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The disease can be diagnosed based on a history of gonorrhea, the development of a typical ocular course, and a bacteriological examination of a secretion smear or conjunctival scrape.
Gonococcal conjunctivitis
- Gonococcal conjunctivitis is also known as "gonorrhea", gonococcal conjunctivitis, and gonorrhea pus. N. gonorrhoeae conjunctivitis is an extremely severe acute purulent conjunctivitis, highly contagious, and can seriously damage vision. The clinical features are highly congestive edema of the eyelid and conjunctiva, and a large amount of purulent secretions. If left untreated, corneal ulcers and perforations can occur in a short time.
Symptoms of gonococcal conjunctivitis
- The disease can be diagnosed based on a history of gonorrhea, the development of a typical ocular course, and a bacteriological examination of a secretion smear or conjunctival scrape.
- The disease is clinically divided into neonatal and adult gonococcal conjunctivitis.
- The incubation period of gonococcal conjunctivitis in adults ranges from 10 hours to 2 to 3 days, and the disease develops in both eyes or in one eye. The condition developed rapidly to the infiltration stage, the eyelid was highly red and swollen and painful; the eyelid conjunctiva was highly congested with small bleeding points and pseudo-membrane formation; the bulbar conjunctiva was edema, which protruded beyond the blepharoplasia; and the auricular lymphadenopathy was painful. At the beginning of the disease, the secretions were serous or bloody, and conjunctival scrapings proved the presence of many Neisseria gonorrhoeae in the epithelial cells. After about 3 to 5 days, the eyelid swelling has been reduced and softened, and replaced with a large amount of purulent secretions, which continuously flow out from the fissure of the eyelid, which is the period of pus leakage. At this time, there was a large amount of Neisseria gonorrhoeae in the secretion. After about 2 to 3 weeks, purulent secretions gradually decrease, but they still contain gonococcus and are infectious; conjunctival edema subsides, hypertrophy of the eyelid and conjunctiva, hypertrophy of the nipple, and rough surface can last for several months. The inflammation then disappears and deep scars can remain on the conjunctiva. Corneal complications are almost inevitable. Except for the spotted fluorescein staining of the corneal epithelium, there may be partial or full ring infiltration in the superficial layer of the corneal periphery. There is a narrow clear zone between the infiltration and the limbus, with a mild anterior chamber reaction. After a few days of mild infiltration, the remaining thin palate subsided. In severe cases, a circular ulcer similar to the immune-mediated limbal corneal fusion, or a central ulcer, is formed, the cornea is diffusely blurred, locally thinned, and the iris prolapses quickly.
- Neonatal gonococcal conjunctivitis is the most serious of neonatal ophthalmitis and was an important cause of blindness in blind children. The incubation period within 2 to 5 days was mostly the mother's birth canal infection, and those who became sick after the 7th day were postpartum infections. The clinical manifestations are severe acute conjunctivitis in both eyes, edema and congestion of the eyelid and bulbar conjunctiva at the beginning of the onset, and the secretions are watery, serumy, and bloody. Sexual secretions. Severe palpebral conjunctival edema and inflammation. The cornea is darkened, with infiltration, ulcers in the periphery, or ulcers in the center. Perforation of ulcers, prolapse of iris, inflammation in the eye, loss of vision. [1-2] [3]
Gonococcal conjunctivitis complications
- Most patients have corneal complications. Bacteria multiply in the corneal epithelium and penetrate the corneal epithelium to infiltrate the corneal stroma. In mild cases, punctate epithelial lesions appear in the cornea. Partial or ring-shaped infiltration of the surrounding corneal parenchyma occurs. After several days of infiltration, it can be absorbed and leave the cloud. In severe cases, ring ulcers or central ulcers can occur around the cornea. The cornea is diffusely cloudy, locally thinned, and can be perforated quickly. It can even perforate within 24 hours after the onset of the disease, forming adhesive leukoplakia, corneal edema, secondary glaucoma or eyes. Enditis. [4]
Causes of gonococcal conjunctivitis
- Neonatal gonococcal conjunctivitis is usually caused by maternal vaginal inflammatory secretions or other items contaminated with gonorrhea at birth. Adult gonococcal conjunctivitis is mostly infected by the urethral secretions of itself or others. Occasionally, people with meningococcal infections are called endogenous gonococcal conjunctivitis, which often develops eyes, undergoes a benign process, and can be accompanied by an increase in body temperature. Often caused by Neisser Neisseria gonorrhoeae infection, the bacteria is G- (Gram-negative) diplococci. Familiarity with the basic principles of prevention and treatment of this disease has important practical significance. [5]
Pathogenesis of gonococcal conjunctivitis
- Neisseria gonorrhoeae mainly invades the genitourinary tract mucosa and conjunctiva, and can extend from the conjunctiva to the cornea. Bacteria can be parasitic in infected cells. The cilia or envelopes on the surface of the bacteria can strongly adhere the bacteria to the host cells, which is beneficial for N. gonorrhoeae to invade the conjunctival epithelial cells and to resist cell phagocytosis. [6]
Gonococcal conjunctivitis related tests
- Neisseria gonorrhoeae conjunctivitis conjunctiva scraping [7]
Physical examination of gonococcal conjunctivitis
- Focus on whether there is a large amount of purulent secretions in the conjunctival sac.
Gonorrhea conjunctivitis auxiliary examination
- Conjunctival scrapes and secretion smears were examined by Gram and Giemsa staining, bacterial culture, drug sensitivity tests, and blood cultures. [8]
Differential diagnosis of gonococcal conjunctivitis
- It has the characteristics of rapid development and large amount of secretions, and can be easily distinguished from acute bacterial conjunctivitis. [4]
Gonococcal conjunctivitis treatment
- Due to the dangerous condition of gonococcal conjunctivitis, rapid development, and serious consequences, active and effective treatment methods should be adopted. At the same time as general antibacterial treatment of conjunctivitis, systemic medication should be emphasized to more quickly and effectively inhibit pathogenic bacteria.
Systemic treatment of gonococcal conjunctivitis
- (1) Penicillin: Neisseria gonorrhoeae is sensitive to penicillin G, but the number of drug-resistant bacteria has increased significantly in the clinic. Therefore, whether to use penicillin G should be determined based on the results of the sensitivity test. Water penicillin G 6 million to 10 million U intravenously for adults was administered once a day for 5 consecutive days; the dosage for neonates was 50,000 U / (kg · d), divided into two intravenous infusions for 7 consecutive days.
- (2) Ceftriaxone (celtriaxone): 1g / d, intravenous drip, is a clinically highly recommended anti-gonococcus drug.
- (3) Cefotaxime: 500 mg intravenously, 4 times / d.
- (4) Spectomycin: 2g, intramuscular injection, drug resistance, suitable for gonococcal infection of sensitive strains.
- (5) Norfloxacin: It also has a certain effect on Neisseria gonorrhoeae, 200mg, 2 ~ 3 times / d, it is not suitable for children.
Local treatment for gonococcal conjunctivitis
- (1) Cleaning the conjunctival sac: It is very important to flush the conjunctival sac with physiological saline to remove pathogenic bacteria in the conjunctival sac. Started every 5 to 10 minutes, and gradually reduced to 15, 30 minutes, 1 hour every day, and every 2 hours after a few days, for 2 weeks, until the secretion disappeared. When rinsing, tilt your head toward the nose to prevent it from flowing into the opposite eye.
- (2) Antibacterial drug eye drop: aqueous eye penicillin G eye drops, 100,000 to 300,000 U / ml, or 0.3% Norfloxacin eye drops, at the beginning of the eye once every minute, half an hour after the eye 1 Eyes, once every 30 minutes after 1 hour. After the condition is relieved, you can extend the interval of drug administration appropriately, taking the drug every 1 to 2 hours, until the inflammation subsides, and it cannot be interrupted. Ofloxacin, ciprofloxacin eye drops and tobramycin or erythromycin or bacitracin eye ointment can also be applied.
- (3) If corneal complications occur, they should be treated as corneal ulcers.
Neisseria gonorrhoeae conjunctivitis care
- The disease is transmitted through contact. It is important that people with gonorrhea be aware of the danger of infecting others or their eyes at any time. Patients should pay attention to cleaning, be sure to wash their hands after defecation, and disinfect with 1: 10,000 liters of mercury solution, 1% Lysol solution or alcohol. It is strictly forbidden to swim in public pools and bathe in public baths. Isolation treatment is performed immediately after the eye is sick. If the eye is sick, the affected eye should wear transparent goggles to protect the healthy eye, and lie on the affected side while sleeping, and the dressing contaminated by the diseased eye should be burned. The daily necessities such as washbasins and towels should be boiled and disinfected. Medical personnel should wear protective glasses when examining and handling patients, and should carefully disinfect their hands after operation. Regarding the prevention of neonatal gonococcal conjunctivitis, prenatal examination should be done. Pregnant women with gonorrhea should be treated immediately and thoroughly. The treatment plan is: ampicillin or ampicillin 0.5g, 3 to 4 times / d, and probenecid 0.5g, 3 to 4 times / d, for those who are allergic to penicillin, 2g of spectinomycin, muscle injection. After the baby is born, it is necessary to strictly follow the Crede eye drop prevention method, that is, immediately after cleaning the dirt on the eyelid, drip 1% silver nitrate solution into the conjunctival sac, or use 1% tetracycline eye ointment or 0.5% erythromycin eye ointment. Painted eyes. [9]
Gonococcal conjunctivitis prevention
- The disease is contagious. For patients with gonococcal urethritis, they should be made aware of the infectivity and consequences of the disease, pay attention to cleaning, and must wash and disinfect hands after use. It is strictly forbidden to swim in swimming pools and public baths to actively treat urethritis. Isolation and treatment should be performed immediately after the eye is sick. If one eye is sick, lie on the affected side while sleeping. Medical staff should carefully disinfect after examining and handling the patient. The contaminated dressings should be properly handled. The patient's towels, face Basin and other daily necessities should be disinfected. For the prevention of neonatal gonococcal conjunctivitis, prenatal check-ups must be done first, and pregnant women with gonorrhea must be treated. After the baby is born, the Grede eye drop prevention method must be strictly implemented, that is, 0.5% to 1% silver nitrate eye drops or 0.3% ofloxacin eye drops are dripped in the conjunctival sac immediately after cleaning the dirt on the eyelids. [10]
Prognosis of gonococcal conjunctivitis
- Untreated or delayed treatment can develop into corneal perforation, endophthalmitis, and the spread of bacteria can lead to arthritis, proctitis, meningitis, pneumonia or sepsis, and even death, and must be paid great attention. [11]