CHLAMYDIAE
Dr. Aye Mi San
Assistant Lecturer
Chlamydiae
• Gram negative bacteria
• Intracellular bacteria
• Cannot synthesize ATP
• Use host’s ATP called energy parasite
MORPHOLOGY
2 forms
• Elementary body
- 0.3 µm
- highly infectious form
- extracellular
• Reticulate body
- 0.5 - 1µm
- replicative form, not infectious
- intracellular
CLASSIFICATION of Chlamydiae
A. Chlamydia trachomatis
B. Chlamydia pneumoniae
C. Chlamydia psittasi
D. Chlamydia picorum
A. Chlamydia trachomatis A, B, Ba, C
Trachoma
Chlamydia trachomatis D-K
Genital infection
Respiratory tract infections
Inclusion conjunctivitis in adults
& inclusion blenorrhoea in newborn
Chlamydia trachomatis L1-L3
Lymphogranuloma venereum (LGV )
• B. Chlamydia pneumoniae acute respiratory tract
infection
• C. Chlamydia psittasi respiratory tract infection
in man
Ornithosis in birds
• D. Chlamydia picorum pathogenic role not clear
Trachoma
• Chronic conjunctivitis that begins with acute
inflammation of conjunctiva and cornea, progress
to scarring and blindness
AETIOLOGY
• Causal organism - Chlamydia trachomatis serovars
A, B, Ba, C
• Infective form - elementary body
• Stain
- Giemsa stain: EB purple
RB blue
- Immunofluoresence stain
- Lugol’s iodine stain: inclusion body brown
• Cultivation
- Cyclohexamide treated McCoy cell culture
(from mouse)
PATHOGENESIS
• IP: 3-10 days
Clinical features
• Early symptoms – lacrimation, mucopurulent
discharge, conjunctival
hyperaemia , follicular
hypertrophy, pannus formation
• Later – conjunctival scarring, eyelid deformities
• Secondary bacterial infection ( + ) blindness
Trachoma: inflammation in the conjunctiva &
inner eyelid
LABORATORY DIAGNOSIS
• Specimen : upper tarsal conjunctival scraping
• Stain : * Giemsa stain
- EB purple
- RB body blue
- inclusion body compact dark purple
mass near the nucleus
* Lugol’s iodine stain
- IB brown
* IF stain with specific Ab
- IB stains bright
• Tissue culture
Cyclohexamide treated McCoy cell culture
Sensitivity – 90%
• Ag detection test
- Used in diagnosis and screening of STD
- Direct fluorescent Ab test using fluorescent tagged
Ab
- ELISA
• DNA amplification - PCR
• Serology - IF test detects antibody
IMMUNITY
- No long lasting immunit.
- Repeated infection can occur.
TREATMENT
Sulphonamide, erythromycin, tetracycline
EPIDEMIOLOGY
• Prevalent in Africa, Asia, Mediterranean basin
• >400 billion people infected, 20 millions are blinded
• Source - patient
• MOT - indirect contact - fingers and fomites
- vector-borne transmission
- on the legs & in the probocis of
house fly
• Predisposing factors
- Poor hygiene, shortage of water supply,
crowded living condition
PREVENTION & CONTROL
• Cases: - early diagnosis & treatment
• Personal: - observation of personal cleanliness
- health education
• Community: - sufficient water supply
- housefly control
- health education
• Vaccine: experimental & not effective
Genital chlamydial infections &
Inclusion conjunctivitis
• Causal organism – Chlamydia trachomatis D - K
GENITAL INFECTIONS
• MOT – sexual contact
• Clinical features
- Male - non gonococcal urethritis(NGU),
- epididymitis
- Female - urethritis, cervicitis, salpingitis, PID,
sterility & ectopic pregnancy
- S/S - asymptomatic
- dysuria, nonpurulent discharge,
urinary frequency
INCLUSION CONJUNCTIVITIS
• MOT
- Adult - by self inoculation of genital secretions
- by contamination (swimming pool
conjunctivitis)
- Newborn - through infected birth canal
- Mucopurulent conjunctivitis
- begins 7-12 days after delivery
Inclusion conjunctivits
LABORATORY DIAGNOSIS
• Specimen - discharge and secretion from cervix,
- swab or cytology brush (endocervix,
vagina, urethra & conjunctiva)
• Antigen detection
- DFA - detect species-specific Ag on outer
membrane protein by using monoclonal
antibody
- ELISA - detect genus-specific LPS
• Nucleic acid detection
- PCR, LCR
• Serology
- detect Ab in serum & genital secretions
• TREATMENT
- both partners and babies to prevent re-infection
- Drugs: Tetracycline, Erythromycin,
azithromycin
• PREVENTION & CONTROL
(a) Genital infections
- early diagnosis & treatment
- avoid sexual promiscuity
- use of condom
(b) Neonatal IC: diagnosis & treatment of pregnant
women and her sex partner
RESPIRATORY TRACT INFECTION
• Causal organism - Chlamydia trachomatis D - K
• Newborns pneumonia
• Adults upper respiratory tract infections
- pharyngitis
- otitis
- nasal obstruction
Newborns
- Newborn with inclusion conjunctivitis develop
pneumonia 2-12 weeks after birth
• Clinical features
- Tachypnea, paroxysmal cough, fever (-)
• Diagnosis
- Isolation of organism from respiratory secretions
- IgM Ab to C. trachomatis – 1 : 32 or more
Adults - patients with inclusion conjunctivitis
develop otitis, pharyngitis & nasal
obstruction
Lymphogranuloma Venereum
( LGV )
• Causal organism - Chlamydia trachomatis L1 - L3
• MOT – sexual transmission
• Clinical features
- Papule or vesicle at the site of exposure (external
genitalia, anus & rectum)
- Male - inguinal L/N enlargement, multiple sinus
tracts
- Female - perirectal L/N enlargement, proctitis,
bloody or mucopurulent discharge
- Meningitis, arthritis
LABORATORY DIAGNOSIS
• Specimen – pus, bubo aspirate, biopsy material
• Stain – Giemsa stain , IF stain
• Culture - McCoy cell culture
• Serology – CF
• FREI test – skin test(delayed type hypersenstivity )
EPIDEMIOLOGY
• MOT- sexual contact
• Source – persons with chronic genital infection
• Air borne infection in lab personnel exposed to
aerosol of C. trachomatis L1- L3
PREVENTION & CONTROL
• Avoid sexual promiscuity
• Use mechanical prophylaxis - condom
• Early diagnosis & treatment
Chlamydia pneumoniae &
Respiratory infections
• Previously known as TWAR agent
• Only one serovar
• Human are only host
Clinical features
- mostly asymptomatic
- pharyngitis, sinusitis, otitis media
• Atypical pneumonia – 5-20% of community
acquired pneumonia
• Spread from to person to person
LABORATORY DIAGNOSIS
• Specimen – pharyngeal swab
• Stain – not sensitive
• Culture
- cyclohexamide treated Hela & Hep-2 cell at
35°C for 3 days
detect inclusion bodies by fluorescent Ab
stained with specific monoclonal Ab
• Serology – micro-immunofluorescent test
EPIDEMIOLOGY
• Infection is common , endemic & epidemic
• Association with atherosclerosis & myocardial
infarct
- monocytes & macrophages infected with
C. pneumoniae are carried into the blood
stream burrow into the arterial tissue
organism is transferred into the cells lining
the arterial wall attract more macrophages
inflammation, formation of plaques,
blood clot ischaemia necrosis of heart
muscles Infarct
Chlamydia psittasi & Psittacosis
• Causal agent - Chlamydia psittasi
• Psittacosis in man & ornithosis in birds
• Infection in birds involves the intestinal tract.
Organisms are shed in faeces spread by aerosol
• MOT - by inhalation
- by handling of infected tissue
• High risk group - bird fanciers, pet shop workers,
farm workers
• Occupational disease
CLINICAL FEATURE
• IP – 10 days
• Transient influenza like disease
• Serious pneumonia
LABORATORY DIAGNOSIS
• Specimen – blood, sputum
• Culture – cell culture, embryonated egg, mice
• Serology – CF
IMMUNITY
- Incomplete, carriers (+ )
TREATMENT
- Tetracycline
PREVENTION & CONTROL
• Control of bird shipment
• Quarantine & testing of imported birds for
psittacosis
• Prophylactic tetracycline in bird feed
