Bacteriology

CHLAMYDIA

GENERAL CHARACTERISTICS
1. Obligate intracellular bacterial parasite infecting birds, mammals, and humans
2. Two distinct species
a. Chlamydia trachomatis
i. Inhibited by sulfonamides
ii. Demonstrates iodine-staining inclusions
b. Chlamydia psittaci
i. Not inhibited by sulfonamides
ii. Lacks iodine-staining cytoplasmic inclusions
3. Human diseases caused by chlamydia
a. Trachoma
b. Inclusion conjunctivitis
c. Lymphogranuloma venereum (LGV)
d. Psittacosis
4. Developmental cycle-3 major stages
a. Attachment and penetration of elementary body into host cell cytoplasm
b. Development of elementary body with reticulate body
c. Formation of elementary body progeny; maturation of reticulate body

Laboratory identification
a. All chlamydia infect chick embryo
b. Tissue cell culture lines
i. McCoy cells
ii. Hela cells
c. Infection in mice except causative agents of trachoma and inclusion conjunctivitis

Antigenic structure
a. Group-specific antigen, associated with cell wall, detects by complement-fixation testing
b. Species-specific and stain-specific antigens
c. Elementary body outer membrane protein
d. Frei test
i. Intradermal skin test for lGV using Iygranum antigen from infected chick embryo
yolk sac material
ii. Examine 48-72 hours after injection for formation of subcutaneous nodule
iii. Not specific for lGV, and less sensitive than complement fixation test
e. 19 or more antigenic types based on immunofluorescence
i. Types A, B, and C, from patient's eyes with trachoma in trachoma endemic locations
ii.Types D through M, from patient's eyes from non-endemic trachoma areas and adult genital
tracts

CHLAMYDIA TRACHOMATIS

1. Develop glycogen-containing microcolonies or inclusions called Halberstadter-Prowazek bodies

2. Ocular trachoma
a. Leading cause of blindness in underdeveloped world
b. In U.S. occurs most frequently in American Indians
c. 4 major stages of disease
i. Stage I, incipient trachoma
(a) Relatively asymptomatic
(b) Keratitis may be present
ii. Stage II, establishes trachoma
(a) Papillary and follicular hypertrophy
 (b) Corneal infiltration, pannus
iii. Stage III, cicatricial complications
(a) Conjunctival scarring
(b) Trichiasis, entropion, pannus
iv. Stage IV, healed trachoma
(a) No active inflammation
(b) May be asymptomatic
d. Protedive immunity to repeated infections poor
e. Diagnosis by microimmunofluorescence of type-specific antibody or visualization of
inclusions by Giemsa stain
f. Treatment and prevention
i. Topical or systemic antibiotics to limit complications and bacterial superinfection
(e.g.,tetracycl i nes)
ii. Systemic vaccine may exacerbate disease

3. Inclusion conjunctivitis, genital trachoma

a. Infantile
i. Associated with maternal genital infection
ii. Symptoms occur within first week of birth
b. Neonatal pneumonia
i. Become ill with pneumonitis 4-16 weeks after birth
ii. Conjunctivitis may precede
ii. Eosinophilia common
c. Adult disease
i. Usually sporadic but epidemic in persons swimming in unchlorinated swimming
pools
ii. Ocular disease often associated with genital disease
iii. Genital infection in males accounts for 20% of nongonococcal urethritis
iv. Causes chronic cervicitis and urethritis in women

4. lymphogranuloma venereum (LGV)

a. More common in males, blacks
b. Organisms cause death when infected intracerebrally in mice
c. Three antigenic types-I, II, III
d. Venereal disease of which humans are only known host
e. 1-4 week incubation period, culminating in headache, myalgia, and fever
f. Primary lesion painless, vesicular, small
g. Large, matted, painful, inguinal and femoral lymph nodes
h. Women may experience elephantiasis of vulva (esthiomene)
i. Other manifestations
i. Diarrhea, tenesmus, abdominal pain
ii. Rectal stricture, perforation
j. Laboratory findings
i. Hyperglobulinemia
ii. Positive rheumatoid factor and cryoglobulins
Diagnosis
i. Compatible clinical findings
ii. Isolation of organism-most definitive
iii. Rising LGV-complement fixation test
iv. Reactive intradermal Frei test

Treatment
i. Sulfadiazine
ii. Tetracycline
iii. Penicillin
CHLAMYDIA PSITTACI
1. Develop severe febrile disease, named according to transmitting animal
a. Psittacosis, disease transmitted from psittacine birds (parrots, parakeets)
b. Ornithosis, disease transmitted from nonpsittacine birds
2. Intracellular microcolonies
a. Do not stain with iodine
b. Inclusions called LCL (Leventhal-Cole-Lillie) bodies, staining with Giemsa
c. Development of inclusives not inhibited by sulfadiazine or cycloserine
3. Epidemiology
a. Occurs more often in autumn
b. May be transmitted by inhalation of organisms from infected birds and their droppings and
humans
i. Parrots, parakeets
ii. Turkeys, ducks, chickens
iii. Pigeons, wild birds
c. Infected animals may range from asymptomatic carriers to clinically ill
4. Clinical manifestations
a. Clinical severity varies; may resemble influenza with initial constitutional symptoms
b. Pulmonary symptoms
i. Nonproductive cough, rales, consolidation
ii. May recur if untreated
iii. Chest x-ray suggests "atypical pneumonia" or bronchopneumonia
c. CNS manifestations
i. Severe frontal headache
ii. Toxic encephalitis may occur leading to death
d. Other less common manifestations
i. Subacute bacterial endocarditis
ii. Hepatitis
iii. Erythema nodosum
iv. Carditis
v. Follicular keratoconjunctivitis
vi. Biologic false positive VDRL
5. Treatment
a. Tetracycline
b. Erythromycin