Chlamydial and

Reckittseal infection
Mustafa Nema
Baghdad College of Medicine
2020
Objectives
• Identify the types of Chlamydial and Reckittseal infections.
• Illustrate clinical presentation scope of such infections.
• Outline investigations needed for these infection.
• Outline treatment and prevention plan.
Chlamydial infections
Introduction
There are three types of chlamydia infections:
Organism Disease caused
Chlamydia trachomatis • Trachoma
• Cervicitis, urethritis, proctitis
• Lymphogranuloma venereum

Chlamydia psittaci Psittacosis

Chlamydia pneumoniae • Atypical pneumonia
• Acute/chronic sinusitis
 A. Chlamydia trachomatis

• A common sexually transmitted disease (STD).

• Most people with chlamydia are asymptomatic and do not
seek testing.
• Chlamydia is most common among young people.
Diseased caused by Chlamydia trachomatis

1. Eye (Trachoma)
2. Genital organs infection: Cervicitis, urethritis, proctitis
3. Lymphogranuloma venereum
1. Trachoma
A chronic keratoconjunctivitis caused by
Chlamydia trachomatis, and is the most
common cause of avoidable blindness.
• The classic trachoma environment is
dry and dirty, causing children to have
eye and nose discharges.
• Transmission occurs through flies,
fingers and within families.
• In endemic areas, the disease is most
common in children.
Pathology and clinical features
• The onset is usually insidious.
• Early symptoms include
conjunctival irritation and
blepharospasm.
• The early follicles are
characteristic.
• Scarring causes inversion of the
lids so that the lashes rub against
the cornea.
• The cornea becomes vascularized
and opaque. The problem may not
be detected until vision begins to
fail.
 Investigations
• Conjunctival scrapings for
staining with iodine or
immunofluorescence.

• Chlamydia may be isolated

with culture.
Rx.. • A single dose of azithromycin
(20 mg/kg)
superior to:
• 6 weeks of tetracycline eye
ointment twice daily for
individuals in mass treatment
programmes.

• Deformity and scarring require

surgical treatment.
Prevention
• Personal and family cleanliness should be improved.
• Proper care of the eyes of newborn and young children is
essential.
• Family contacts should be examined.
2.Genital organs involvement
Chlamydial infection in men
• Chlamydia is transmitted and presents in a similar way to
gonorrhoea; however, urethral symptoms are usually
milder and may be absent in over 50% of cases.
• Burning with urination, blood in the urine, urinary urgency,
and increased urinary frequency can occur if the urethra
is infected.
• Conjunctivitis may developed;
• Pharyngitis does not occur.
• The incubation period varies from 1 week to a few months.
• Without treatment, symptoms may resolve but the patient
remains infectious for several months.
• Complications, such as epididymoorchitis and Reiter’s
syndrome, or sexually acquired reactive arthropathy
(SARA), are rare.
Chlamydial infection in women
• The cervix and urethra are commonly
involved.
• Infection is asymptomatic in about 80%
of patients but may cause dysuria,
vaginal discharge/ bleeding.
• Some infections may clear spontaneously
but others persist.
• Untreated chlamydia may increase a
person’s chances of acquiring or
transmitting HIV for both male and
female.
• Pelvic inflammatory diseases (PID),
with the risk of tubal damage and
subsequent infertility or ectopic
pregnancy, is a rare but important
long-term complication.

• Perinatal transmission may lead to

‘ophthalmia neonatorum’ and/or
pneumonia in the neonate.
3.Lymphogranuloma venereum
 B. Chlamydia pneumoniae
• Chlamydia pneumoniae
infection is a type of atypical
bacterial pneumonia that is
characterized by relatively
long incubation periods (3 to 4
weeks) and a wide spectrum
of clinical symptoms.
Transmission
• Close person-to-person contact by airborne droplets.
• Has a higher incidence in elderly adults; this is in contrast
to Mycoplasma pneumoniae infection, which occurs most
commonly in younger age groups.
Chlamydia pneumoniae presented with

• Laryngitis
• Pharyngitis
• Coryza
• Malaise
• Fever
• Cough
• Headache
• Since the diagnosis of C. pneumoniae is often not
established, treatment commonly begins with empiric
therapy for atypical pneumonia.
• Extrapulmonary manifestations including:
• Meningoencephalitis
• Guillain-Barré syndrome
• Reactive arthritis
• Myocarditis
C. Chlamydophila psittaci
• Cause psittacosis
• Contracted from infected parrots and
pigeons.
• Infected birds shed the bacteria through
feces and nasal discharges, which can
remain infectious for several months.

Signs and symptoms

• In humans, the symptoms of the disease
range from inapparent illness to systemic
illness with severe pneumonia.
• It presents chiefly as an atypical
pneumonia.
• In the first week: mimic typhoid fever
with high fevers, joint pains, diarrhea,
and low level of WBC in the blood

• The second week: acute bacteremic

pneumococcal pneumonia with
continuous high fevers, cough and
dyspnea.
• X-rays show patchy infiltrates or a
diffuse whiteout of lung fields.
Rickettsial infection
Rickettsial fevers

• The rickettsial fevers are the most common tick-borne

infections.
• It is important to ask potentially infected patients about
contact with ticks, lice or fleas.
• There are two main groups of rickettsial fevers: spotted
fevers and typhus.
Pathogenesis
• The rickettsiae are intracellular Gram-
negative organisms which parasitise the
intestinal canal of arthropods.
• Bacteria invade endothelial cells, cause
vasculitis & systemic illness, thrombosis and
purpura.
• An eschar, a black necrotic crusted sore,.
This is due to vasculitis following
immunological recognition of the inoculated
organism. Tick bites

• Regional lymph nodes often enlarge.

• The brain and lungs are the major target
organs.

Eschar
 Spotted fever group

Rocky Mountain spotted fever:

• Rickettsia rickettsii is transmitted by tick bites.
• In USA
• The incubation period is about 7 days.
• The rash appears looking at first like measles,
but in a few hours a typical maculopapular
eruption develops.
• The rash spreads from wrists, forearms and
ankles to the back, limbs and chest, and then
to the abdomen, where it is least pronounced.
• Larger cutaneous and subcutaneous
haemorrhages may appear in severe cases.
• The liver and spleen become palpable.
• At the extremes of life, the mortality is 2–12%.
 Typhus group

Scrub typhus fever

• Scrub typhus is
caused by Orientia
tsutsugamushi
(formerly Rickettsia
tsutsugamushi),
transmitted by mites.
• It occurs in the Far
East.
• Mild or subclinical
cases are common.
 Epidemic (louse-borne) typhus
• Epidemic typhus is caused by R. prowazekii and is
transmitted by infected faeces of the human body louse,
usually through scratching the skin.
Endemic (flea-borne) typhus
• Flea-borne or ‘endemic’ typhus caused by R. typhi is
endemic worldwide.
Clinical features of typhus fever
• The onset of symptoms is usually sudden, with headache
(often retro-orbital), fever, malaise,, the general symptoms
increase, with apathy and prostration.
• An erythematous maculopapular rash appear with
generalized painless lymphadenopathy.
• The rash fades by the 14th day.
• The temperature rises rapidly and continues as a remittent
fever with sweating until it falls on the 12th–18th day.
• In severe infection, the patient is prostrate with cough,
pneumonia, confusion and deafness. Cardiac failure, renal
failure and haemorrhage may develop.
• Convalescence is often slow and tachycardia may persist
for some weeks.
Investigation of rickettsia infection

• Routine blood investigations are not diagnostic but malaria

must be excluded by blood film examination in most cases,
and there is usually hepatitis and thrombocytopenia.
• Diagnosis is made on clinical grounds and response to
treatment, and may be confirmed by antibody detection or
PCR in specialized laboratories.
Differential diagnoses of rickettsia
infection include
• Malaria
• Typhoid
• Meningococcal sepsis
• Leptospirosis.
Management of rickettsial fevers

The different rickettsial fevers vary greatly in severity but all

respond to:
• Tetracycline 500 mg 4 times daily, or
• Doxycycline 200 mg daily or
• Chloramphenicol 500 mg 4 times daily.

Duration of Rx 7 days
• Nursing care is important, especially in epidemic typhus.
• Sedation may be required for delirium and blood
transfusion for haemorrhage.
• To prevent rickettsial infection, lice, fleas, ticks and mites
need to be controlled with insecticides.
References
• Davidson principle and practice of medicine 22th ed 2014
• Center of disease control http://www.cdc.gov
• World health organization http://www.who.int/en