Bilateral Purulent Conjunctivitis in A Newborn: An Atypical Isolate

Introduction: Routine neonatal ocular prophylaxis remains controversial, even though it is known to decrease the incidence of bacterial neonatal conjunctivitis in developed countries. The most severe bacterial pathogens are C. trachomatis and N. gonorrhoea, however many atypical isolates have been described.

Case report: A seven-day-old female was admitted with bilateral purulent conjunctivitis, marked swelling of the eyelids and profuse exudate, as well as nasal congestion. Prenatal history was unremarkable, without signs of maternal vaginal infection or sexually transmitted disease; Group B Streptococcus screening was negative. The patient was born at 37w2d from a vaginal delivery and prophylaxis with chloramphenicol eye drops was performed at birth. In the emergency department, ocular exudate was collected for microbiological examination and empiric therapy with intravenous ceftriaxone (single dose) and azithromycin (3-day treatment) was initiated. Gram stain of the exudate was negative. Clinical evolution was favourable after 24 hours of treatment and remained uneventful during hospitalization, therefore swabbed conjunctival specimens or maternal vaginal cultures were not obtained. A 10-day treatment course with topical chloramphenicol was performed. Initial ocular exudate culture was positive, with an isolate of Alloiococcus otitidis. At two months of age, the infant remains asymptomatic.

Discussion: Alloiococcus otitidis is often isolated in the middle ear fluid of children with otitis media, however there is currently insufficient evidence to determine its pathogenic potential. Regarding ocular infections/isolates, only one report in an adult with acute endophthalmitis is available. We are not certain that A. otitidis was the infectious agent responsible in this setting since conjunctival specimens were not collected. Nevertheless, it should be noted that early empiric antibiotic therapy towards the most serious bacterial causes is of paramount importance to avoid complications such as blindness or disseminated disease on the newborn with exudative conjunctivitis.