Chlamydia Pneumoniae – Etiology of Follicular Conjunctivitis and SubsequentKeratoconjunctivitis Sicca in Adult Patients

Overview

The authors refer to 21 adult patients at the age of 22 to 87 years,whohave sufferedfrom a chronic form of follicular conjunctivitis, found to be caused by Chlamydia pneumoniae as the etiological agent. The observation wasmade in the period fromJuly 1999 to December 2002. Chl. pneumoniae was detected by a direct demonstrationof the conjunctiva smears and by means of serological examination. Theprint preparations on glass were examined by the method of indirect immunofluorescenceby means of specific monoclonal antibodies (Medac, Germany). Theserological examination included detection of genus-specific IgG, IgA, IgM antibodies,respectively (Medac, Germany) and species-specific anti-Ch. pneumoniaeIgG, IgA abd IgM antibodies, respectively (FOCUS Technologies, U.S.A.).The clinical picture included various long-termsubjective complaints (within therange of several months to ten years), particularly a pathological secretion orincreased lacrimation, cutting, burning or feeling of a foreign body in the eye. Theobjective examination revealed chronic changes characterized by a mild edemaof bulbar conjunctiva with increased meandering in vessels of irregular caliberand edema in the lower transition plica with follicular structure crossing into thetarsal conjunctiva. In the fornix there was an apparent sticking aqueous ormucinous secretion.The therapy was indicated by the positivesmears alone in four patients or positiveIgA and/or IgM of genus- or species-specific antibodies in 12 patients. The therapyin the remaining five patients was recommended by the combination of suspectpositivesmears in combination with positive genus- or species specific antibodyreaction. The therapy made use of systemic administration of a macrolide antibiotic,azithromycin, for the period of 12 to 14 days in a single course of treatment.The pretreatment was always followed by control smears after two weeks and byserological examinations after three and six months. The serological findingsremained virtually unchanged during that period of time in all patients underobservation. In two of them only the species-specific antibodies anti-Ch. pneumoniaeIgA antibodies disappeared six months after the therapy. The clinical findingsdisappeared slowly, particularly the follicular changes occurred aftermorethan six months after the therapy ended.The subjective complaints, accompanied by a transient hyperemia of conjunctivesin particular, remained after the therapy in nine patients older than 45 years, whowere foundto suffer fromkeratoconjnunctivitis sicca.Theocular symptomatologywas not accompanied by symptoms of autoimmune disease.The general treatment by antibiotics and the results supportive treatment succeededin 67% of patients who were completely free of subjective complaints and thepathological process in conjunctives was inhibited.

Key words:
Chlamydia pneumoniae, Follicular conjunctivitis, Keratoconjunctivitissicca, Mecrolide antibiotics