Trachoma Lymphogranuloma venereum

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C. trachomatis is a pathogen that infects only humans. Table 4.16 lists the relevant diseases, biovars, and serovars.

Trachoma is a follicular keratoconjunctivitis. The disease occurs in all climatic zones, although it is more frequent in warmer, less-developed countries. It is estimated that 400 million people carry this chronic infection and that it has caused blindness in six million. The pathogen is transmitted by direct contact and indirectly via objects in daily use. Left untreated, the initially acute inflammation can develop a chronic course lasting months or years and leading to formation of a corneal scar, which can then cause blindness. The laboratory diagnostics procedure involves detection of C. trachomatis in conjunctival smears using direct immunofluorescence microscopy. The fluoro-chrome-marked monoclonal antibodies are directed against the MOMP (major outer membrane protein) of C. trachomatis. The pathogen can also

Table 4.16 Human Infections Caused by Chlamydia trachomatis

Disease/syndrome

Biovar

Most frequent serovars

Trachoma

Inclusion conjunctivitis

Urethritis, cervicitis, salpingitis (pharyngitis, otitis media)

Lymphogranuloma venereum (syn. lymphogranuloma inguinale, lymphopathia venerea, Favre-Durand-Nicolas disease)

trachoma trachoma trachoma lymphogranuloma venereum

Determined with microimmunofluorescence.

be grown in cell cultures. The therapeutic method of choice is systemic and local application of tetracyclines over a period of several weeks.

Inclusion conjunctivitis. This is an acute, purulent papillary conjunctivitis that may affect neonates, children, and adults (swimming-pool conjunctivitis). Newborn children are infected during birth by pathogens colonizing the birth canal. Left untreated, a pannus may form as in trachoma, followed by corneal scarring. Laboratory diagnosis and therapy as in trachoma.

Genital infections. C. trachomatis is responsible for 30-60% of cases of nongonococcal urethritis (NGU) in men. Possible complications include prosta-titis and epididymitis. The pathogens are communicated by venereal trans-mission.The source of infection is the female sexual partner, who often shows no clinical symptoms.

In women, C. trachomatis can cause urethritis, proctitis, or infections of the genital organs. It has even been known to cause pelvioperitonitis and perihepatitis. Massive perinatal infection of a neonate may lead to an interstitial chlamydial pneumonia.

The relevant diagnostic tools include:

1. Detection under the microscope in smear material using direct immuno-fluorescence (see under trachoma).

2. Direct identification by means of amplification of a specific DNA sequence in smear material and urine.

3. Growing in special cell cultures.

Lymphogranuloma venereum. This venereal disease (syn. lymphogranulo-ma inguinale, lymphopathia venerea (Favre-Durand-Nicolas disease) not to be confused with granuloma inguinale, see p. 305) is frequently observed in the inhabitants of warm climatic zones. A herpetiform primary lesion develops at the site of invasion in the genital area, which then becomes an ulcus with accompanying lymphadenitis. Laboratory diagnosis is based on isolating the proliferating pathogen in cell cultures from purulent material obtained from the ulcus or from matted lymph nodes. The antibodies can be identified using the complement binding reaction or the microimmunofluorescence test. Tetracyclines and macrolides are the potentially useful antibiotic types.

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