Notably, infection of the nasopharynx is thought to be a precursor condition that is usually asymptomatic, but can progress to pneumonia. It is an obligate intracellular human pathogens. EBs enter the cell and two hours later are transformed into RBs which grow and divide over the next hours, resulting in a rapid increase in number. Screening for chlamydia in asymptomatic persons significantly reduces the incidence of chlamydia-associated complications and is recommended in all sexually active women younger than age 25, as well as in other persons at high risk of infection. Hosseinzadeh, S. (2003). Chlamydia trachomatis infection: host immune responses and potential vaccines. Humans are the only natural host. [10,25] Chlamydia-associated PID can result in tubal scarring that may cause tubal factor infertility and increase the risk for ectopic pregnancy. Chlamydia trachomatis is an obligate intracellular bacterium with a cell wall and ribosomes similar to those of gram-negative organisms. Two main types of serologic tests are used for diagnosis: (1) chlamydia complement fixation test (CFT), which measures antibody against group specific lipopolysaccharide antigen, and (2) micro-immunofluorescence (MIF). The majority of women with chlamydial infection initially have no signs or symptoms, but may present later with uncomplicated infection (cervicitis or urethritis); some women develop complicated infections, including pelvic inflammatory disease, perihepatitis, endometritis, salpingitis, or reactive arthritis. Since oropharyngeal C. trachomatis can be transmitted to genital sites of sex partners[62,63], detection of C. trachomatis from an oropharyngeal sample warrants treatment with either azithromycin 1 gram orally as a single dose or doxycycline 100 mg orally twice daily for seven days.. The documentation should include notification that partner(s) have been exposed, information about the importance of treatment, signs and symptoms of potential complications, as well as possible therapy-related allergies and adverse effects. These quick questions are meant to keep you on track and check your understanding. Falk, L., Fredlund, H., and Jensen, J.S. There are several key epidemiologic features of chlamydial infections as reported for 2018 in the United States. The elementary body is the dispersal form, which is analogous to a spore. Patient counseling and education should additionally cover the nature of the disease, transmission issues, and risk reduction. Ct is diagnosed by urinary testing or genital swab.  All specimens should be retained for additional confirmatory testing. Chlamydia pneumonia in infants occurs 4 to 12 weeks after delivery. Risk factors associated with acquisition of chlamydial infection include new or multiple sex partners, a history of STIs, presence of another STI, and lack of barrier contraception. Flow cytometric analysis of leukocytes in the human female reproductive tract: comparison of fallopian tube, uterus, cervix, and vagina. However, use of azithromycin in the neonatal period has also been associated with a higher risk of infantile hypertrophic pyloric stenosis, particularly if given in the first 2 weeks of life. LGV is characterized by transient papules on the external genitalia, followed in 1 to 2 months by painful swelling of inguinal and perirectal lymph nodes. Symptoms may include dysuria and urinary frequency, especially in young women with a recent, new sex partner. In men, untreated sexual transmitted Ct can cause complications such as urethritis (Stamm and Cole, 1986) and chronic prostatitis (Skerk, 2003). These cells produce interferon-γ (IFN-γ) which is known to inhibit chlamydial reproduction (Perry et al., 1997). The cervix is the site of infection in 75% to 80% of women with chlamydia infection. [23,24] Causes of mucopurulent cervicitis other than C. trachomatis include N. gonorrhoeae and less frequently M. genitalium. , Infection with C. trachomatis OmpA types D through K in the rectal region is usually asymptomatic, but can lead to proctitis or proctocolitis, which can manifest as rectal pain, mucoid or hemorrhagic discharge, fever, and/or tenesmus. Discuss prevention strategies such as abstinence, monogamy with an uninfected partner, condom use, and limiting the number of sex partners. Prevalence of Chlamydia trachomatis Genital Infection Among Persons Aged 14–39 Years — United States, 2007–2012 – MMWR September 26, 2014. The life cycle of Chlamydia trachomatis consists of two stages: elementary body and reticulate body. It is the cycle of recurrent infection, with conjunctival scarring and pannus extending over the cornea, which results in impaired vision or blindness. these are the infectious elementary body (EB) and the intracellular reticulate body.  Data on the use of other macrolides (azithromycin and clarithromycin) for the treatment of neonatal chlamydial infection are limited. In shorten words, they will start as a small evil body but it will seek and destroy others. Within eight hours, the now-intracellular elementary body interacts with glycogen and transforms into a reticulate body, which begins to multiply within an isolated intracellular structure referred to as an inclusion. Chlamydia’s spreading capability relies not upon its own force but its need to invade host nutrients. The elementary body attaches to and enters a host cell. MMWR Morb Mortal Wkly Rep. 2014;63:834-8. The reticulate bodies are the noninfectious replicating form. NHANES = National Health and Nutrition Examination Survey. The Journal of Immunology 158, 3344-3352. Due to high specificity, culture has retained a role in the work-up of suspected sexual abuse in children. Which one of the following statements best describes the reporting requirements for a person diagnosed with Chlamydia trachomatis infection in the United States? In patients who develop symptomatic infection, the incubation period for C. trachomatis infection is estimated to be 7 to 21 days. Up to 70% of sexually transmitted cases of epididymitis are due to C. trachomatis; infection with N. gonorrhoeae can also cause epididymitis.. [4,27], Untreated pelvic infection in women with C. trachomatis can cause inflammation of the liver capsule, which is commonly referred to as perihepatitis or the Fitz-Hugh-Curtis Syndrome. First, C. trachomatis attaches to a new host cell as a small spore-like form called the elementary body.  Diagnosis can be supported via anoscopy findings (mucopurulent discharge, pain, and spontaneous or induced bleeding). It is a weak Gram-negative bacteria. Chlamydia—Rate of Reported Cases, by Sex, United States, 2012-2018, Chlamydia—Rate of Reported Cases, by Age Group, United States, 2018, Chlamydia—Rates of Reported Cases by Sex and Age Group, United States, 2018, Chlamydia—Rates of Reported Cases by Race/Ethnicity, United States, 2018, Chlamydia—Rates of Reported Cases by Region in United States, 2012-2018, Chlamydia—Rates of Reported Cases by State, 2018, Chlamydia Prevalence among Sexually Active Females Aged 14-24 Years, by Race/Ethnicity, 2007-2012, Reiter's Syndrome and Circinate Balanitis, for Treatment of Urogenital Chlamydial Infections in Adolescents and Adults, 500 mg orally four times a day for 7 days, 800 mg orally four times a day for 7 days, Workowski KA, Bolan GA; Centers for Disease Control and Prevention. The most common site for chlamydial infection in heterosexual men is the urethra. Urethral infection with chlamydia in women is usually asymptomatic, but it can cause “dysuria-pyuria” syndrome, or an “acute urethral syndrome”, mimicking acute cystitis. 13 Chlamydiae protect infected cells against apoptosis as a result of external stimuli during early stages of infection and may induce apoptosis of the host cell during later stages of the life cycle.  Genital or rectal infection can persist for as long as two to three years, so infection in young children may be the result of perinatally-acquired infection. Within 48 hours, some of the reticulate bodies begin to reorganize back to elementary bodies. [40,41,42,43,44] In addition, in men and women, self-collected rectal swabs for NAAT have also performed well. Children ages 1-9 years and women harbor the greatest burden of disease.  Since many persons with chlamydial infection may have minimal or no symptoms, the actual number of annual infections is significantly higher than the reported cases. The signs range from mild scant mucoid discharge to severe copious purulent discharge, chemosis, pseudomembrane formation, erythema, friability, and edema. This disorder is not a sexually transmitted disease and it is not transmitted from mother-to-child during birth. Figure 1. Chlamydia trachomatis has been identified as a causative agent for acute urethral syndrome, defined as acute dysuria and frequent urination in women whose voided urine was sterile or contained <10 5 organisms per milliliter. The elementary body, a small, infectious, but non-replicating particle found in secretions, attaches to and enters a host cell, such as an endocervical or urethral columnar epithelial cell. Chlamydiae reproduce via binary fission, and complete their biphasic developmental cycle within 40-60 hours. Women with C. trachomatis infection can develop pelvic inflammatory disease (PID), which is a subclinical to acute clinical syndrome associated with the ascending spread of microorganisms from the cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures.  The life cycle of C. trachomatis involves five key steps (Figure 9): Sexually-acquired C. trachomatis is highly transmissible, with chlamydial infection rates between sexual partners reported of approximately 55%, with a per-act transmission risk of about 10%. At the site of infection there is a strong inflammatory reaction mediated mainly by CD4+ T cells with a Th1 phenotype to clear the infection (Loomis & Starnbach, 2002, Figure 2). Serologic testing is rarely used to diagnose uncomplicated genital infections caused by C. trachomatis because chlamydia serologic tests do not reliably distinguish current from prior infection. Ct infection usually occurs in the lower genital tract and attracts different types of immune cells such as lymphocytes, macrophages and dendritic cells to infiltrate the epithelium. The rate for cases of chlamydia was consistently higher in females than in males during 2012 to 2018. Life cycle: C. trachomatis has a life cycle consisting of two morphologically distinct forms. Sexually Transmitted Disease Surveillance 2018. [2,56] Rectal chlamydial infections are treated similarly to urogenital infection with the caveat that data from observational trials suggest doxycycline may have greater efficacy than azithromycin for the treatment of rectal C. trachomatis infection.[57,58,59,60,61]. Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. Habitat and Morphology of Chlamydia trachomatis. Finally, expedited partner therapy is not legal in all states; the CDC maintains an updated information page (Legal Status of Expedited Partner Therapy) that identifies the legal status of expedited partner therapy in each state in the United States, as well as providing links to each state for more detailed state policies. When signs or symptoms occur, they usually start one to two weeks after exposure to chlamydia. Multiple invasion of a laboratory-infected HeLa 229 cell. The treatment of infants and children with chlamydia is stratified into three groups: (1) younger than 8 years of age and weight less than 45 kg, (2) younger than 8 years of age and weight 45 kg or greater, and (3) age 8 or older (Table 5). The contact with the host cell membrane causes the elementary body to induce its own endocytosis. Neonatal ocular prophylaxis with silver nitrate solution or antibiotic ointments for prevention of gonorrhea transmission does not prevent perinatal transmission of C. trachomatis from mother to infant. The genus Chlamydia includes three species that infect humans: C. trachomatis, C. pneumoniae, and C. psittaci. Which one of the following is the preferred method to diagnose chlamydial urethritis in men? The alternative regimens in pregnancy are amoxicillin, erythromycin base, or erythromycin ethylsuccinate (Table 2). Which one of the following is most consistent with current CDC recommendation for screening for chlamydial infection? The entire intracellular life cycle of the chlamydia occurs within the endosome. Bacteria travel between cells and between people to create new infections, but these bodies don't replicate or change; they are just carried around in bodily fluids. Chlamydiaceae is a family of gram-negative, obligate intracellular bacteria that includes 3 organisms pathogenic to humans: Chlamydia trachomatis, Chlamydophil… Chlamydia infections – Knowledge for medical students and physicians  Use of NAATs for the 2-week follow-up test is not appropriate due to false-positive results from residual C. trachomatis nucleic acids at 2 weeks post-treatment.. There is concern that widespread use of antibiotics reduces the individual’s ability to make a proper protective immune response, although the correlates of protective immunity are themselves not well understood. Signs and symptoms include multiple, enlarged, matted, tender inguinal lymph nodes that may be suppurative and are usually bilateral. The elementary bodies are released to infect adjacent cells or to be transmitted to and infect another person. Infection begins when EBs attach to the membrane of a cell of the inner layer (epithelium) of the urogenital tract (Figure 1). Within 48 hours, some of the reticulate bodies begin to reorganize back to elementary bodies. trachomatis.[2,4,39]. (1997). (2005). Historically, cell culture to detect C. trachomatis was the most sensitive and specific method available to detect chlamydial infection. Chlamydia trachomatis is a gram negative organism, meaning that when stained in a laboratory, it will appear pink under a microscope. Chlamydia trachomatis is a bacteria species in the genus Chlamydia. [14,15] The organisms replicate within a host cell, eventually causing death of the host cell. The characteristics of the syndrome include conjunctivitis, urethritis, oligoarthritis, and skin lesions (keratoderma blennorrhagica) and circinate balanitis (Figure 10). Chlamydial pelvic inflammatory disease. The excellent sensitivity and specificity of the NAAT has led to its use in place of culture for most clinical situations; the use of culture for C. trachomatis is limited to evaluation of suspected cases of sexual assault in children. [73,74], For infants with pneumonia caused by C. trachomatis, the recommended treatment is a 14-day course of erythromycin base or erythromycin ethylsuccinate; azithromycin, which is much easier to administer and requires only a 3-day course, is considered an alternative regimen (Table 4).. Normally the female reproductive tract does not have associated organised lymphoid tissue but there are dendritic cells, macrophages and a few resident lymphocytes scattered throughout the four main epithelial areas, the vagina, the cervix, the uterus and the Fallopian tubes (Givan et al., 1997). Not prevent neonatal chlamydial infection and pelvic inflammatory disease ( Hillis et al., 1997 ) in evaluation of LGV! 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