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Chlamydia

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Chlamydia

  1. 1. Chlamydia Dr Kamran Afzal Asst Prof Microbiology
  2. 2. Obligate intr acellularbacteria• Rickettsia• Coxiella• Ehrlichia• Bartonella• Mycobacteria (a few species)• Chlamydia – C. trachomatis – C. pneumoniae – C. psittaci – C. pecorum
  3. 3. Char acteristics - Chlamydia• Family Chlamydiaceae• Obligate intracellular bacteria• Rod-shaped or coccoid• Aerobic• Gram negative but difficult to stain• Cell Wall – lipopolysaccharides form the outer membrane, not peptidoglycan• Infect columnar epithelial cells• Forms elementary bodies (EB)• Non-motile• 37°C
  4. 4. ChlamydiaceaeSpecies (genus) DiseaseC. trachomatis Trachoma, conjunctivitis,2 biovars, non-LGV NGU, PID, LGV, Infantile LGV pneumonia Pharyngitis, bronchitis,C. pneumoniae pneumoniaC. psittaci Psittacosis
  5. 5. Chlamydiatrachomatis
  6. 6. Chlamydia trachomatis• Further divided – 15 serovars • defined by serological differences in the major outer membrane protein (MOMP) – Different serovars cause different diseases • Trachoma (A, B, Ba, C) • Urogenital-STDs (D, E, F, G, H, I, J, K) • LGV (L1, L2, L3)
  7. 7. Tr achoma• Largest single cause of preventable blindness in the world – 500 million cases worldwide – 5.9 million blind – Primarily in developing countries• Caused by serovars A, B, Ba, C• Clinical manifestations – Chronic follicular kerato-conjunctivitis • With conjunctival scarring and pannus formation
  8. 8. Pathogenesis• Caused by repeated infections – Causes inflammation of the eye – Eyelids turn inwards so the eye lashes rub against the cornea causing scar tissue to form irreversible blindness – 1st infection in childhood • subsequently persistent infection or many re-infections • final stages 15-20 years later – Sensitivity to products of the organism causes most of the pathogenesis
  9. 9. • Treatment – Azithromycin – Topical doxycycline – Improved sanitation – Surgical intervention
  10. 10. Tr achoma
  11. 11. D sS T a rs D -K er ov S
  12. 12. Epidemiology of STDs• Incidence – 4-6 million cases/year in US – Increasing in some locations• Only reservoir is human – Person to person transmission – Asymptomatic carriers important in transmission
  13. 13. Pathogenicity• Chlamydia (STD) – Transmitted through direct contact between infected membranes – If left untreated, common cause of infertility – Newborns can contract the disease from infected mothers
  14. 14. How is it transmitted? Passed through an infected Passed through an infected person to a partner by: person to a partner by: Vaginal Sex Anal Sex Passed through an infected Passed from an infected mother person to a partner by: to her unborn child. Oral Sex
  15. 15. Infections in male• Urethritis – 50-75% symptomatic • urethral discharge • pyuria • itching • dysuria – 25-50% asymptomatic• Inclusion conjunctivitis• Epididymitis – acute and unilateral inflammation of epididymis – may result in decreased fertility• Proctitis
  16. 16. Male• Discharge from penis• Dysuria• Pain, blood, discharge from rectum• Signs and symptoms 1-3 weeks after exposure
  17. 17. Infections in female• Urethritis (60-80%) – dysuria – pyuria• Proctitis – inflammation of the rectum• Inclusion conjunctivitis• Peri-hepatitis – infection of liver capsule
  18. 18. Infections in neonate / infant• Acquired from direct contact with infected cervical secretions of mother at delivery• Inclusion conjunctivitis – most common cause of neonatal conjunctivitis (2-6% infants) – acute mucopurulent eye discharge – systemic therapy with erythromycin• Pneumonia – 33-50% of all cases of interstitial pneumonia – failure to thrive
  19. 19. Female• Often no symptoms (silent injury)• Unusual discharge• Burning with urination• Pain, blood, discharge from rectum• Fever• Dysperunia• Signs and symptoms 1-3 weeks after exposure
  20. 20. Complications• Reiter’s syndrome – A reactive arthritis secondary to an immune-mediated response o It may present as asymmetric polyarthritis, urethritis, inflammatory eye disease, mouth ulcers o 80% of affected patients are HLA-B27 positive• Deeper pelvic complications in the female o PID o Potential infertility o Spread to the newborn during parturition
  21. 21. a lom nu V) og ra p h ( LGLy m re u m and L 3 n e s L 1, L 2 v e var ser o •Climatic or tropical bubo •Lymphogranuloma inguinale
  22. 22. Stages of infection• Primary stage (untr eated) – 3 to 30 days after incubation – Small painless papule which may ulcerate at site of inoculation: self limiting• Secondary stage – Inguinal lymph nodes (more common in males) • Painful lymphadenopathy – Necrosis in lymph nodes – may enlarge to form abscess – Acute haemorrhagic proctitis (10cm of the anorectal canal) – Fever, myalgia and headaches• Tertiary stage – Chronic inflammatory lesions typical of chlamydial infection – Scarring in genital tract – Fibrosis, lymphatic obstruction, elephantiasis – Rectal strictures and fistulae
  23. 23. Risk factor s• Adult risks – Non-white race – Multiple sexual partners – Age younger than 19 years – Non-barrier contraceptive use – Poor socio-economic conditions• Neonatal risks – Conjunctivitis – Neonatal pneumonia
  24. 24. Dif fer ential Diagnoses• Genital ulceration – Herpes simplex, syphilis, chancroid, donovanosis, non-venereal infections e.g; cutaneous leishmaniasis• Inguinal lymphadenopathy – Herpes simplex, syphilis, chancroid, bubonic plague in endemic regions, carcinoma• Proctitis – Ulcerative colitis, Crohn’s disease, rectal carcinoma
  25. 25. Chlamydia pneumoniae
  26. 26. Chlamydia pneumoniae• Chlamydia pneumophila• Pneumonia, bronchitis, sinusitis, pharyngitis, laryngitis• Variety of mild respiratory infections w/ fever, cough
  27. 27. Epidemiology• Person to person spread by respiratory droplets • no animal reservoirs known• May be common infection among children 5-14 years old • 10% of pneumonia • 5% of bronchitis • 50% antibody prevalence in adults
  28. 28. • Infects the lungs – Majority of humans are infected – All effects of disease not known • Asthma, chronic bronchitis?• Also, it has recently been linked to heart disease and atherosclerosis – organisms found in valve lesions
  29. 29. Chlamydia psittaci• Sporadic disease in humans – 100-200 cases / year in US • generally associated with contact with an infected bird – Inhalation of respiratory secretions, droppings of infected birds • organism secreted in high numbers
  30. 30. • Diagnosis of Chlamydia psittaci infection• Primarily clinical diagnosis – Acute onset febrile LRTI with hepato-splenomegaly, history of exposure to birds – Symptoms • fever, headache, malaise, muscle aches, dry hacking cough, bilateral interstitial pneumonia – Occasional systemic symptoms • myocarditis, encephalitis, hepatitis
  31. 31. Chlamydia life cycle
  32. 32. Developmental cycle• Morphologically distinct infectious and replicative forms• Stage 1. Attachment of elementary bodies (EBs) Infectious form • found in secretions • relatively resistant to environment Usual target cell • columnar epithelial cells of mucous membranes • not normally phagocytic
  33. 33. • Stage 2. Entry of EBs• Chlamydia-specific receptor mediated endocytosis• EBs enter cell within a phagosome – All development occurs here until rupture – Called an inclusion when visible
  34. 34. • Stage 3. EBs change morphologically to reticulate bodies (RBs) – 8 hours after entry – RB more permeable • metabolically active – not infectious at this stage
  35. 35. • Stage 4. Replication – RBs divide by binary fission for 20-24 hours
  36. 36. • Stage 5. RBs change back to EB form – DNA condenses – decreases in size – cell wall becomes more resistant – mature inclusion can contain hundreds of organisms
  37. 37. • Stage 6. Release of infectious EBs – both cell and inclusions lyse
  38. 38. T he Chlamydial Life Cycle
  39. 39. Dia gnosis• Cytological diagnosis – By using Giemsa, iodine or papanicolaou stains to detect chlamydial inclusions in epithelial cells• Isolation in cell culture – It is gold standard, but slow process and expensive • collect material containing columnar epithelial cells from urethra or cervix – Culture on monolayer of McCoy cell lines • incubation is for 40-72 hours – Stain with fluorescein-conjugated anti-Chlamydia monoclonal antibody after 48 hours and look for characteristic inclusions
  40. 40. Dia gnosis• Antigen detection and nucleic acid hybridization – DFA staining (direct fluorescent antibody) – ELISA – Detection of chlamydial ribosomal RNA by hybridization with DNA probe• Amplification techniques – PCR - LCR• Serology – ICT – CFT – Micro-immunofluorescence test
  41. 41. Tr eatment• Azithromycin – treatment of choice – effective against C. trachomatis and N. gonorrhoeae – well tolerated• Tetracycline, especially doxycycline• Erythromycin for pregnant women and children• No drug resistant C. trachomatis
  42. 42. Pr evention• No vaccine• Safe sex – Barrier contraceptive• Topical antimicrobials – Silver nitrate not effective – topical erythromycin• Regular Screening• Educational programs
  43. 43. Pap smear showing Chlamydia in the vacuoles 500x H&E
  44. 44. Q&A

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