(P272) Chlamydial Ophthalmia Neonatorum: Case Series from Gaborone, Botswana

Background: Ophthalmia neonatorum is acute conjunctivitis occurring usually within the first month of life. It carries significant risk of corneal ulceration, corneal perforation, and blindness. We describe a case series of chlamydial ophthalmia neonatorum. The data presented in the case series were obtained from the “Maduo” study, a prospective cluster-controlled study of the relationship between curable sexually transmitted infections in pregnancy and adverse neonatal outcomes.

Methods: We recruited pregnant women from four antenatal clinics in Gaborone, Botswana. Chlamydial ophthalmia neonatorum cases were confirmed with GeneXpert® diagnostic testing. Our exposure of interest was C. trachomatis infection in the mother. Our outcome of interest was the diagnosis of chlamydial conjunctivitis in the infant.

Results: Our study population consisted of 29 infants born to mothers who were recruited at their first antenatal visit (February 2021 - April 2022) and tested positive for C. trachomatis within 8 weeks of delivery. Chlamydial ophthalmia neonatorum was diagnosed in twelve (41%) of twenty-nine exposed infants. Eight cases were confirmed with GeneXpert® diagnostic testing while four were identified as probable cases based on high suspicion from clinical history and presentation. Nine had clinical signs of conjunctivitis, while three were asymptomatic. Four infants had signs suggestive of chlamydial pneumonia. All but one infant had received ocular tetracycline 1% prophylaxis at birth. Four had been managed for chlamydial conjunctivitis or pneumonia at a different health facility. Two of five symptomatic cases who completed the prescribed course of erythromycin had lingering symptoms. Case findings are summarized in the Table.

Conclusions: Our findings affirm that current prophylaxis modalities for chlamydial ophthalmia neonatorum may be inadequate. To the extent feasible in low- and middle-income healthcare settings, we recommend implementation of routine C. trachomatis screening and treatment in pregnant women to prevent chlamydial ophthalmia neonatorum.