CHLAMYDIA SPP.

PATHOGENIC CHLAMYDIA

 Chlamydia trachomatis,
 Chlamydia pneumoniae
 Chlamydia psittaci,
GENERALITIES

 STRUCTURE:
Outer cell wall has a relatively high lipid content
including lipopolysaccharide of low endotoxic activity.
does not contain a typical bacterial peptidoglycan.
(ATYPICAL BACTERIA)
MOMP component encoded by ompA; antigenic variants
of C. trachomatis are associated with different clinical
syndromes.
Penicillin-binding proteins occur in chlamydiae,
and chlamydial cell wall formation is inhibited by penicillins
and other drugs that inhibit transpeptidation of bacterial
peptidoglycan.
Cannot use Penicillins in treating atypical bacterial infections.
Lysozyme has no effect on chlamydial cell walls.
N-acetylmuramic acid appears to be absent from chlamydial cell walls.
GENERALITIES

 DEVELOPMENTAL CYCLE:

ELEMENTARY BODY (EB) = TRANSMISSIBLE FORM:

“E” FOR ENTER
Purple on Giemsa stain

RETICULATE BODY (RB)= REPPLICATIVE FORM: “R”

FOR REPLICATION; DIVISION THRU BINARY FISSION
Blue on giemsa stain

Gram reaction is of no use.

48- 72 HOURS to complete cycle.

GENERALITIES

 Antigens

shared group (genus)–specific antigens (heat stable lps 2-keto-3-deoxy-octanoic acid as an

immunodominant component) detected by complement fixation (CF) and immunofluorescence

Species-specific or serovar-specific antigens: mainly outer membrane proteins detected by

immunofluorescence, particularly using monoclonal antibodies.
C. trachomatis 15 serovars that are separated into two biovariants that cause different clinical
syndromes.
trachoma biovar serovars A, B, Ba, and C as well as the genital tract serovars D–K.
lymphogranuloma venereum (LGV) biovar  serovars L1, L2, and L3.
Only one serovar of C. pneumoniae has been described.
 Growth and Metabolism

Intracellualr, dependent on cell host.

Culture medium: McCoy Cells treated with cycloheximide
C. Pneumonia grows better in HL or Hep-2 cells.

Penicillins and Cephalosphorins are ineffective

Inhibitors of protein synthesis (tetracyclines, macrolides) are effective in most clinical infections.
CLINICAL DISEASES

 Trachoma

chronic keratoconjunctivitis that begins with acute inflammatory changes in the conjunctiva and cornea
and progresses to scarring and blindness.
The C. trachomatis serovars A, B, Ba, and C are associated with clinical trachoma.
Clinical Findings:
incubation period: chlamydial conjunctival infection is 3–10 days.
earliest symptoms: lacrimation, mucopurulent discharge, conjunctival
hyperemia, and follicular hypertrophy.
Presentation is insidious, usually starts early during childhood in endemic areas
Microscopic examination of the cornea: epithelial keratitis, subepithelial
infiltrates, and extension of limbal vessels into the cornea (pannus).

Treatment: Azithryomycin (Macrolide)

CLINICAL DISEASES

 Trachoma

Laboratory Diagnosis:
Culture: Inoculation of conjunctival scrapings into cycloheximide- treated
McCoy cell cultures permits growth of C. trachomatis if the number of viable
infectious particles is sufficiently large. The diagnosis can sometimes be made
in the first passage after 2–3 days of incubation by looking for inclusions by
immunofluorescence or staining with iodine or Giemsa stain.
Serology: Immunofluorescence is the most sensitive method for their
detection. Neither ocular nor serum antibodies confer significant resistance to
reinfection.
Molecular Methods: PCR
CLINICAL DISEASES

 CHLAMYDIA TRACHOMATIS GENITAL INFECTIONS AND INCLUSION CONJUNCTIVITIS

C. trachomatis serovars D–K cause sexually transmitted diseases, may also produce infection of the eye
(inclusion conjunctivitis).
In sexually active men, C. trachomatis causes nongonococcal urethritis and epididymitis.
In women, C. trachomatic causes urethritis, cervicitis, and pelvic inflammatory disease, which can lead to
sterility and predispose to ectopic pregnancy.
In men who have sex with men Proctitis and proctocolitis

Inclusion conjunctivitis of the newborn begins as a mucopurulent conjunctivitis 5–12 days after delivery.
CLINICAL DISEASES

 CHLAMYDIA TRACHOMATIS

GENITAL INFECTIONS AND INCLUSION CONJUNCTIVITIS

Laboratory diagnosis:
Specimen: cervical discharge or swab, urine
Lab: NAAT
 Treatment: It is essential that chlamydial infections be treated simultaneously in both sex partners and in
offspring to prevent reinfection. Tetracyclines (eg, doxycycline) are commonly used. Azithromycin is
effective and can be given to pregnant women.
CLINICAL DISEASES

 CHLAMYDIA TRACHOMATIS

NEONATAL PNEUMONIA
Of newborns infected by the mother, 10–20% may develop respiratory tract involvement 2–12 weeks after birth,
culminating in pneumonia.
Diagnosis: Immunoglobulin M (IgM) antibody titer to C. trachomatis of 1:32 or more is considered diagnostic.
Treatment: Oral azithromycin for 5 days is recommended; systemic azithromycin is effective treatment in severe
cases.
CLINICAL DISEASES

 CHLAMYDIA TRACHOMATIS

LYMPHOGRANULOMA VENEREUM
suppurative inguinal adenitis; it is most common in tropical climates.
Clinical Findings:
1. Small, evanescent papule or vesicle develops on any part of the external genitalia, anus, rectum, or elsewhere.
The lesion may ulcerate, but usually it remains unnoticed and heals in a few days.
2. Days to weeks later, the regional lymph nodes enlarge and tend to become matted and painful (bubo).
3. Systemic symptoms: including fever, headaches, meningismus, conjunctivitis, skin rashes, nausea and vomiting, and arthralgias
4. Without effective antimicrobial treatment, the chronic inflammatory process progresses to fibrosis, lymphatic obstruction, and
rectal strictures.
5. The lymphatic obstruction may lead to elephantiasis of the penis, scrotum, or vulva.
CLINICAL DISEASES

 CHLAMYDIA TRACHOMATIS

LYMPHOGRANULOMA VENEREUM
Laboratory Diagnosis
A. Smears: Pus, buboes, or biopsy material may be stained, but particles are rarely recognized.
B. Nucleic Acid Amplification Tests: All of the commercial NAATs detect all of the LGV serovars but cannot
differentiate them from other C. trachomatis serovars.
C. Culture: Suspected material is inoculated into McCoy cell cultures. The inoculum can be treated with an
aminoglycoside (but not with penicillin) to lessen bacterial contamination. The agent is identified by morphology and
serologic tests.
CLINICAL DISEASES

 CHLAMYDIA TRACHOMATIS

LYMPHOGRANULOMA VENEREUM
Laboratory Diagnosis
D. Serology: Antibodies are commonly demonstrated by the CF reaction. The test becomes positive 2–4 weeks after
onset of illness. In a clinically compatible case, a rising antibody level or a single titer of more than 1:64 is good
evidence of active infection.
CLINICAL DISEASES

 CHLAMYDIA TRACHOMATIS

LYMPHOGRANULOMA VENEREUM
Oral doxycycline and erythromycin for 21 days are effective therapies.
CLINICAL DISEASES

 CHLAMYDIA PNEUMONIAE AND RESPIRATORY INFECTIONS

 Most infections with C. pneumoniae are asymptomatic or associated with mild illness, but severe disease has been
reported.
 There are no signs or symptoms that specifically differentiate C. pneumoniae infections from those caused by many
other
 agents. Both upper and lower airway diseases occur. Pharyngitis is common.
 Sinusitis and otitis media may occur and be accompanied by lower airway disease.
 An atypical pneumonia similar to that caused by Mycoplasma pneumoniae is the primary recognized illness.
 The proportion of cases of community-acquired pneumonia caused by C. pneumoniae varies in the literature from
0% to 40%, but seems to be lower in more recent series (<5%).
CLINICAL DISEASES

 CHLAMYDIA PNEUMONIAE AND RESPIRATORY INFECTIONS

 Swab specimens of the pharynx should be put into a chlamydiae transport medium and placed at 4°C; C. pneumoniae is rapidly
inactivated at room temperature.
 It grows poorly in cell culture, forming inclusions smaller than those formed by the other chlamydiae.
 C. pneumoniae grows better in HL and HEp-2 cells than in HeLa 229 or McCoy cells; the McCoy cells are widely used to culture C.
trachomatis.
 The sensitivity of the culture is increased by incorporation of cycloheximide into the cell culture medium to inhibit the eukaryotic cell
metabolism and by centrifugation of the inoculum onto the cell layer.
 Growth is better at 35°C than 37°C. After 3 days’ incubation, the cells are fixed and inclusions detected by fluorescent antibody
staining with genus- or species-specific antibody or, preferably, with a C. pneumoniae–specific monoclonal antibody conjugated with
fluorescein.
 Giemsa staining is insensitive, and the glycogen-negative inclusions do not stain with iodine.
 It is moderately difficult to grow C. pneumoniae—as evidenced by the number of isolates described compared with the incidence of
infection
CLINICAL DISEASES

 CHLAMYDIA PNEUMONIAE AND RESPIRATORY INFECTIONS

 Serology using the MIF test is the most sensitive method for diagnosis of C. pneumoniae infection.
 C. pneumoniae is susceptible to the macrolides and tetracyclines and to some fluoroquinolones.
CLINICAL DISEASES

 CHLAMYDIA PSITTACI AND PSITTACOSIS

 The agent enters through the respiratory tract, is found in the blood during the first 2 weeks of the disease, and may
be found in the sputum at the time the lung is involved.
 Psittacosis causes a patchy inflammation of the lungs in which consolidated areas are sharply demarcated. The
exudates are predominantly mononuclear. Only minor changes occur in the large bronchioles and bronchi. The
lesions are similar to those found in pneumonitis caused by some viruses and mycoplasmas. The liver, spleen, heart,
and kidney are often enlarged and congested.
CLINICAL DISEASES

 CHLAMYDIA PSITTACI AND PSITTACOSIS

 A diagnosis of psittacosis is usually confirmed by demonstrating complement-fixing or microimmunofluorescent
antibodies in serum specimens.
 A confirmed case is one with a positive culture result or associated with a compatible clinical illness plus a fourfold
or greater change in antibody titer to at least 1:32 or a single MIF IgM titer of at least 1:16.
CLINICAL DISEASES

 CHLAMYDIA PSITTACI AND PSITTACOSIS

 Information on therapeutic efficacy comes from several clinical trials.
 Doxycycline and tetracycline are the preferred agents for treatment; macrolides and fluoroquinolones may be
alternatives.