Chlamydia trachomatis

Introduction

• MC cause of

1. STD worldwide
2. Opthalmia neonatorum
3. Epididymitis
4. Post-gonococcal urethritis
5. Inclusion conjunctivitis of neonate 
6. Adult form is called as “swimming pool disease

LIFE CYCLE

• Chlamydia trachomatis occurs in two forms during its life cycle(biphasic)

Elementary body.

• Extracellular
• Small
• Infectous
• Inactive
• It enters cell in an endocytotic
• Inside cell, it transforms itself into a reticulate body

Reticulate body (RB).

• Active replicative form.
• The ability to inhibit lysosomal fusion is unique to chlamydia
• C trachomatis also inhibits apoptosis of epithelial cells
• Thus enabling completion of its replicative cycle.
• Reticulate body divides by binary fission
• Chlamydial microcolony formed known as inclusion body
• Inside the cell Chlamydia trachomatis evades phagolysome

15 serotypes are known:

 Clinical manifestations

Trachoma

• Serotypes A, B, and C causes a conjunctival and corneal infection 

Stages

• Trachoma dubium
• Protrrachoma
• Established trachoma(stages I to IV)

• The lesions begin with formation of lymphoid follicles in the conjunctiva
• In established trachoma, there may be 
• superior epithelial keratitis
• sub epithelial keratitis
• pannus, or superior limbal follicles
• Ultimately the pathognomonic cicatricial remains of these follicles, known as Herbert’s pits—small depressions covered by epithelium at the limbo corneal junction. 
• Signs of trachoma are more severe in the upper than in the lower conjunctiva and cornea.

With disease progression, there is:

• tissue necrosis
• granulation tissue deposition
• scar formation leading to blindness
• Lacrimal duct obstruction and distortion of the eyelids.
• Loss of an adequate tear system
• Cornea becomes vulnerable to dehydration and opacification.
• Also, the vigorous inflammatory response can directly involve the cornea, with resulting opacity.

GENITAL INFECTIONS

• Genital chlamydiasis
• Serotypes D to K
• Mostly asymptomatic
• MC of nongonococcal and postgonococcal urethritis

Men:

• urethritis (non-gonococcal)
• epididymitis
• proctitis
• conjunctivitis
•  Reiter’s syndrome 

Women: 

• acute urethral syndrome
• bartholinitis
• mucopurulent cervicitis
•  endometritis
• salphingitis(infertility)
• pelvic inflammatory disease
• conjunctivitis
• perihepatitis (Fitz-Hugh-Curtis syndrome)
•  Reiter’s syndrome
• Salphingitis due to chlamydia and gonnorrea are common causes of tubal block resulting in infertility
• Gram stained smears of urogenital exudates show significant number of neutrophils

 Nongonococcal Urethritis:

Diagnosed

• Documentation of a leukocytic urethral exudate
• Exclusion of gonorrhea by Gram’s staining or culture.

Symptoms

• Urethral discharge (often whitish and mucoid rather than frankly purulent)
• Dysuria
• Urethral itching.

Physical examination

• Reveal meatal erythema
• Tenderness as well as a urethral exudate.

Lymphogranuloma venereum (LGV)

• Primary lesion: small painless papulovesicular lesion on external genitalia
• Secondary stage: lymphadenopathy
•  in males inguinal nodes are most commonly involved
•  in females intrapelvic and pararectal nodes
• Enlargement of chain of lymph nodes above and below inguinal ligament (groove sign)

Late sequelae –

•  rectal strictures
• elephantiasis of vulva (esthiomene)
• Clinical, sigmoidoscopic and histologic findings resemble Crohn’s disease in homosexual men
• Frei’s test: intradermal test for LGV

Reiter’s Syndrome

• triad of recurrent conjunctivitis, polyarthritis and urethritis in men or cervicitis in women
• Associated with HLA B 27

Diagnosis 

• LCR and PCR

Treatment

STD: Azithromycin DOC

Trachoma

• Tetracycline
• Erythromycin
• Rifampicin