A 4-day-old girl is brought to the office due to bilateral eye discharge that began 2 days ago and is worsening. The patient's mother is a 20-year-old woman, gravida 2 para 2, who had limited prenatal care. During the first trimester, the mother was treated for a sexually transmitted infection. During the third trimester, group B streptococcal screening was positive. The mother had no additional testing or treatment during the pregnancy. Delivery occurred vaginally with no known complications at home under the care of a midwife. Temperature is 36.7 C (98.1 F). The patient has bilateral chemosis, severe eyelid swelling, and significant purulent discharge. The face and chest have mild jaundice. The rest of the examination is normal. Which of the following would most likely have prevented this infant's clinical findings?

Question

A 4-day-old girl is brought to the office due to bilateral eye discharge that began 2 days ago and is worsening.  The patient's mother is a 20-year-old woman, gravida 2 para 2, who had limited prenatal care.  During the first trimester, the mother was treated for a sexually transmitted infection.  During the third trimester, group B streptococcal screening was positive.  The mother had no additional testing or treatment during the pregnancy.  Delivery occurred vaginally with no known complications at home under the care of a midwife.  Temperature is 36.7 C (98.1 F).  The patient has bilateral chemosis, severe eyelid swelling, and significant purulent discharge.  The face and chest have mild jaundice.  The rest of the examination is normal.  Which of the following would most likely have prevented this infant's clinical findings?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d6c8_4ad5_bc81_2b4b53f3a4b1_MD0003_00 This infant's severe, purulent eye drainage and eyelid swelling in the first week of life are consistent with conjunctivitis secondary to Neisseria gonorrhoeae. Infants acquire gonococcal conjunctivitis through contact with infected genital secretions. Symptoms usually begin at age 2-5 days and include significant purulent discharge, eyelid swelling, and chemosis (conjunctival edema). If not treated promptly, gonococcal conjunctivitis leads to corneal ulceration, scarring, and blindness. N gonorrhoeae may be visible as gram-negative intracellular diplococci. Culture of gonococci on Thayer-Martin agar is the gold standard for diagnosis. Treatment for the infant is one dose of intramuscular third-generation cephalosporin (eg, cefotaxime). gram-negative intracellular diplococci Gonococcal conjunctivitis in neonates can be prevented by screening pregnant women (age <25 or with risk factors) and treating their infections. However, the majority of infants with gonococcal conjunctivitis are born to mothers who: Were not screened during pregnancy Had negative screening early in pregnancy but were infected later Had positive screening and were either not treated or treated and reinfected Had home delivery or refused postpartum prophylaxis with topical erythromycin All infants, regardless of maternal screening results, should receive topical erythromycin prophylaxis shortly after birth to prevent gonococcal disease. (Choice A) Antenatal acyclovir prophylaxis can reduce the risk of maternal herpes simplex virus outbreaks and the need for cesarean delivery. Herpetic keratitis presents with vesicular or ulcerative corneal disease, usually in the second or third week of life. (Choices B and E) Oral azithromycin is the treatment of choice for Chlamydia trachomatis. Chlamydial conjunctivitis is less severe than gonococcal disease and presents in the second week of life with watery, serosanguineous, or mildly purulent discharge. (Choice C) Intrapartum ampicillin prophylaxis can prevent early-onset group B streptococcal disease, which usually presents as sepsis or pneumonia in the first 24-48 hours of life. Group B Streptococcus is typically invasive and widespread, not a focal infection to the eye. (Choice D) Third-generation cephalosporins are used for the treatment of gonococcal conjunctivitis. First-generation cephalosporins (ie, cefazolin) are not recommended for treatment or prophylaxis due to bacterial resistance. Educational objective: Gonococcal conjunctivitis occurs in infants born to untreated mothers and presents at age 2-5 days with severe conjunctivitis that can ulcerate, scar, and blind without prompt treatment. Prophylactic erythromycin ophthalmic ointment administered shortly after birth is highly effective in preventing gonococcal conjunctivitis. References: Chlamydial and gonococcal infections in infants and children. (http://www.ncbi.nlm.nih.gov/pubmed/22080275) Sexually transmitted diseases treatment guidelines, 2015. (http://www.ncbi.nlm.nih.gov/pubmed/26042815)

A 4-Day-Old Girl Is Brought to the Office Due to Bilateral