Nami - Chlamydia

Chlamydia
Ni Nyoman Nami Arthisari

PPDS-1 Mikrobiologi Klinik
Pembimbing: Dr. dr. Ni Made Adi Tarini, Sp.MK(K)
Taxonomy
OPTION 1
DOMAIN : Bacteria
OPTION 2
KINGDOM : Bacteria
OPTION 3
PHYLUM : Chlamydiae
OPTION 1
CLASS : Chlamydiae
OPTION 2
ORDER : Chlamydiales
OPTION 3
FAMILY : Chlamydiaceae
OPTION 4
GENUS : Chlamydia
OPTION 5
SPECIES : Chlamydia trachomatis
4 species : C. trachomatis, C. pneumoniae, C.

psitacci, C. pecorum
Lippincott’s Illustrated Reviews: Microbiology. Third edition. Lippincott. 2001

General Characteristics
• Small obligate intarcellular paracites
• Contain DNA, RNA and ribosomes
• Extremely difficult to culture or non-culturable
• Gram Negative cell wall:
• Cell wall not well characterized
• Inner and outer membrane  MOMP (Major
Outer Membrane Protein)
• LPS  extractable
• Dependant on energy molecules
• Deficient in energy metabolism
• Family Chlamydiaceae consist of 2 genera :
1. Chlamydia : C. trachomatis
2. Chlamydophila: C. pneumonia, C. psittacii, and C.pecorum
Mahon CR, Lechman DC, Manuselis G. Textbook of Diagnostic Microbiology. 6th Edition. Elsevier : 2019.
Structure and Physiology
Elementar Reticulate
y body body
Two
morphological
forms
Dworkin M et al. The Prokaryotes 3rd ed Volume 7. Springer: 2006.
Structure and Physiology
Elementary Bodies (EB) Reticulate bodies (RB)
• Small (0.3 – 0.4 µm), • Larger (0.8 - 1 µm)
• Extracellular • Intracellular
• Rigid outer membrane, Resistant • Fragile membrane
• Non-replicating, non-metaboli- • Metabolically active
cally active • Replicating
• Infectious • Non-infectious
• Bind to columnar epithelial cells /
Macrophage
General Characteristics

Life Cycle of Chlamydia
Growth cycle involves two distinct

forms :
 Elementary body (EB) 
infectious, metabolically
active
 Reticulate body (RB) 
non infectious
Patricia M.Tille. Bailey & Scott’s Diagnostic Microbiology. Fourteenth Edition. 2017. Elsevier
Epidemiology
Chlamydia Chlamydophila Chlamydophila
trachomatis pneumoniae psittaci
Natural Hosts Humans Humans Birds, lower animal
Inhalation dried
Mode of Person to person, Respiratory droplet;
droplets from in-
transmission mother to infant person to person
fected animals
Employees in poultry, Vet-
Crowded, poor com-
erinarians,
munities, poor per- Live or work in crowded Laboratory workers,
Risk Factors sonal hygiene, inade- settings, older adults Farmers, Zoo workers
quate sanitation
Virulence Factors
• EB has an outer membrane (similar to GN) that called MOMP (major outer
membrane protein)
• MOMP  transmembrane protein that contains both species-specific and
subspecies-specific epitopes that can be defined by monoclonal antibod-
ies.
• LPS : contain ketodeoxyoctonate which is primary antigen detectable
Clinical Infections
Chlamydia trachomatis
• Biovars  biologic variants
• Trachoma
• Lymphogranuloma venerum
 Other urogenital diseases
• Serovars  serological variants
• MOMP  separated C. trachomatis into
20 serovars
• A to L

C. trachomatis Infections
LYMPHOGRANULOMA UROGENITAL
Reiter’s Syndrome : TRACHOMA VENEREUM DISEASES
Conjunctivitis,
polyarthritis, urethritis,
mucocutaneous
lesions
OFF
Chronic eye infection, Sexually transmitted ds. In Adult women :
START
Follicular conjunctivitis Bacteria enter the lymph urethritis, follicular
Lorem ipsum dolor sit amet,
withconsectetur
diffuse adipiscing
inflammation nodes near the genital cervicitis (leukorrhea
elit.
 eyelids to turn inward
Vestibulum in conset. tract & produce strong hyperthropic cervical
 Continual abrasion to inflamatory response  erosion), endometritis,
the cornea from the eye bubo formation proctitis, salpingitis, PID.
lashes scarring and Primary lesion (papule or In Adult men : NGU,
ulceration of the cornea ulcer) : penis, urethra, epididymitis, prostatitis
 blindness glans, scrotum, vaginal
wall, cervix, vulva)
C. trachomatis infection
Trachoma Lymphogranuloma venerum Urogential diseases
• Worldwide • Sexually transmitted • Females:asymptomatic
• Poverty and overcrowding • First stage : small painless (80%), cervicitis, urethri-
• Endemic: Africa, Middle vesicular lesion at infection tis, salpingitis, postpar-
East, India site, fever, headache and tum fever. Increased
• Infection of children myalgia rate: premature deliv-
• Transmission: droplets, • Second stage:inflammation ery, ectopic pregnancy
hands contaminated, of draining lymph nodes, • Males: Symptomatic
clothing, flies, contami- fever, headache, myalgia, (75%), urethritis, dy-
nated birth canal rupture and drain, procitis, suria, pyuria. Cause of
• Genital tract infections  ulcer or elephantiasis nongonococcal urethri-
STD tis (35-50%). Common
cause of postgonococ-
cal urethritis
C. trachomatis  infant pneumonia
• Associated with genital chlamydia
• Infection arises from contaminated birth canal
• Wheezing cough and pneumonia but no fever
• Often preceded by conjunctivitis  mucopurulent discharge,
corneal infiltrates, scarring can occur
• In neonates : apparent 5-12 days after birth
• Ear infection and rhinitis often accompany ocular disesase

Chlamydia pneumoniae
• Human pathogen
• Transmitted : person to person by aerosolized droplets via respiratory route
• Spread of infection is low
• Has been associated with pneumonia, bronchitis, pharyngitis, sinusitis, and flu-like
illness
• 5-10% causes Community-acquired pneumonia
BRONCHITIS FARINGITIS PNEUMONIA

SINUSITIS
Chlamydia psitacci
• Common in birds and domestic animals

• Epidemiology  endemic pathogen of all birds species  par-
rots, parakeets are a major reservoirs
• Humans acquire the disease by inhalation of birds dried
droplets  organism are deposited in the alveoli
• Clinical findings associated with this infection are diverse and
include pneumonia, severe headache, mental status changes,
and hepatosplenomegaly.
C. psittaci Infections
PSITTACOSIS ENDOCARDITIS ABORTION
OFF
START
Lorem ipsum dolor sit amet,

Incubation : 5 – 14 days
consectetur adipiscing elit.
Psittacosis (parrot
Vestibulum in conset. fever)  transmitted to human
Natural reservoir : birds (ornithosis), cow, sheep, goat
infection by respiratory tract and spread to RE cells of liver & spleen 
multiply  focal necrosis
Laboratory Diagnosis
Direct Microscopic Examination
Cell Culture
Immunoassays
Nucleic Acid Hybridization and Amplification Assays
Direct Microscopic Examination
• Cytologic examination  cell

scrapings from the conjunctiva of
newborns or persons with ocular
trachoma  to detect C. tra-
chomatis inclusions (Giemsa
stain)
• C. trachomatis infections  DNA
amplification performed on urine
specimens (High sensitivity and
specificity)

Cell Culture
• Gold standard
• Has been limited:
• Inherent technical complexity; Time and specimen handling requirements; Expense, and
labile nature of the organism
• Although its specificity approaches 100%, the sensitivity of culture has been estimated at between
70% and 90%
• The cell lines commonly used: McCoy, HeLa, and buffalo green monkey kidney cells lines
Immunoassay
• Enzyme Immunoassay (EIA)
 detected chlamydial antigen
(LPS)
• Direct Fluorescence Antibody
(DFA)  methods use fluores-
cein-isothiocyanate conjugated
monoclonal antibodies to ei-
ther MOMP or LPS  to de-
tect elementary bodies
Antibody Detection
• Complement-fixation (CF)  detect antibodies to a genus-spe-

cific antigens  titer greater than 1:64  LGV
• Micro Immunofluoresence Assay (Micro-IF)  used to detect
antibodies  high titer of IgM (1:32)  recent infection ; IgG
titer greater than or equal 1:16 but less 1:512  past infection
exposure
Nucleic Acid Hybridization and Amplification Assays
• Two hybridization tests were commercially developed for the detection
of Chlamydia, Gen-Probe PACE 2C (Hologic-Gen-Probe, San Diego,
CA) and Digene Hybrid Capture II assay
• Nucleic Acid Amplification Tests (NAATs) : Polymerase Chain Reac-

tion (PCR), Stand Displacement Amplification (SDA), Transcription-me-
diated Amplification (TMA)  Detect organism-specific DNA or RNA
To detect C. pneumonia :
Specimens collected from sputum, bronchial lavage
fluid, nasopharyngeal aspirates, throat washings, and
throat swabs
 C. pneumoniae may be cultured on selected cell
lines and visualized with fluorescein-conjugated
monoclonal antibodies. Human cell lines
including HEp-2 are the most sensitive.
 Monoclonal antibodies specific for C.
pneumoniae are used to identify inclusions in cell
culture.
 Isolation of C. psittaci in culture, although

diagnostic, is difficult, dangerous, and not
routinely used.
 Therefore almost all diagnoses of C. psittaci are
based on serologic evaluation
Therapy & Prevention
Chlamydophila Chlamydophila
Chlamydia trachomatis
pneumoniae psittaci
Treatment with tetracy-
Azithromycin, doxycycline, cline, doxycycline, Tetracycline is the drug of
erythromycin and other macrolides, fluoro-
Therapy choice for psittacosis.
macrolide antibiotics, tetracy- quinolones, and ery-
clines, and fluoroquinolones. thromycin
has been successful.
Behavioral changes to prevent Avoiding aerosolized Treating infected birds or
chlamydial urogenital infec- droplets from infected by quarantining imported
Prevention tions. By identifying and
people. birds for a month
treating persons with genital
chlamydia.
References
• Lippincott’s Illustrated Reviews: Microbiology. Third edition.

Lippincott. 2001
• Mahon CR, Lechman DC, Manuselis G. Textbook of Diagnostic Mi-
crobiology. 6th Edition. Elsevier : 2019.
• Patricia M.Tille. Bailey & Scott’s Diagnostic Microbiology. Four-
teenth Edition. 2017. Elsevier
• Dworkin M et al. The Prokaryotes 3rd ed Volume 7. Springer: 2006.
Mode of Transmission C. pneumoniae
Chlamydia pneumoniae probably is a strictly human
pathogen that is transmitted by respiratory droplets.
Dworkin M et al. The Prokaryotes 3rd ed Volume 7. Springer: 2006
Levinson W. Review of Medical Microbiology and Immunology 14 th ed. California. McGraw Hill: 2016
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Chlamydia

Ni Nyoman Nami Arthisari

SPECIES : Chlamydia trachomatis

4 species : C. trachomatis, C. pneumoniae, C.

Lippincott’s Illustrated Reviews: Microbiology. Third edition. Lippincott. 2001

Lippincott’s Illustrated Reviews: Microbiology. Third edition. Lippincott. 2001

Growth cycle involves two distinct

Natural Hosts Humans Humans Birds, lower animal

Lippincott’s Illustrated Reviews: Microbiology. Third edition. Lippincott. 2001

Dworkin M et al. The Prokaryotes 3rd ed Volume 7. Springer: 2006.

BRONCHITIS FARINGITIS PNEUMONIA

• Common in birds and domestic animals

PSITTACOSIS ENDOCARDITIS ABORTION

Lorem ipsum dolor sit amet,

Direct Microscopic Examination

Nucleic Acid Hybridization and Amplification Assays

• Cytologic examination  cell

Lippincott’s Illustrated Reviews: Microbiology. Third edition. Lippincott. 2001

• Complement-fixation (CF)  detect antibodies to a genus-spe-

• Nucleic Acid Amplification Tests (NAATs) : Polymerase Chain Reac-

 Isolation of C. psittaci in culture, although

• Lippincott’s Illustrated Reviews: Microbiology. Third edition.

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