Chlamydia Dr Hala AlDaghistani 1 Chlamydia is a

Chlamydia Dr. Hala Al-Daghistani 1

• Chlamydia is a genus of pathogenic bacteria that are obligate intracellular parasites of mammals and birds. • Classification – order chlamydiales – contains one medically important genus – chlamydia • Chlamydia infections are the most common bacterial Sexually transmitted diseases in humans and are the leading cause of Infectious blindness worldwide. • Reported rates 3 times higher in females than in males. • contain DNA and RNA, and ribosomes, lack ATP, biosynthetic pathways, non motile. Multiply in the cytoplasm of the host cell. Three important spp. , Ø C. trachomatis Ø C. psittaci Ø C. pneumoniae 2

Transmission • Transmission is sexual, RT, or vertical • Highly transmissible • Incubation period 7 -21 days • Significant asymptomatic reservoir exists in the population • Re-infection is common • Perinatal transmission (relating to the time, immediately before and after birth) results in neonatal conjunctivitis in 30%-50% of exposed babies 3

Have a complex developmental cycle The infectious form is called an Elementary Body (EB) which is ) circular in form and is taken into the cell by induced phagocytosis. Inside the phagocytic vesicle replication takes place. Over the next 6 -8 hours, the EB reorganizes into the noninfectious, but metabolically active Reticulate Body (RB) which is larger and less dense than the EB. For 18 -24 hours the RB synthesized new materials and divides by RB binary division to form Inclusion Bodies that reorganize and Inclusion Bodies condense into EBs Between 48 -72 hours, the cell lyses and releases the EB which begin the cycle again.

• 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. 5

Chlamydia inclusion bodies

Chlamydiaceae Family Species (genus) C. Trachomatis (many serotypes) C. Pneumoniae (TWAR) Taiwan acute Disease Trachoma, NGU, PID, neonatal conjunctivitis, inclusion conjunctivitis, Infant pneumonia, LGV Pharyngitis, Bronchitis, Pneumonia respiratory agent C. psittaci (many serotypes) Psittacosis(influenza-like illness) 8

Clinical significance. Chlamydia trachomatis 1 - Genital tract infection– is sexually transmitted and frequently found concomitantly with N. gonorrhoeae (In males symptoms include urethritis, dysuria and it sometimes progresses to epididymitis; In females symptoms include mucopurulent cervical inflammation which can progress to salpingitis and PID). - Inclusion conjunctivitis –occurs in both newborns and adults and a genital tract infection is the source of the infection. - Newborns are infected during the birth process, with a mucopurulent discharge. - In adults causes an acute follicular conjunctivitis with little discharge (autoinoculation). - Trachoma, greatest cause of blindness in underdeveloped countries. (Transmission is by direct contact, flies, and in poor, less developed countries, children may be infected in the first three months of life. - Lymphogranuloma venereum (LGV) is a venereal disease that occurs in poor, tropical areas. painless lesion occurs at the site of entry with symptoms of regional suppurative lymphadenopathy (buboes)

Inclusion conjunctivitis - foreign body sensation - watery eyes - eyelids that stick together -Large follicles may be seen if the lower lid is pulled down. Trachoma The inside of the eyelid can become so severely scarred that causes the eyelashes to rub against the eyeball, impairment breakdown and scarring of the cornea, resulting in constant pain and light intolerance Left untreated, leads to visual and eventual blindness 10

Chlamydia psittaci naturally infects avian species causing mild to severe illness (affect bird beak, eyes, RT, GIT, feathers). In man causes psittacosis( parrots fever, ornithosis) and is acquired by contact with an infected animal. Infection can range from subclinical to fatal pneumonia. Most commonly causes an Atypical pneumonia with fever, chills, dry cough, headache, sore throat, nausea, and vomiting. Chlamydia pneumoniae This bacterium was recognized as a Resp. pathogen, after isolation from 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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Pathogenesis - Chlamydiae have a hemagglutinin that may facilitate attachment to cells. - An endotoxin-like toxin has been described. Laboratory Diagnosis • Culture • Non-culture tests – Nucleic Acid Amplification Tests – Non-Nucleic Acid Amplification Tests including Direct fluorescent antibody (DFA) – Nucleic acid hybridization (NA probe) – Serology (EIA) Enzyme immunoassay. 13

Prevention • Nature of the infection – Chlamydia is commonly asymptomatic in men and women. – In women, there is an increased risk of upper reproductive tract damage with re-infection. • Transmission issues – Abstain from sexual intercourse until partners are treated for 7 days after a single dose of azithromycin 14