Chlamydia, Rickettsia, and

Similar Organisms

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1
Comparative Properties of Microorganisms

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2
General Characteristics of Chlamydiae

• Obligate intracellular parasites

• Two forms
• Elementary body (EB)
• Infectious
• Major outer membrane protein (MOMP)
• Detected by monoclonal antibodies
• Reticulate body (RB)
• Noninfectious

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3
General Characteristics

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4
Life Cycle of Chlamydia Organisms

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5
Reticulate and Elementary Bodies

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Chlamydia trachomatis

• Three biovars
• Trachoma, lymphogranuloma venereum, mouse pneumonitis
• Obligate intracellular pathogenic bacteria
• Symptoms of trachoma biovar
• Urethritis with purulent discharge
• Cervicitis, salpingitis (inflammation of fallopian tubes)
• Eye infections: conjunctivitis and scarring of the eye (mechanical
deforming of eyelashes)
• Neonatal: eye infections and pneumonia

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7
Human Diseases Caused by Chlamydiaceae
Species

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8
Conjunctival Scarring and Hyperendemic
Blindness

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Lymphogranuloma Venereum (LGV)

• C. trachomatis serovars L1, L2, L2a, L2b, and L3

• LGV
• Also linked to Parinaud oculogladular conjunctivitis
• Survive in mononuclear cells
• Bubo formation then can rupture lymph node
• Uncommon in the United States
• Tropics and subtropical areas abroad

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10
Inguinal Swelling and
Lymphatic Drainage

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Other Urogenital Diseases

• Majority of infections are asymptomatic

• Serovars D through K
• Men
• Nongonococcal urethritis (NGU)
• Epididymitis
• Prostatitis
• Conjunctivitis

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Other Urogenital Diseases (Cont.)

• Serovars D through K (cont.)

• Women
• Urethritis
• Folicular cervicitis
• Endometritis
• Proctitis
• Salpingitis
• Pelvic inflammatory disease (PID)
• Perihepatitis
• Reiter syndrome
• Urethritis, conjunctivitis, polyarthritis, and mucocutaneous lesions

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Chlamydia Infection in the Newborn

• Conjunctivitis
• Nasopharyngeal infection
• Pneumonia
• Otitis media
• Less frequent
• Erythromycin eyedrops are used to prevent eye infections.

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Inclusion Conjunctivitis in the Neonate

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Laboratory Diagnosis

• Test selection depends of the following factors

• Knowledge of population at risk
• Capability and facilities available for testing
• Cost of assays
• Ability to batch specimen types
• Experience of the laboratory scientist

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Laboratory Diagnosis (Cont.)

• Specimen
• Dacron, rayon, calcium alginate swabs scraping mucosa
• Wooden shafts are toxic; use plastic or metal.
• Need scraping; discharge not enough
• First morning urine and vaginal swabs are excellent specimens.

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 Appropriate Specimens for Detection
of Chlamydial Infections

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Laboratory Diagnosis (Cont.)

• Direct detection
• Cytologic methods of trachoma and inclusion conjunctivitis
• Technically demanding but sensitive
• Antigen detection
• Enzyme-linked immunosorbent assays (ELISAs), direct fluorescent antibody (DFA) from
swabbed material transferred to slide
• McCoy, HEp-2, HeLa, and buffalo green monkey kidney cell cultures: “gold
standard”
• Shell vials usually in conjunction with DFA staining
• Serology
• Molecular methods
• DNA probes
• Nucleic acid amplification tests

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Cytologic Endocervical Specimens for C.
trachomatis

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Antibody Detection

• Micro-immunofluorescence
• Infections of the upper genital tract
• Would not be detected in cultures or swabs
• Antibodies still present
• Complement fixation
• Helpful in identification of LGV

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 Appropriate C. trachomatis Assays for
Selected Patient Population

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Detection Capabilities of
Various Methods

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 Detection of Chlamydia Species by Various
Serologic Methods

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Results Reporting

• Agree in advance with obstetrics/gynecology (OB/GYN) and

emergency departments on test profiles
• Report test performed and not performed
• Report unusual observations
• Pure cultures of pseudomonas, Haemophilus,
N. meningitidis, and yeast

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Chlamydophila pneumoniae

• Formerly Chlamydia sp., strain TWAR

• 10% of world’s pneumonia
• Diseases
• Acute respiratory disease
• Pneumonia
• Pharyngitis and otitis media
• Risk factor for Guillain-Barré syndrome (GBS)
• Also possible relationships
• Sarcoidosis, asthma, and cardiovascular disease
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 Summary of Epidemiologic and Clinical
Features

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C. pneumoniae

• Clinical picture
• Biphasic clinical course
• Phase 1
• Sore throat and hoarseness
• 5 to 7 days
• Flulike lower respirator tract symptoms
• 8 to 15 days
• Phase 2
• Pneumonia and bronchitis

• Third most common cause of infectious respiratory disease

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Who to Evaluate for
C. pneumoniae

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 Laboratory Diagnosis
• Specimens
• Sputum
• Bronchoalveolar lavage (BAL)
• Nasopharyngeal aspirates
• Throat washings and swabs
• Culture
• Human lines and Hep-2
• Detect via monoclonal antibody
• Serology
• Microimmunofluorescence (MIF)
• ELISA
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 Detection of C. pneumoniae by Fluorescent
Antibody

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Chlamydophila psittaci

• Formerly Chlamydia psittaci

• Bird chlamydia
• Parakeets, turkey, other psittacine birds
• Parrot fever or psittacosis
• Causes pneumonia in humans
• Usually mild chronic pneumonia
• Can culture
• Not recommended
• Serology
• Current method of choice

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Rickettsiae
• Rickettsiae and Orienta
• Obligate intracellular bacteria
• Gram-negative bacilli (0.8-2.0 µm by 0.3-0.5 µm)
• Grow in cell lines
• Most are arthropod-borne
• Transmission
• Transovarial transmission in ticks
• Infection through feeding
• Exception
• R. prowazekii
• Humans are reservoir
• Transmitted by body lice

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Spotted Fever Group

• Rocky Mountain spotted fever (RMSF)

• R. rickettsii
• Humans are accidental hosts
• Usually transmitted by D. variabilis and D. andersoni ticks

• Clinical manifestations
• Flulike symptoms
• Fever, headache, myalgia, nausea, and vomiting
• Rash
• Erythematous patch on ankles or wrists
• May extend to hands and soles of the feet but not the face

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 Dorsal View of
Dermacentor variabilis

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Boutonneuse Fever

• Mediterranean spotted fever

• Reservoirs include ticks and dogs
• Similar to RMSF
• Rash involves the palms and soles of the feet and the body and face
• Taches noires
• Black spots at primary site of infection

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Typhus Group

• Endemic typhus
• Also known as murine typhus
• R. typhi
• Epidemic louse-borne typhus
• Primarily in Africa and Central and South America
• Also known as Brill-Zinsser disease
• R. prowazekii

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37
Female Head Louse

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Murine Typhus

• Vector
• Oriental rat flea: Xenopsylla cheopis
• Cat flea: Ctenocephalides felis
• Reservoir
• Rat and transovarian transmission
• Infection
• Occurs when flea defecates on skin
• Scratching infects the bite.
• Symptoms
• Fever, headache, and rash
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Epidemic Louse-Borne Typhus

• Vector
• Human louse: Pediculus humanus
• Squirrel flea: Orchopeas howardii
• Squirrel louse: Neohaematopinus sciuriopteri
• Occurs in areas of sanitation disruption
• Infection
• Defecates into the bite wound via scratching
• Symptoms
• Rash affects the body, including the face
• Recrudescent typhus
• Lies dormant in lymph tissue and reactivates occasionally
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Rickettsialpox

• R. akari
• Reservoir is the common house mouse
• Vector is the mouse mite Liponyssoides sanguineus
• Clinical manifestations
• Papule forms at bite and progresses to a pustule
• Pustule becomes an indurated eschar
• Other symptoms
• Headache, nausea, and chills
• Rash on face, trunk, and extremities but not palms or soles

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Scrub Typhus

• Causative agent is Orientia tsutsugamushi

• Vector
• Chigger: Leptotrombidium deliensis
• Transovarial transmission between chiggers
• Reservoir
• Rat
• Symptoms
• Tache noire at the site of inoculation
• Fever, headache, and rash that does not involve the palms, the soles of the
feet, or the face
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Family Anaplasmataceae

• Genera Ehrlichia, Anaplasma, Neorickettsia

• Ehrlichia
• Dogs infected with brown dog ticks died.
• Rickettsial-like inclusions in the monocytes

• Human ehrlichiosis
• Many are asymptomatic.
• Fever, headache, malaise, and myalgia but may have nausea, vomiting,
diarrhea, cough, joint pains, confusion, and occasionally rash

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Morulae

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Ehrlichia chaffeensis

• Human monocytic ehrlichiosis (HME)

• E. ewingii produces indistinguishable disease
• Natural hosts
• Dogs, deer, and humans
• Primary vector
• Lone star tick: A. americanum

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HME
• Many are asymptomatic.
• Fever, headache, malaise, and myalgia but may have nausea, vomiting,
diarrhea, cough, joint pains, confusion, and sometimes rash
• Can have leukopenia and neutropenia, thrombocytopenia, and elevated liver
enzymes
• Severe complications possible
• Toxic shock-like syndrome, central nervous system (CNS) involvement, acute
respiratory distress syndrome (ARDS)
• Nucleic acid amplification testing
• Most frequent of detection
• Serology
• Indirect fluorescent antibody (IFA)

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Human Granulocytic Anaplasmosis

• Anaplasma phagocytophilum
• Incubation period 5 to 11 days with similar symptoms to HME
• Endemic to upper Midwest and Northeast United States
• Rarely have a rash
• Morulae in granulocytes
• Reservoirs
• Deer, rodents, horses, cattle, and humans
• Vectors
• Ixodes scapularis
• Ixodes pacificus

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 Coxiella

• Coxiella burnetii
• Causative agent of Q fever (Query fever)
• Potential bioterror agent
• Reservoirs
• Cattle, sheep, goats, dogs, cats, deer, fowl, and humans
• Exposure in vet or animal handlers
• Inhalation of dried birthing fluids or ingestion of unpasteurized milk

• Symptoms
• Only half of infections are symptomatic.
• Acute influenza-like illness
• Prolonged fever, headaches, cough, myalgia, and arthralgia

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Coxiella (Cont.)

• Laboratory diagnosis
• DFA of infected tissue
• Nucleic acid amplification testing
• Highly contagious, so culture only in biosafety level 3 (BSL3)
• EIA kits

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