June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Adult Inclusion Conjunctivitis: Misdiagnosis, Management and Missed Opportunities
Author Affiliations & Notes
  • Alexander Jesus Alfonso
    Ophthalmology, University of Miami School of Medicine, Miami, Florida, United States
  • Darlene Miller
    Ophthalmology, University of Miami School of Medicine, Miami, Florida, United States
  • Jorge Maestre
    Ophthalmology, University of Miami School of Medicine, Miami, Florida, United States
  • Guillermo Amescua
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Eduardo Alfonso
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Harry W Flynn, Jr.
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Footnotes
    Commercial Relationships   Alexander Alfonso None; Darlene Miller None; Jorge Maestre None; Guillermo Amescua None; Eduardo Alfonso None; Harry Flynn, Jr. None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2932. doi:
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      Alexander Jesus Alfonso, Darlene Miller, Jorge Maestre, Guillermo Amescua, Eduardo Alfonso, Harry W Flynn, Jr.; Adult Inclusion Conjunctivitis: Misdiagnosis, Management and Missed Opportunities. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2932.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Inclusion conjunctivitis is a sexually transmitted disease. It is typically caused by Chlamydia trachomatis but may rarely be associated with Chlamydia pneumoniae or Chlamydia psittaci. Diagnosis is clinical and quite challenging with frequent delayed and misdiagnoses. Our goal was to determine the prevalence of chlamydia species and highlight diversity of clinical diagnosis, symptom duration, age and gender among patients presenting with recalcitrant conjunctivitis over a 13-year period.

Methods : We used species-specific PCR to detect C. trachomatis, C. pneumoniae, and C. psittaci signatures among 138 unscreened archived (n=41, 2009-2017) and 97 recent (2020-2022) samples. Positive samples (n=20) among this group were coupled with 34 positive C. trachomatis samples and screened for serovar determination using PCR targeting the omp1 gene and sequencing. We also reviewed and determined the chlamydia positivity rate for 616 samples (2015-2022) evaluated by direct fluorescent antibody screening (DFA) and/or culture. Positive results were correlated with patient gender, age, clinical diagnosis, and symptom duration.

Results : The overall chlamydia positivity rate for the 13-year period was 13.1% (99/754). The rate for PCR was higher at 24.6% (34/138) than for DFA and culture at 10.5% (65/616). Ninety-seven percent (98/101) of isolates were identified as C. trachomatis. The remaining 3 isolates were C. pneumoniae (3%) of which two were co-pathogens. Among the 9 (13.2%, 9/68) identified, serovar D (4/9, 44%) and one each of E, G, Ia, Ja and LGV1 were evident among positive samples. Gender identification included male 59.3% (48/81) and female 40.7% (33/81), Patient ages ranged from 15-84 years with an average of 28.1 for males and 38.2 for females. Clinical assessment resulted in 22 different diagnoses; chronic conjunctivitis was most frequent at 53.2% (42/79). Symptom duration ranged from 2-365 days with an average of 43.5 days. Chlamydia positivity was highest for the age group 15-29 for both females 48.5%, (n=33) and males 58.3% (n=48).

Conclusions : Accurate and early diagnosis of adult inclusion conjunctivitis is essential but challenging. Delayed and/or misdiagnosis can result in more adverse complications, antibiotic abuse, potential and perpetual transmission of chlamydia from the ocular surface.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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