Eye Infection In Newborn Can Be Due To Chlamydial Infection

Question: Our two-month-old son has an eye infection since birth. There is always some pus in his eyes, especially when he wakes up in the morning or after a nap. At the beginning, our doctor gave him an eye ointment. It helped a little, but as soon as we stopped the ointment, the infection came back. Lately he started getting congested and coughs. Our doctor said that he might have picked up an infection from me at the time of delivery, and an antibiotic may be necessary to get rid of the infection. I can’t believe this. I never had any infection myself, how can I give it to my son?

Answer:

Although it is very hard for you to believe, your doctor is probably right. The eye infection that you described is likely caused by a germ called Chlamydia trachomatis. It is a rather complicated issue, let me try to explain to you in greater detail here.

There are many different strains of Chlamydia. The kind that I am talking about here is very common in North America. It is usually passed from men to women, back and forth, through sexual intercourse. Fortunately, this germ does not cause any obvious infection in the penis of men or the vagina in the majority of females. Unfortunately, because the infection is not obvious, those infected individuals are unaware of it and will not seek help. As a result, infection can be passed onto other sexual partners unknowingly.

A small percentage of females, however, can develop symptoms of vaginal or cervical infection. The symptoms are usually mild, and may include a vaginal discharge which has a strong odour. Once in a while, the infection can spread to other organs in the pelvis, resulting in “pelvic inflammatory disease.” This is a very serious infection, usually with high fever and a lot of pain.

Chlamydial infection is one of the most common sexually transmitted disease in North America. In some places, as many as 30% of women are infected. It is also the most common cause of infertility in women. The silent nature of infection in most men and women allows spreading of this germ without suspicion.

As I have mentioned earlier, many women have been infected with Chlamydia and carry the bacteria in their cervix or vagina without ever knowing their existence. At the time of normal vaginal delivery, babies pass through their mothers’ birth canals and come into contact with these bacteria. In this way, this germ can enter the eyes, nasal passage and throat of newborn babies.

It usually takes Chlamydia several days to weeks to establish an eye infection. The only symptoms include presence of mucus or pus discharging from the eyes. Sometimes one eye is more severely infected than the other, and the eyelids can be swollen. The infection is generally mild, but antibiotic ointment alone may not be effective.

The bigger problem is spreading of infection to the respiratory tract. These bacteria can enter the nostrils and throat of newborn babies at birth. With time, they grow and gradually spread to the bronchial tubes and the lungs. Once in a while, if the infection is serious, it can even cause pneumonia, which can be diagnosed with chest X rays. Children with Chlamydial pneumonia usually have a sharp cough and can breathe fast, although they do not have fever.

You may wonder, is there any way of finding out for certain whether you son has Chlamydia infection or not. Unfortunately, Chlamydia is the type of germ that does not grow well by regular culture technique. A swab culture from his eyes, or from your cervix, will not provide the answer.

Newer techniques, called PCR test, can detect the presence of Chlamydia in eye swabs, cervical swabs, or urine sample from the mother.  They look for parts of the bacteria, even when they have already died, and are much more sensitive than culture technique. However, just like any test, there is possibility of false negative results.

Erythromycin is the most effective antibiotic to treat Chlamydial infection. It is available as an eye ointment, but it is only effective for the eyes. As I have mentioned earlier, it is very common for the infection to spread into the respiratory tract of children. To prevent the spread, many specialists recommend giving erythromycin by mouth, so that it can kill the germs in the eyes as well as those in the respiratory tract, even before the onset of breathing problems.

Erythromycin has to be given for two weeks. It is effective in about 80% of children. Sometimes a second two-week course may be necessary to completely eliminate the bacteria.

How about yourself and your husband? Should both of you be treated also? Since Chlamydial infection in newborns starts from the birth canal, many specialists also recommend that both parents receive treatment at the same time. Erythromycin is still the most effective antibiotic. However, if you are allergic to it, tetracycline is also effective, but this cannot be given to children.

I hope you have a better understanding about the importance of this persistent eye infection in your son. Please bring him back to your doctor and discuss about the best treatment for your family.

[Note to Readers: A newer antibiotic called Biaxin or Clarithromycin is also very effective in treatment of Chlamydia infection.]