Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms

Rietveld, Remco P; Riet, Gerben ter; Bindels, Patrick J E; Sloos, J. H.; Weert, Henk van

doi:10.1136/bmj.38128.631319.ae

Cited by 140 publications

(81 citation statements)

References 10 publications

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“…Brook,4 in a study of acute conjunctivitis in children, found that control eyes were culture-positive 90.9% of the time. Perkins et al, 5 in a similar study, recovered bacterial isolates in 90.6% of control eyes. Moreover, all three of the abovementioned bacteria were found to be colonizing control eyes.…”

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confidence: 86%

Comment on “Clinical Features of Bacterial Conjunctivitis in Children”

Pelletier

Haim

Patel

2007

Academic Emergency Medicine

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The authors conclude that pediatric conjunctivitis is mostly bacterial in etiology and suggest that the empiric use of topical antibiotics in children presenting with conjunctivitis may be useful.The utility of topical antibiotic therapy relies on the assumption that the conjunctivitis being treated is indeed caused by bacteria. Conjunctivitis in both children and adults can be caused by multiple etiologies, including allergy, viral infection, bacterial infection, and other less common causes. There is a large body of literature that supports a viral etiology in most cases of conjunctivitis. For example, in a study of 388 patients with conjunctivitis, adenovirus was deemed responsible in up to 75% of the patients, whereas bacteria were determined to be causative in 18%.2 In another study of 459 children with conjunctivitis, in 60%, the illness was viral in etiology. 3The methodology used in the Patel et al.1 study did not test for a viral cause of conjunctivitis, thereby incorrectly citing bacteria as the causative agent in all culturepositive cases (78%). Common isolates in their study included Haemophilus influenza, Streptococcus pneumoniae, and Staphylococcus aureus. Brook, 4 in a study of acute conjunctivitis in children, found that control eyes were culture-positive 90.9% of the time. Perkins et al.,5 in a similar study, recovered bacterial isolates in 90.6% of control eyes. Moreover, all three of the abovementioned bacteria were found to be colonizing control eyes.In the study conducted by Patel et al., 1 the authors described clinical variables correlating with positive bacterial cultures as a history of so-called sticky lids and the presence of mucoid and/or purulent discharge on examination. It is well known in the ophthalmologic community that sticky lids and mucoid discharge are frequently associated with both viral and allergic conjunctivitis in addition to dry eye, lacrimal dysfunction, and chemical irritation. We believe that the authors' conclusion regarding the etiology of conjunctivitis in pediatric ED patients may be flawed. It is possible that some of the eyes cultured were infected with a virus and that the positive bacterial cultures are only representative of the normal pediatric conjunctival flora or contaminants. Methods of improving the study to better support the conclusion could have included the use of controls and testing for virus by cell culture with confirmatory immunofluorescense staining, polymerase chain reaction, or Rapid Pathogen Screening Adeno Detector. 6 The use of clinical history is important, but performance of a slit lamp examination is also vital in diagnosing etiologies of different conjunctivitis. The methodology used in the study did not include the use of a slit lamp in identifying etiologic causes of conjunctivitis. Findings indicative of adenovirus infestation of conjunctiva, such as petechial hemorrhages, follicular reaction, and subepithelial infiltrates, can be seen by using this method. The examination of everted eyelids with a slit lamp is the mainstay p...

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confidence: 86%

Comment on “Clinical Features of Bacterial Conjunctivitis in Children”

Pelletier

Haim

Patel

2007

Academic Emergency Medicine

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“…Rietveld study stated that glued eye, itch and history of conjunctivitis provided optimal discrimination between patients with bacterial and viral aetiology, a history of both infectious conjunctivitis and itch make the probability of bacterial aetiology less likely, while glued eye is strong hint for bacterial aetiology [18]. On the other hand a very valuable report coming after searching the literature by Gigliotti, stated that he was unable to find evidence of the diagnostic usefulness of clinical signs, symptoms or both in distinguishing bacterial conjunctivitis from viral conjunctivitis and he recommended further researches to provide general practitioners with easy to use diagnostic tools to differentiate bacterial from viral conjunctivitis to tailor antibiotic prescriptions [21].…”

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confidence: 99%

Non Chlamydial Acute Bacterial Conjunctivitis in Sudanese Children

Almajeed¹,

Bushara²,

Omer³

et al. 2015

J Bacteriol Parasitol

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In children there is a paucity of data in recent literature on the prevalence of infective conjunctivitis and almost it is absent from an area like Sudan. This research was aimed to study the point prevalence of a cute bacterial conjunctivitis in Sudanese children and put light on causative bacterial pathogens. Acute bacterial conjunctivitis is a common infection in children and it may be extremely contagious and easily spread in day care centres and school class rooms leading to absences or lost time from work for parents, outbreaks may occur. Common presenting symptoms are red eye and eye discharge. Commonly involved bacteria are Staphylococcus aureus and Haemophilus influenzae. Generally it is a mild disease but more serious complications may occur.Methods: Hundred children with clinical presentation of acute conjunctivitis were included in this study. For each patient a sample for bacterial culture and sensitivity to commonly used antibiotics was obtained by a thin cotton micro swab, isolation and identification of pathogens was done by conventional methods. Antimicrobial susceptibility testing was performed according to method standardized by CLSI. Data was analyzed by SPSS computer program. Results:The most common presenting symptom is the red eye. Bacterial pathogens were detected in 65% of the studied sample. Predominant bacterial pathogens were Staphylococcus aureus and Haemophilus influenzae, Klebsiella pneumoniae is a cause in small number of patients. All isolates are sensitive to Gentamycin. Conclusion:acute bacterial conjunctivitis is a common infection in children, muco purulent discharge points to bacterial cause in acute infective conjunctivitis. Staphylococcus aureus is a common pathogen and it is sensitive to Gentamycin.

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“…Additionally, a study by Rietveld et al in adults found a similar connection between these findings and bacterial etiologies. 5 We appreciate the value of using a slit lamp when examining the eyes. However, we do not believe that its use is vital in making the diagnosis of conjunctivitis.…”

Section: In Replymentioning

confidence: 99%