microscopy, culture and sensitivity. No neonate was found to have membrane formation or corneal lesions. Seventy percent of the deliveries were SVD and 30% through CIS. Prophylaxis treatment was instituted in only 52.5% of the cases. Of the 57 neonates who did not receive prophylaxis, 49 had positive cultures while 61 of 63 neonates who received prophylaxis had positive culture. Conjunctival swabs taken were culture positive in 110 (91.6%) neonates. Thirty-five out of 36 CIS deliveries and 75 out of 84 SVD had positive conjunctival swab cultures. Positive cultures were most common in the age grQUPof 0-14 days. Conjunctival growth VIII colonies were also studied in all cases. Ninety one (75.9%) cases had colonies between 25-45 and 4 (3.3%) yielded a growth of more than 45 colonies. Staph. aureus, coagulase negative Staphylococci and E.coli were the most common organisms isolated. Staph. aureus and coagulase negative Staphylococci were found to be resistant to Tetracycline, Kanamycin, and Penicillin, sensitive to Ofloxacin, Amikacin, Neomycin and Gentamycin. E. coli was resistant to Penicillin, Cephalexin, and Polymixin-B and sensitive to Ofloxacin, Amikacin, Kanamycin, and Gentamycin. N. Gonorrhoea was isolated in only 4 cases. Gram-positive organisms had more trends to cause neonatal conjunctivitis than the Gram-negative organisms. Resistant to tetracycline and penicillin was very common in the organisms. Conjunctival scrapings of all the study cases were taken for Direct IF test to detect C. trachomatis antigen and were found to be positive for C. trachomatis antigen in 24 (20%) cases from the age of 2 days. The incidence of C. trachomatis antigen was found to be higher when compared to recent studies done in Kenya. IX