Diagnosis can be made by scraping the conjunctiva and culturing the material. Giemsa staining of the conjunctival scrapings revealing the presence of blue-stained intracytoplasmic inclusions within the epithelial cells is diagnostic. PCR is also available. Infants with conjunctivitis and pneumonia are treated with oral erythromycin for 14 days. Topical treatment of conjunctivitis is ineffective and unnecessary. The recommended topical prophylaxis with silver nitrate, erythromycin, or tetracycline for all newborns for the prevention of gonococcal ophthalmia does not prevent neonatal chlamydial conjunctivitis.
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Kim Blake and Lisa M. Allen 12
The leading causes of mortality (Table 67-1) and morbidity (Table 67-2) in adolescents in the United States are behaviorallymediated. Motor vehicle injuries and other injuries account formore than 75% of all deaths. Unhealthy dietary behaviors andinadequate physical activity result in adolescent obesity withassociated health complications (e.g., diabetes, hypertension).
It is the physician’s responsibility to use every opportunity to inquire about risk-taking behaviors (Fig. 67-1), regardless of the presenting issue. Physical symptoms in adolescents are often related to psychosocial problems.
The adolescent interview shifts from information gathering from the parent to the adolescent. Interviewing an adolescent alone and discussing confidentiality are the cornerstones of obtaining information regarding risk-taking behaviors, anticipatory guidance, and protective factors (see Chapters 7 and 9).
The interview should take into account the developmental age of the adolescent (Table 67-3). Conversations about sports, friends, movies, and activities outside of school can be useful for all ages and help build rapport (Fig. 67-2).
Confidentiality is a key element when interviewing an adolescent (Table 67-4). The vital, open discussion about risk-taking behavior is more likely to happen when the adolescent is