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47. Chlamydia. Chlamydial conjunctivitis and pneumonia in children
Chlamydia is an infectious disease of humans, animals and birds caused by chlamydia.
Etiology. Chlamydia are obligate intracellular parasites with a discrete membrane similar to that of Gram-negative bacteria.
They include RNA and DNA. Their activity is suppressed by some antibiotics.
Parasites do not stain according to Gram, they perceive Giemsa stain, which makes it possible to detect them in the form of characteristic cytoplasmic perinuclear inclusions.
The genus Chlamydia is divided into two groups:
1) group A includes C. trachomatis and the causative agent of inguinal lymphogranuloma;
2) group B includes pathogens of psittacosis (ornithosis), Reiter's disease, pneumonia and encephalomyelitis in cows and polyarthritis in sheep.
Epidemiology. Chlamydia is widespread throughout the world. Infection occurs sexually (in adults) with the development of inguinal lymphogranuloma or non-specific non-gonococcal urethritis, by contact when the pathogen is transferred by hand. Newborns become infected during the passage of the fetus through the birth canal of a sick woman.
Chlamydial conjunctivitis and pneumonia in children
Clinical manifestations. Conjunctivitis usually begins in the 2nd week of life, rarely develops after 3 days or after 5-6 weeks.
The child becomes irritable, the body temperature does not rise, the eyelids swell, pus begins to stand out from the eyes, and pseudomembranous formations appear in them.
The bacterial flora is usually not detected during sowing of the discharge. After 2-3 weeks, conjunctivitis resolves, sometimes even without appropriate treatment.
Local application of antibiotics is accompanied by an effect, but does not protect against recurrence of the disease.
Physical examination reveals dry rales. Conjunctivitis develops in 50% of children.
Diagnosis. Chlamydial infection can be clinically suspected if the newborn consistently develops conjunctivitis with a long persistent course, bronchitis that occurs with bouts of painful coughing, small-focal pneumonia, and also if eosinophilia and a significantly accelerated ESR are detected with a relatively mild general condition.
Laboratory confirmed by methods that allow:
1) identify chlamydial antigen in biological material;
2) isolate chlamydia in cell culture;
3) determine specific anti-chlamydial antibodies of class G and M, etc.
Treatment. With conjunctivitis, antibacterial drugs are prescribed in the form of an ointment, with pneumonia - erythromycin and other antibacterial drugs in an age dosage.
In severe cases, combined treatment with two or more drugs (erythromycin with biseptol, other sulfanilamide drugs or furazolidone) is prescribed. With a recurrent course, immunostimulating therapy is indicated.
Preventive measures should be directed at the source of infection, the route of transmission and the susceptible organism. Active prophylaxis has not been developed.
Author: Pavlova N.V.
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