A 10-day-old term infant born by normal vaginal delivery develops bilateral purulent conjunctival discharge. Gram stain of the discharge is unremarkable and cultures on routine media are sterile. Giemsa stain of a conjunctival scraping shows basophilic cytoplasmic inclusions in epithelial cells. In addition to topical therapy, systemic oral treatment is essential because:

• A Topical agents cannot penetrate the corneal stroma
• B The same organism colonising the eye will cause neonatal meningitis if untreated
• C Untreated ocular chlamydia can progress to chlamydial pneumonia in the infant ✓
• D Topical treatment selects for resistance in commensal Neisseria

Explanation

This is neonatal chlamydial inclusion conjunctivitis caused by B. trachomatis serovars D to K acquired during passage through an infected birth canal. Oral erythromycin for about two weeks is recommended because the nasopharynx is colonised and untreated infants may develop afebrile chlamydial pneumonia at 4 to 11 weeks of age. The risk in question is pulmonary, not meningeal, since chlamydia does not cause neonatal meningitis.

Reference: Nelson Textbook of Pediatrics, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.