Chlamydia

Filename: Chlamydia.ppt

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 Chlamydia

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 Chlamydia
 Obligate intracellular coccoid parasites
 contain DNA and RNA, and ribosomes
 lack ATP, biosynthetic pathways
 cell wall but peptidoglycan absent -
– use disulfide bonds
 non motile

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 Obligate Parasites
 Obligate intracellular parasites of mammals
and birds
– not transmitted by arthropods.
– incorrectly called the PLT viruses or Bedsonia or
basophilic viruses,
 Multiply in the cytoplasm of the host cell.
– generally epithelial cells
– Basophilic inclusions
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 Similar to Viral Infections
 The methods used to study Chlamydia
are those of the virologist rather than
the bacteriologist.
 The clinical features, pathogenesis,
pathology and epidemiology of
chlamydial infections are similar to
those of viral infections.

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 Energy Parasites
 The cells can synthesize DNA, RNA and
protein.
 No flavoproteins or cytochromes.
 lack of ATP-generating ability
 need to obtain ATP from the host cell.

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 Three species:
C. trachomatis
C. psittaci
C. pneumoniae

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 Ecology
Chlamydia form two main ecological groups.
 Infect only humans
– Subgroup A
– trachoma, inclusion conjunctivitis, and
lymphogranuloma venereum
 Zoonotic Infections
– Subgroup B
– Respiratory tract infections
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 Zoonotic Infections
 transmitted to man
 About 100 species of birds are naturally
infected with chlamydia.
– 71 species of parrots
– finches, pigeons, chickens, ducks, turkeys
and seabirds.

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 C trachomatis
Trachoma
conjunctivitis
proctitis
urethritis
salpingitis
Lymphogranuloma venereum

C psittaci & C
pneumoniae

Upper respiratory infection

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 Chlamydial Morphologies
 Elementary body
– 0.25 - 0.3 um diameter
– electron-dense nucleoid
– Released from ruptured infected cells.
Human to human
– & bird to human.
 Reticulate Body
– Intracytoplasmic form 0.5 - 1.0 um
– Replication and growth. ( Inclusion body )
– without a dense center.
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 Developmental Cycle of
Chlamydia

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13 C trachomatis elementary bodies
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 C trachomatis inclusions

Glycogen Inclusions

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 Subgroups
 Subgroup A  Subgroup B
 Mammalian parasites  Primarily bird parasites
 Compact inclusions  Diffuse inclusions
 Glycogen synthesized  Glycogen not synthesized
 Folates synthesized  Folates not synthesized
– Sensitive to D-cycloserine – Resistant to D-cycloserine
 Restricted host range  Broadening of host range
 Chlamydia trachomatis  Chlamydia psittaci

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 Evolution of Chlamydia
 Gram-negative cocci
 Facultative intracellular parasites of mammals
 Obligate intracellular parasites
 Host range restricted to rodents
 Restricted virulence (compact inclusions)
 Folates synthesized (sulfonamide susceptible)
 Glycogen synthesized and deposited in
inclusions
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 Conjunctivitis
 Inclusion conjunctivitis:
– Transmitted by infectious secretions of the
genitourinary tract
– autoinoculation
 Infantile conjunctivitis:
– Acquired in the birth canal -- 5-12 days
after birth
– most common type of conjunctivitis
 Antibiotic prophylaxis: erythromycin,
tetracycline. 6/21/2018
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 Chlamydial Infection of
Ocular Conjunctiva

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 Trachoma
 infection of conjunctival epithelial cells.
– subepithelial infiltration of lymphocytes.
– Infected epithelial cells contain cytoplasmic
inclusion bodies
– Cell infiltrations to cornea cause clouding
 Trichiasis: abnormal inward growth of
eyelashes.

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 Predisposing factors:
 climate - hot , dry
 shortage of water
 standards of hygiene low
Transmitted by flies, dirty towels, fingers,
cosmetic eye pencils.
Initial infection in childhood mostly by 10-
15 years of age.
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 Trachoma

 Almost six million people have become blind

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 Trachoma Incidence

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 Chlamydia trachomatis
Clinical disease
 lymphogranuloma venereum
 nongonoccal urethritis (NGU)
 epididymitis
 salpingitis
 mucopurulent cervicitis
 pelvic inflammatory disease (PID)
 Reiter's syndrome
 neonatal chlamydia 6/21/2018
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 Chlamydia: Rates by Gender

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 Chlamydia Symptoms In Men
 Symptoms usually appear
between 7 and 28 days after
infection, usually with mild
burning when urinating, a
more frequent need to
urinate, and a white
discharge from the penis.
Occasionally, blood may
appear in the urine. The
symptoms occur most
frequently in the morning.
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 Erythematous meatus and
urethra with balanitis
Hyperlink to original

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 Chlamydial Urethritis in Males

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 Nongonococcal urethritis (NGU) -
Reiter's syndrome
 Swollen, painful right knee in which needle
aspiration for synovial fluid was performed
(yellow discoloration from the betadine prep)

Hyperlink to original
site 6/21/2018
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 Lymphogranuloma venereum LGV
 200 reported cases per year.
 Incubation period is 5 to 20 days.
 Lesion: Transient vesicles on penis or
vagina that are often unnoticed and
patients do not usually seek medical
advice.

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 Bilateral inguinal adenopathy
with overlying erythema

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R
 LGY: "Groove sign"

 Pompart's
ligament is
preserved despite
the involvement of
multiple inguinal
nodes

R Roberts MD 6/21/2018
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 LGV: Microscopy
 lymph node shows
both necrosis and
granulomatous
reaction (dimorphic
necrotizing
granulomatous
reaction)

R Roberts MD
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 Chlamydia pneumoniae
 This bacterium was first recognized in
1983 as a respiratory pathogen, after
isolation from a college student with
pharyngitis.
 Pneumonia or bronchitis, gradual onset
of cough with little or no fever. Less
common presentations are pharyngitis,
laryngitis, and sinusitis.
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 Incidence
 Each year an estimated 50,000 adults
are hospitalized with pneumonia in the
United States. The overall incidence is
unknown.

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 6/21/2018
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 Transmission
Person-to-person transmission by respiratory
secretions.
 Risk Groups
 All ages at risk but most common in school-
age children. By age 20 years, 50% of
population have evidence of past infection.
Reinfection throughout life appears to be
common.
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 C. pneumoniae Associations
 Associated with Heart Disease
 infection may be associated with
– atherosclerotic vascular disease
 Proposed Associations
– Alzheimer's diseases, asthma, and reactive
arthritis

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 Treatment Chlamydia
 Adults Conjunctival,  Children < 45 kg,
urethral, cervical, rectal: urogenital & rectal:
– Azithromycin 1 gm x 1 – erythromycin 50
dose mg/kg/day in 4 doses for
– Doxycycline 100 mg BID 10-14 days
for 7 days  Neonates (ophthalmia,
– Ofloxacin 300 mg po BID infants born to infected
for 7 days mothers):
– Erythromycin 500 mg QID – erthromycin 50
for 7 days mg/kg/day in 4 doses for
– Amoxacillin 500 mg TID 10-14 days
7-10 days 6/21/2018
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 Chlamydia Antigens

Antigens: group specific & species specific

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 Laboratory Diagnosis
 Isolate the organism from infected tissue.
– Inoculate the yolk sac of seven-day chick embryos
– Inoculate McCoy human cells.
 Characteristic cytoplasmic inclusion bodies in
infected cells.

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 Immunofluorecent tests
 Microimmunofluorescent tests
– patients with eye infections
– Check tears for the presence of anti-
chlamydia antibody.
 Direct immunofluorescence
– of conjunctive cells with fluorescein -
conjugated monoclonal antibody is sensitive
and specific.
– In neonatal conjunctivitis and early trachoma
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 Serological diagnosis:
 Immunofluorecent tests
 Delayed Type Skin Reaction
 Antibodies to Family antigen

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 FREI Test
 Delayed-type skin reaction to killed
organisms in genitourinary infections

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 Antibodies to Family antigen
 Rising titer of antibody against the
chlamydial family antigen in lung
infections.
– Complement fixation test
– Fluorescent antibody test.

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 DONE!!!

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