Gonococcal conjunctivitis

Introduction to gonococcal conjunctivitis Neisseria gonorrhoea conjunctivitis is an extremely severe acute suppurative conjunctivitis with strong contagiousness and can seriously impair vision. The clinical features are highly congested edema of the eyelids and conjunctiva, and a large amount of purulent secretions. If not treated in time, corneal ulcers and perforations can occur in a short period of time. basic knowledge The proportion of illness: 0.1% - 0.3% Susceptible people: no special people Mode of infection: contact spread Complications: corneal staphyloma glaucoma

The cause of gonococcal conjunctivitis

Infection (35%):

Caused by Gram-negative gonorrhoeae caused by Gram-negative infection, adult gonococcal conjunctivitis is caused by infection with ocular secretions from gonococcal urethritis secretions or gonococcal conjunctivitis patients Occasionally, those who have been infected with menstrual blood, so-called endogenous gonococcal conjunctivitis, often have bilateral onset, benign, may be associated with elevated body temperature, neonatal gonococcal conjunctivitis is mostly due to maternal gonococcal vaginitis secretions Or infected by items that are contaminated.

Pathology (35%):

Neisseria gonorrhoeae mainly invades the mucosa and conjunctiva of the genitourinary tract and can be extended to the cornea by the conjunctiva. The bacteria can be parasitic in the infected cells. The cilia or capsule on the surface of the bacteria can strongly adhere the bacteria to the host cells, which is beneficial to the invasion of Neisseria gonorrhoeae. Conjunctival epithelial cells are resistant to phagocytosis of cells.

Neisseria gonorrhoea prevention

The disease is contact infection. For patients suffering from gonococcal urethritis, it should be made aware of the contagiousness and consequences of the disease. Pay attention to cleanliness. Wash hands and disinfect after washing. It is strictly forbidden to swim in the swimming pool and bath in the public bath. Active treatment Urinary tract inflammation, after eye disease, should be immediately isolated treatment, if at first glance, sleep on the affected side, medical staff should be carefully disinfected after treatment and treatment, the dressing contaminated by the eye should be properly handled, the patient's Towels, washbasins and other daily necessities should be disinfected. For the prevention of neonatal gonococcal conjunctivitis, first of all, prenatal examination should be done. For pregnant women with gonorrhea, treatment must be given. After the baby is born, Grede eye drops must be strictly enforced. The preventive method, that is, after cleaning the dirt on the eyelids, immediately drops 0.5% to 1% silver nitrate eye drops or 0.3% ofloxacin eye drops into the conjunctival sac.

Neisseria gonorrhoea conjunctivitis complications Complications, corneal staphyloma, glaucoma

Most patients have corneal complication, bacteria in the corneal epithelial cells, and can penetrate the corneal epithelium into the corneal stroma, light corneal epithelial lesions appear, the peripheral corneal parenchyma occurs in part or ring infiltration, after infiltration for several days Absorbed and left with cloud sputum, severe ring ulcer around the cornea or central ulcer, corneal diffuse opacity, local thinning, rapid perforation, even perforation within 24 hours after onset, formation of adhesive corneal leukoplakia, corneal staphyloma , secondary to glaucoma or endophthalmitis.

Neisseria gonorrhoea conjunctivitis symptoms Common symptoms Conjunctival edema and corneal ulcer conjunctiva on the conjunctiva conjunctival hyperemia exposed Conjunctival congestion conjunctival nipple hyperplasia conjunctiva dry spots neonatal pus

Clinically, the disease is divided into adult gonococcal conjunctivitis and neonatal gonococcal conjunctivitis.

Adult gonococcal conjunctivitis has a short incubation period of several hours to three days, usually starting from one side, but most of them involve both eyes, and the onset is rapid, the condition is progressive, eye pain, photophobia, tearing and other symptoms are obvious, and the eyelids are highly swollen. , pain, with conjunctival hypercongestion, with small bleeding points and pseudomembrane formation, bulbar conjunctival edema, severe protrusion in the cleft palate, swollen lymph nodes in the ear, severe patients may even have suppuration of the lymph nodes in the ear, the characteristics of this disease There is a large amount of secretions, the early secretion is serous or bloody, and the presence of diplococcus in the cytoplasm of the conjunctival smear epithelial cells. After 3 to 5 days, the swelling of the eyelids is relieved, and a large amount of purulent secretions appear, constantly The conjunctival sac flows out, forming a typical pus phenomenon. At this time, there are a large number of gonococcal bacteria in the secretion; after 2 to 3 weeks, the purulent secretion gradually decreases, the conjunctival edema subsides, the palpebral conjunctiva is highly hypertrophy, and the nipple hyperplasia can last for several months. For a long time, eventually the inflammation subsides and a deep scar can be left on the conjunctiva.

Neonatal gonococcal conjunctivitis is the main cause of neonatal ophthalmia. Most of them are infected by the mother's birth canal. The incidence rate is about 0.04%, the incubation period is 2 to 4 days, and both eyes are involved at the same time. The clinical manifestations are similar to those of adults. It is severe acute. Suppurative conjunctivitis, but the clinical process is slightly milder than that of adults. Corneal complications are less than that of adults and occur later and lighter. However, if the treatment is not timely, corneal ulcers and perforations may occur, and most of them occur in the center of the cornea and seriously affect vision.

Examination of gonococcal conjunctivitis

Acute conjunctival sac secretion smear or conjunctival smear, Gram staining, a large number of Gram-negative diplococcus, conjunctival sac culture, immunofluorescein-labeled antibody or immuno-enzyme labeling in the cytoplasm of epithelial cells and neutrophils Wait, you can make a diagnosis.

No other special auxiliary checks.

Diagnosis and differentiation of gonococcal conjunctivitis

diagnosis

According to the history of gonorrhea, typical clinical manifestations and bacteriological examination of conjunctival sac secretion or sacral conjunctival smear can be confirmed.

Differential diagnosis

It has the characteristics of rapid development and large amount of secretion, and it is easy to identify with acute bacterial conjunctivitis.

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