gonococcal conjunctivitis
Introduction
Introduction to gonococcal conjunctivitis Gonococcon conjunctivitis, also known as gonorrhea or gonococcal pyorrhea, is an extremely severe acute suppurative conjunctivitis. The disease is characterized by high eyelids, conjunctival congestion and edema and a large number of purulent secretions. If the treatment is not timely, corneal ulcers and perforation will occur in a short period of time, leading to serious consequences of blindness. After liberation, the disease is controlled with sexually transmitted diseases. It has been extremely rare in China, but in recent years, gonococcal genitourinary infection has been increasing year by year in China. basic knowledge The proportion of the disease: the incidence rate of multi-sex partners is about 0.05% - 0.07% Susceptible people: no special people Mode of infection: contact infection Complications: corneal ulcer
Cause
Cause of gonococcal conjunctivitis
Neonatal gonococcal conjunctivitis is often caused by maternal vaginal inflammatory secretions or other gonococcal-contaminated products. Adult gonococcal conjunctivitis is caused by urinary tract secretions of oneself or others. Infected person is called endogenous gonococcal conjunctivitis, often developed in both eyes, benign, can be accompanied by elevated body temperature, often caused by Neisser gonococcal infection, this strain is G- (Gram negative) dicocci, familiar with and master this The basic prevention and treatment principles of diseases have important practical significance.
Prevention
Gonococcal conjunctivitis prevention
The disease is transmitted through contact. It is important that the gonorrhea patients understand that they are at risk of infecting others or their eyes at any time. Patients should pay attention to cleanliness, wash hands after urination, and use 1:10000 liters of mercury solution, 1% to Su Disinfect the solution or alcohol, it is strictly forbidden to swim in the public swimming pool and take a bath in the public bath. Immediately after the eye is sick, it should be treated in isolation. If the eye is sick, the eye should wear a transparent eye mask to protect the healthy eye, and sleep on the affected side. Eye-contaminated dressings should be burnt, washbasins, towels and other daily necessities should be boiled and sterilized, and others should not be used. Medical personnel should wear protective glasses when inspecting and handling patients. The hands should be carefully disinfected after operation. About neonatal gonococcal conjunctivitis Prevention, to do a good prenatal checkup, pregnant women with gonorrhea, should be completely treated immediately, the treatment plan is: amoxicillin or ampicillin 0.5g, 3 ~ 4 times / d, while oral administration of propionate 0.5 g, 3 ~ 4 times / d, for those who are allergic to penicillin, can be used spectinomycin 2g, intramuscular injection, after the baby is born, must strictly follow the Crede eye drops prevention method, that is, the stain on the cleaning eyelids Immediately after the application, a 1% silver nitrate solution was added to the conjunctival sac or the eye was coated with 1% tetracycline eye ointment or 0.5% erythromycin eye ointment.
Complication
Complications of gonococcal conjunctivitis Complications corneal ulcer
If the disease continues to worsen, there is a yellow infiltration of the corneal edge, which rapidly develops into a corneal edge ulcer or even a perforation, and eventually becomes blind due to total ocular inflammation and corneal leukoplakia.
Symptom
Symptoms of gonococcal conjunctivitis Common symptoms Conjunctival congestion, conjunctival hyperemia, conjunctival papillary hyperplasia, conjunctival edema, and corneal ulceration
Clinically, the disease is divided into neonatal and adult gonococcal conjunctivitis.
Adult gonococcal conjunctivitis: the incubation period ranges from 10 hours to 2 to 3 days, both eyes or monocular disease, the disease develops sharply to the infiltration stage, the eyelids are highly red and swollen; the conjunctiva is highly congested with small bleeding points and pseudomembrane formation; Conjunctival edema, severely prominent in the cleft palate; there is swelling and pain in the lymph nodes before the ear, at the beginning of the disease, the secretion is serous or bloody, the conjunctival scraping film proves that there are many gonococcal bacteria in the epithelial cells, about 3 to 5 days later, the eyelids The swelling is relieved and softened, and replaced by a large amount of purulent secretions, which continuously flow out from the cleft palate, which is for the pus period. At this time, there are a large number of gonococcal bacteria in the secretions, about 2 to 3 weeks. Purulent secretion gradually decreases, but still contains Neisseria gonorrhoeae, infective; conjunctival edema subsides, sputum conjunctiva is highly hypertrophy, nipple hypertrophy, rough surface, can last for several months, then inflammation disappears, sacral conjunctiva can be left deep Scars, corneal complications are almost inevitable, except for corneal epithelial fluorescein staining, the parenchyma of the corneal peripheral part of the shallow part of the visible or full annular infiltration, infiltration and the narrow edge of the corneal margin clear, Mild anterior chamber reaction, mild infiltration after a few days to resolve the remaining thin sputum, severe form of ring ulcer similar to immune-mediated marginal corneal melting, or central ulcer, corneal diffuse blur, local thinning, rapid perforation, iris Come out.
Neonatal gonococcal conjunctivitis: It is the most serious cause of neonatal ophthalmitis. It has been an important cause of blindness in blind children. Most of the incubation period is 2 to 5 days, and the mother is infected with the birth canal. After 7 days of birth, the postpartum infection is clinical manifestation. For acute acute conjunctivitis of both eyes, the initial stage of sputum and bulbar conjunctival edema, congestion, secretions are watery, serum-like, bloody, but progresses rapidly, after a few hours of onset, it turns into a pus-period, with a large amount of purulent secretion. Physical, severe sacral conjunctival edema and inflammation, corneal darkening, peripheral infiltration, ulcers, or central ulcers, ulcer perforation, iris prolapse, intraocular inflammation, loss of vision.
Examine
Examination of gonococcal conjunctivitis
1. Physical examination: Focus on the conjunctival sac with a large amount of purulent secretions.
2. Auxiliary examination: Conjunctival scraping and secretion smear Gram and Giemsa staining, bacterial culture, drug sensitivity test and blood culture.
Diagnosis
Diagnosis and identification of gonococcal conjunctivitis
diagnosis
The disease can be diagnosed according to the history of gonorrhea, typical ocular disease progression and bacteriological examination of secretion smear or conjunctival smear.
Differential diagnosis
Clinically, it should be differentiated from acute catarrhal conjunctivitis.
