Inclusion conjunctivitis

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

A number of infections caused by Chlamydia trachomatis, such as trachoma, inclusion conjunctivitis, pneumonia, and urethritis, can be treated with topical or systemic sulfonamides, although tetracycline or erythromycin is preferred. 

Treatment of corneal ulcers, conjunctivitis and other superficial infections of the eye, pro-phylaxis after injuries to the eye/removal of foreign bodies, adjunctive therapy for trachoma and inclusion conjunctivitis Ophthalmic Solution l-Sdropstolowerconjunc-tival sac q2-3h. Seborrheic dermatitis, seborrheic sicca (dandruff), secondary bacterial skin infections Topical Ointment Apply small amount in lower conjunctival sac 1 -4 times/day and at bedtime. 

Chlamydia causing lymphogranuloma venereum, psittacosis, trachoma and inclusion conjunctivitis. 

V. Trachoma and inclusion conjunctivitis Sulphacetamide (10-30%) local eye drops are used. 

Erythromycin is also an effective alternative to tetracycline for the treatment of adult chlamydial sexually transmitted disease. Adults should receive 2 g of erythromycin daily in four divided doses for at least 7 days. Trachoma and inclusion conjunctivitis in older children or adults... 

Katusic D, Petricek I, Mandic Z, et al. Azithromycin vs doxycy-chne in the treatment of inclusion conjunctivitis. Am J Ophthalmol 2003 135 447-451. 

Chlamydiae are obligate intracellular parasites that depend on the host cell to carry out metabolic biosynthe-sis.The genus includes two major species C. trachomatis, which causes disease in humans, and Chlamydia psittaci, which infects primarily nonhumans. The many different serotypes cause a wide spectrum of disease states, including inclusion conjunctivitis, trachoma, lymphogranuloma venereum, and cervicitis or urethritis. 

Inclusion conjunctivitis presents in teenagers and sexually active adults as an acute or chronic follicular conjunctivitis often accompanied by a mucopurulent discharge. Upper respiratory symptoms and fever generally are lacking. The disease often occurs in patients who have acquired a new sexual partner in the last 1 to 2 months. After an incubation period of 5 to 12 days, there is acute onset of conjunctival injection, mixed follicular-papillary... 

Figure 25-15 Mixed follicular-papillary hypertrophy in adult inclusion conjunctivitis.

Topical therapy of adult inclusion conjunctivitis by itself cannot effect a cure. Currently, the CDC recommends azithromycin 1 g orally in a single dose or doxycycline... 

Figure 25-20 Neonatal inclusion conjunctivitis with prominent mucopurulent exudates. (Courtesy William Wallace, O.D.)...

Sulfacetamide, a sulfonamide antibiotic (instill 1 to 2 drops of 10% solution into lower conjunctival sac), is used in inclusion conjunctivitis, corneal ulcers, trachoma, and prophylaxis for ocular infection. 

Resistance to sulfonamides is now common for N. meningitidiSy as well as in cases of bacillary dysentery. Antibiotics have generally replaced the sulfonamides for these purposes. Sulfonamides, particulady sulfisoxazole and sulfadiazine, are of value in treatment of infections due to Nocardia species, and sulfonamides are effective for trachoma. Inclusion conjunctivitis is also treated with sulfacetamide ointment. Oral administration of a sulfonamide, eg, sulfisoxazole, has been successful for treatment of lymphogranuloma venereum and chancroid Dapsone and sulfonamides have also been used for treatment of the skin disorder dermatitis herpetiformis. Sulfonamides have been used for long term prophylaxis of rheumatic fever, but are being replaced by penicillin for this purpose, except in cases of hypersensitivity to penicillin (19). 

The drug is the durg of choice in the treatment of ehloera, relapsing fever, granuloma inguinale and infeetions produced by rickettsia, Borrelia, Mycobacterium fortuitum and marinum, and Chlamydia psittaci and trachomatis (except pneumonia and inclusion conjunctivitis). 

Inclusion conjunctivitis A chlamydial infection that can result from self-inoculation with Chlamydia trachomatis. 

---