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

Bronchitis
Pneumonia

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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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C trachomatis elementary bodies

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C trachomatis inclusions
Glycogen Inclusions

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Subgroups

Subgroup A Mammalian parasites Compact inclusions Glycogen synthesized Folates synthesized

Sensitive to D-cycloserine

Subgroup B Primarily bird parasites Diffuse inclusions Glycogen not synthesized Folates not synthesized
Resistant to D-cycloserine

Restricted host range Chlamydia trachomatis

Broadening of host range 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

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Antibiotic prophylaxis: erythromycin, tetracycline.

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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 1015 years of age.

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Trachoma

Almost six million people have become blind and another 540 million almost 10% of the worlds population are at risk
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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 23

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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

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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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LGY: "Groove sign"

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

R Roberts MD 31

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LGV: Microscopy

lymph node shows both necrosis and granulomatous reaction (dimorphic necrotizing granulomatous reaction)

R Roberts MD 32

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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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Transmission
Person-to-person transmission by respiratory secretions. Risk Groups All ages at risk but most common in schoolage 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, urethral, cervical, rectal:

Azithromycin 1 gm x 1 dose Doxycycline 100 mg BID for 7 days Ofloxacin 300 mg po BID for 7 days Erythromycin 500 mg QID for 7 days Amoxacillin 500 mg TID 7-10 days

Children < 45 kg, urogenital & rectal:

erythromycin 50 mg/kg/day in 4 doses for 10-14 days

Neonates (ophthalmia, infants born to infected mothers):

erthromycin 50 mg/kg/day in 4 doses for 10-14 days
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Chlamydia Antigens
Antigens: group specific & species specific Major outer membrane protein (cysteine-rich) Eucaryotic cell binding protein Host response: damage to specific tissues

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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 antichlamydia 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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