Inclusion Conjunctivitis
Introduction
Introduction to inclusion body conjunctivitis Inclusion body conjunctivitis is conjunctivitis caused by DK antigen-type chlamydia in Chlamydia trachomatis. Inclusion conjunctivitis is an acute or sub-acute filtration caused by D-K-type Chlamydia trachomatis through sexual contact or birth canal. Follicular conjunctivitis. This type of chlamydia infects the male urethra and the female cervix, and spreads to the conjunctiva through sexual contact or hand-eye contact. The swimming pool can indirectly spread the disease, and the newborn may also be infected through childbirth. Clinically, it is divided into neonatal and adult inclusion body conjunctivitis. Often invaded and both eyes, for acute onset. basic knowledge The proportion of illness: 0.006%-0.008% Susceptible people: no specific population Mode of transmission: sexual transmission, birth canal transmission Complications: respiratory infections
Cause
Inclusion body conjunctivitis etiology
(1) Causes of the disease
The pathogen is D-K type Chlamydia trachomatis. This type of chlamydia can cause cervicitis and urethritis. The eye infection comes from the genitourinary system and often invades the eyes. It is an acute disease.
(two) pathogenesis
It is related to the local allergic reaction caused by chlamydia.
Prevention
Inclusion body conjunctivitis prevention
Strengthen the publicity and education of sexually transmitted diseases knowledge, and actively treat pregnant women with Chlamydia trachomatis cervicitis to reduce the infection of newborns. Newborns use 0.5% erythromycin eye ointment after birth, which has a good preventive therapeutic effect. The specific measures are as follows:
1. Patients with inclusion corpus urethritis or cervicitis should be actively treated.
2. Pay attention to personal hygiene and do not share towels.
3. Those with inclusion body conjunctivitis are strictly prohibited from entering the public swimming pool to prevent the spread of infection by others.
Complication
Complications of inclusion body conjunctivitis Complications, respiratory infections
After the acute phase subsides, the conjunctiva is still hypertrophic, hyperemia, and follicles, lasting for 3 months to 1 year, no vasospasm, no scars, and natural regression, can be complicated by respiratory infections.
Symptom
Inclusion of body conjunctivitis symptoms common symptoms corneal ulcer purulent secretion eye infection conjunctival hyperemia pre-ear lymph node enlargement conjunctival foreign body
1. Neonatal inclusion body conjunctivitis, also known as neonatal inclusion body pus, when the newborn is born, infected in the birth canal of chlamydial cervicitis, 50% to 70% of the mother's birth canal infected with Chlamydia trachomatis Infants born to the child can be infected with Chlamydia trachomatis, 20% to 50% of which can develop conjunctivitis. Chlamydia trachomatis is the most common pathogen of neonatal conjunctivitis reported in recent years. It has been reported to be as high as 74%, with an incubation period of 5 to 12 days, and both eyes are affected. For acute or subacute performance, eyelid swelling, phlegm conjunctival hyperemia, hypertrophy, nipple hypertrophy, mainly seen in the lower jaw and lower jaw conjunctiva, the adenoid layer of the neonatal conjunctiva has not yet developed, so no follicular formation within 2 to 3 months, There may be pseudomembrane formation. When the cornea is involved, it may be mild epithelial inflammation or subepithelial infiltration around the cornea. Generally, corneal ulcers do not occur, and there are many secretions, which are initially serous, but quickly develop into purulent, so It should be differentiated from neonatal gonococcal conjunctivitis. After about 2 to 3 weeks, it will be transferred to the chronic phase. In the late stage, there will be significant follicular formation. It will resolve spontaneously within 3 months to 1 year without scarring or corneal vasospasm.
2, adult inclusion body conjunctivitis, also known as swimming conjunctivitis, because many patients have a history of swimming in a polluted swimming pool, in fact, the disease is contaminated by the Chlamydia trachomatis DK type urinary system infection, towel or water infection To the eye; it is called a contact infection, gynecologists in the examination of chlamydial cervicitis patients, secretions can also get sick in the eyes, the incubation period of 5 to 12 days, often single eye first, after 1 to 3 weeks after the other eye At the beginning, the conjunctiva is congested, and soon the eyelids are red and swollen. The lymph nodes in the ear are swollen. There are many follicles in the conjunctiva of the ankle. The bottom is the most. The conjunctiva is thick due to cell infiltration. The conjunctival sac has many purulent secretions and contains a lot of polymorphism. In the nucleated leukocytes, the conjunctival smear is visible in the inclusion body. After the acute phase subsides, the conjunctiva is still hypertrophic, congested, and has follicles. It lasts for 3 months to 1 year, no vasospasm occurs, no scar is left, and it naturally resolves.
Examine
Examination of inclusion body conjunctivitis
1. The secretion smear or conjunctival scraping can be used for Giemsa staining. Neutrophils can be seen. Chlamydial inclusion bodies can be found in some epithelial cells. Immunofluorescence-labeled antibody assay and immunoenzyme-linked immunosorbent assay can also be used for diagnosis. .
Neonatal inclusion body conjunctivitis: the secretion is purulent, the amount is large, can be used for smear examination, basically no bacteria, and inclusion bodies.
Adult inclusion body conjunctivitis: purulent secretion of conjunctival sac, containing a large number of polymorphonuclear leukocytes, conjunctival scraping visible inclusion bodies.
2. Pathological examination
Histologically, although Chlamydia trachomatis only invades the conjunctival epithelial cells, the pathological changes reach deep tissues. In the early stage of the lesion, the epithelial cells are degenerated and exfoliated, deep hyperplasia, stromal layer neovascularization, fibrous tissue hyperplasia, inflammatory cell infiltration, and nipple formation. Infiltrating lymphocytes aggregate to form follicles, follicular center degeneration and necrosis and phagocytic cell debris, especially nuclear debris macrophages, called Leber cells, and conjunctival specimens of active trachoma were found to be immunohistochemical studies: conjunctiva The inflammatory cells infiltrated by the epithelium are mainly polymorphonuclear granulocytes, macrophages, T lymphocytes and dendritic cells; the inflammatory cells infiltrated in the matrix are mainly lymphoid follicles formed by B lymphocytes, diffuse infiltrating plasma cells and scattered Infiltrating B lymphocytes, dendritic cells, T lymphocytes, macrophages and polymorphonuclear granulocytes.
Conjunctival scraping specimens can be found in inclusion bodies: basophilic inclusion bodies are easily detected in the cytoplasm of epithelial cells.
Diagnosis
Diagnosis and differentiation of inclusion body conjunctivitis
According to the clinical manifestations, it is not difficult to diagnose. The laboratory test method is the same as trachoma. The basophilic inclusions are easily detected in the cytoplasm of neonatal inclusion body conjunctivitis epithelial cells. Serological detection is of little value in the diagnosis of ocular infection. However, the detection of IgM antibody levels is very helpful for the diagnosis of infant chlamydia pneumonia. Neonatal inclusion body conjunctivitis needs to be identified with Chlamydia trachomatis and Neisseria gonorrhoeae infection.
Differential diagnosis
1. Chronic follicular conjunctivitis (chronic follicular conjunctivitis) The cause is unknown. It is common in children and adolescents. Both are bilateral. The lower condyle and lower jaw conjunctiva see uniform size, neatly arranged follicles, no fusion tendency, conjunctival hyperemia and There are secretions, but not hypertrophy, self-healing without leaving traces after a few years, no corneal vasospasm, no secretions and conjunctival hyperemia and other symptoms of inflammation, conjunctivial folliculosis, generally no treatment, only Treated with chronic conjunctivitis when there are symptoms.
2. Vernal conjunctivitis (vernal conjunctivitis) The nipple of the conjunctival hyperplasia is large and flat, with no lesions in the upper iliac crest, no corneal vasospasm, and a large number of eosinophils in the conjunctival secretion smear.
3. Inclusion conjunctivitis The main difference between this disease and trachoma is that there are significant conjunctiva and sacral conjunctiva below the follicle, no corneal vasospasm, and the laboratory can pass monoclonal antibodies against different Chlamydia antigens. Immunofluorescence assays are performed to identify antigen serotypes for identification.
4. Giant papillary conjunctivitis The conjunctival nipple caused by this disease can be confused with trachoma follicles, but there is a clear history of contact lens wear.
5. Trachoma: can occur at any age, the upper conjunctiva and the upper condylar conjunctiva have nipple hyperplasia, follicular formation, irregular shape, size, irregular arrangement, blood vessels blurred, scars after the recovery, corneal vasospasm, The secretion is not purulent.
6. Neonatal gonococcal conjunctivitis: usually 2 to 3 days after birth, a large number of purulent secretions, smear examination can find Neisseria gonorrhoeae.
