A 2-week-old presents with mucopurulent eye discharge with conjunctival injection and edema. The mother had no prenatal care. What is the most likely organism?

A 2-week-old presents with mucopurulent eye discharge with conjunctival injection and edema. The mother had no prenatal care. What is the most likely organism?

• A. Staphylococcus aureus
• B. Gonococcus
• C. C. pneumoniae
• D. C. trachomatis

Answer: (D)

The timing and quality of the discharge in neonatal eye infections help distinguish common pathogens. Gonococcal conjunctivitis tends to appear within the first couple of days after birth and usually causes a very copious, thick purulent discharge with pronounced eyelid swelling. In contrast, Chlamydia trachomatis–related conjunctivitis often presents later, around 1 to 2 weeks of life, with mucopurulent discharge and milder lid edema and conjunctival injection. This baby is 2 weeks old with mucopurulent discharge and conjunctival injection with edema, and the mother had no prenatal care—factors that fit Chlamydia trachomatis most closely. Maternal infection without prenatal screening increases the chance that the infant acquired chlamydial conjunctivitis during delivery. Therefore, the organism most consistent with this presentation is Chlamydia trachomatis. Management would include treating the infant with an oral macrolide (for example, azithromycin), treating the mother and partners, and addressing any other neonatal or maternal infections as indicated.

The timing and quality of the discharge in neonatal eye infections help distinguish common pathogens. Gonococcal conjunctivitis tends to appear within the first couple of days after birth and usually causes a very copious, thick purulent discharge with pronounced eyelid swelling. In contrast, Chlamydia trachomatis–related conjunctivitis often presents later, around 1 to 2 weeks of life, with mucopurulent discharge and milder lid edema and conjunctival injection.

This baby is 2 weeks old with mucopurulent discharge and conjunctival injection with edema, and the mother had no prenatal care—factors that fit Chlamydia trachomatis most closely. Maternal infection without prenatal screening increases the chance that the infant acquired chlamydial conjunctivitis during delivery.

Therefore, the organism most consistent with this presentation is Chlamydia trachomatis. Management would include treating the infant with an oral macrolide (for example, azithromycin), treating the mother and partners, and addressing any other neonatal or maternal infections as indicated.