Neonatal Conjunctivitis

4 day infant presents to ED with eye discharge.  On exam there is intense chemosis and purulent discharge bilaterally.  The mother admits to poor prenatal care.  What is the most likely organism? (scroll down for answer) 

A) Neisseria gonorrhoeae

B) Chlamydia trachomatis 

C) Strep pneumoniae

D) Staph aureus

E) HSV

The correct answer is A) Neisseria gonorhoeae. 

Common Causes of Neonatal Conjunctivitis

Chemical:  

    - caused by prophylactic erythromycin ointment applied at birth 

    - presents within 24 hrs of birth

    - b/l watery discharge

    - negative gram stain

    - watchful waiting 

Gonococcal:

    - erythromycin ointment applied at birth for prophylaxis

    - caused by neisseria gonorrhoeae

    - presents at day 2 to 7

    - intense chemosis, copious discharge

    - gram negative diplococci on gram stain

    - admit for IV antibiotics (cefotaxime or ceftriaxone)

Chlamydial

    - caused by chlamydia trachomatis 

    - presents at day 7 to 14

    - intense erythema, purulent discharge

    - admit for PO antibiotics (azithromycin or erythromycin)

Viral

    - caused by HSV2, less commonly HSV1

    - presents at day 14 to 28

    - dendrites on fluorescein exam 

    ​- admit for IV antibiotics (acyclovir) 

Stapczynski, J. Stephan,, and Judith E. Tintinalli. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.