Neonatal conjunctivitis: Difference between revisions
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*Vesicles + conjunctivitis = full sepsis eval + acyclovir | *Vesicles + conjunctivitis = full sepsis eval + acyclovir | ||
== | ==Clinical Features== | ||
*Chlamydial | *Chlamydial | ||
**Can range from mild to severe hyperemia w/ thick mucopurulent discharge | **Can range from mild to severe hyperemia w/ thick mucopurulent discharge | ||
*Gonococcal | *Gonococcal | ||
**May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration | **May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**Peaks at 6-14 days of life | **Peaks at 6-14 days of life | ||
**May lead to keratitis and disseminated infection | **May lead to keratitis and disseminated infection | ||
==Diagnosis== | |||
*Gram stain/culture to r/o N. gonorrhea vs C. trachomatis | |||
**C. trachomatis will have negative gram stain because it is an intracellular parasite. | |||
==Treatment== | ==Treatment== | ||
Revision as of 19:03, 20 May 2015
Background
- Vesicles + conjunctivitis = full sepsis eval + acyclovir
Clinical Features
- Chlamydial
- Can range from mild to severe hyperemia w/ thick mucopurulent discharge
- Gonococcal
- May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration
Differential Diagnosis
- Chemical
- Due to ocular prophylaxis
- Occurs on 1st day of life
- Gonococcal
- Peaks at 3-5 days after birth
- Has potential to cause loss of vision
- Chlamydia
- Peaks from 1wk to 1 month after birth
- Leading cause of preventable blindness in the world
- Herpetic
- Peaks at 6-14 days of life
- May lead to keratitis and disseminated infection
Diagnosis
- Gram stain/culture to r/o N. gonorrhea vs C. trachomatis
- C. trachomatis will have negative gram stain because it is an intracellular parasite.
Treatment
- Gonococcal
- Cefotaxime 100mg/kg IV or IM OR ceftriaxone 25-50mg/kg IV or IM x1 (not to exceed 125mg)
- Cefotaxime is preferred b/c does not displace bilirubin
- Disseminated disease should be suspected until CSF is negative
- Topical tx is unnecessary
- Cefotaxime 100mg/kg IV or IM OR ceftriaxone 25-50mg/kg IV or IM x1 (not to exceed 125mg)
- Chlamydial
- Erythromycin 50mg/kg PO QD in 4 divided doses x 14 days
- Topical tx is unnecessary
- Herpetic
- Acyclovir 20mg/kg IV q8hr x 14-21d
- Topical antiviral
- Full sepsis evaluation
- Chemical
- Watchful waiting
Disposition
- Gonococcal
- Admit
- Herpetic
- Admit
See Also
Source
Tintinalli