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PubMed2005

Improving services for sex partners of chlamydia-infected patients in an HMO.

OBJECTIVE: To improve services for sex partners of chlamydia-infected patients (ie, chlamydia partner services [CPS]) at an HMO. STUDY DESIGN: Assessment of current CPS policy, practices, and opinions in Kaiser Permanente Northwest Region (KPNW) and in local health departments, and design, implementation, and evaluation of 4 CPS interventions. METHODS: We reviewed KPNW policy documents, conducted focus groups with KPNW clinicians, and did phone interviews with KPNW chlamydia-infected patients and health department disease intervention specialists. We then implemented 3 informational interventions: CPS information was added to the after-visit summary given to patients tested for chlamydia; information on how to test, treat, and counsel chlamydia-infected patients was added to KPNW's electronic clinical-decision tool; and CPS information and a direct link to KPNW's chlamydia screening and treatment guidelines were added to KPNW's Web site. We also organized training for KPNW clinicians to review the roles of CPS and disease intervention specialists. We evaluated intervention uptake and impact by reviewing electronic medical charts, Web site "hits," and posttraining evaluations. RESULTS: Clinicians and disease intervention specialists reported that KPNW's CPS policy and the roles of disease intervention specialists regarding KPNW patients were unclear. Clinicians and patients wanted more CPS information. Clinicians commonly used the after-visit summary and Web-based CPS information and reported that training improved CPS knowledge. However, none used the clinical-decision tool. CONCLUSIONS: Several simple, centralized informational interventions to improve CPS were feasible and used by KPNW clinicians. These interventions could potentially be used in other settings structured like KPNW.

Chlamydia Infections↗
PubMed2000

The many faces of chlamydiae.

The application of modern research tools has broadened our understanding of the chlamydiae and their role in disease. Chlamydial genome analysis showed the presence of genes for ATP and peptidoglycan synthesis, contradicting the common belief that chlamydiae lack the ability to produce these compounds. Phylogenetic tree analysis suggests that chlamydiae could have evolved from an intracellular existence in amoebae. Newly discovered obligate intracellular organisms with chlamydia-like life-cycles have been classified as chlamydiae by rRNA homology with existing chlamydial species. A proposed new classification adds three new families to the order Chlamydiales as well as creates two genera and nine species within the family Chlamydiaceae. Chlamydiae are incriminated in an increasingly large spectrum of diseases both in humans and in animals. The emergence of multi-drug resistant C. trachomatis strains forewarns therapeutic problems with this organism. While C. pneumoniae remains a significant respiratory pathogen, the role it plays in the pathogenesis of atherosclerosis and ischaemic heart disease awaits definition.

Animals↗
PubMed2006

Chlamydia trachomatis and herpes simplex virus 2 infection in vulvar intraepithelial neoplasia associated with human papillomavirus.

BACKGROUND: The role of viral and bacterial co-infection is stressed in VIN. A view that VIN is a sexually transmitted disease made the area of research larger and stimulated scientists to seek other sexually transmitted factors, among which Chlamydia trachomatis and Herpes simplex are frequently examined. PURPOSE: The aim of the study was to evaluate the frequency of occurrence of HPV DNA and the frequency of co-infection with Herpes virus type 2 and Chlamydia trachomatis in VIN. MATERIAL AND METHODS: We identified archival diagnostic phase tissue specimens from 41 cases of vulvar intraepithelial neoplasia III. From the same paraffin blocks containing material from the margins of surgical sections during vulvectomy, normal epithelial tissue fragments were collected. They constituted the control group. Lesion characteristics were examined in comparison with the presence of HPV DNA, HSV-2 and Chlamydia trachomatsis. Identification was performed using PCR. RESULTS: In the study group HPV infection was found in 75.6% of cases. In 73% of cases it was HPV 16. In the control group we found HPV 16 DNA in only one case (2.43%). In the HPV positive study group HPV 16 was found in 30 (30/31) cases. In only one case (1/31) it was HPV 18 type. In the study group of 41 cases with VIN, HSV-2 infection was found in six cases (14.63%). In comparison with the control group (9.75%) the difference was not statistically significant. The frequency of occurrence of Chlamydia trachomatis in the analyzed study material was 14.63% (6/41) and in the control group it was 9.75% (4/41). The difference was not statistically significant. Statistical analyses of correlations between the occurrence of DNA HPV and HSV-2 as well as of HPV and Chlamydia trachomatis showed no correlation in either case. CONCLUSION: No correlation was found between the frequency of occurrence of HPV and HSV-2 and HPV and Chlamydia trachomatis in either group.

Adult↗
PubMedDate not supplied

[Etiology of lower acute respiratory infections in hospitalized infants. 3. Investigation of Chlamydia trachomatis].

Five infants with Chlamydia trachomatis associated pneumonia are analyzed. They were diagnosed out of 80 infants admitted to the hospital with pneumonia whose etiology was studied for virus, bacteria and Chlamydia trachomatis. Serum IgM antibodies to Chlamydia tr. were measured by indirect immunofluorescence (IIF), which is considered to be specific in high titers (1 greater than or equal to 32). The five cases represented 10.4% of infants studied younger than six months. One child was born by cesarean section suggesting the possibility of other non oculogenital still undefined mechanism of transmission. Clinical symptoms and laboratory findings were characteristics of those described in Chlamydia tr. pneumonia. Chlamydia trachomatis must be considered an etiologic agent in infantile pneumonia specially in the first six months of life. The high specificity and sensitivity of the IFF makes this serologic test the best non-invasive method for diagnosis of Chlamydia tr. pneumonia currently available.

Antigens, Bacterial↗
PubMed1990

[Chlamydia trachomatis infection in women with ectopic pregnancy].

Chlamydia trachomatis infection, presumably sexually transmitted, has been implicated in the spread of tubal infertility and ectopic pregnancy. In searching evidence of Chlamydia trachomatis infection as a possible cause of tubal ectopic pregnancy, we enrolled 40 consecutive pathologically proven tubal ectopic women and 37 normal early intrauterine pregnant women from our OPD and ward from Jan. 1989 to July 1989. All cases underwent a structured interview giving particular attention to past reproductive history, contraception history and past history of STD. The levels of serum antibody IgG to Chlamydia trachomatis in all cases were determined. Seven ectopic women with wearing IUD in situ (group A) and 33 ectopic women with no identical factor (group B) were compared with 37 normal early intrauterine pregnant women (control group). The result showed group B more often had IgG antibody to Chlamydia trachomatis than control group (P = 0.001). Group A had higher antibody to Chlamydia trachomatis than control group but the difference was not statistically significant (P greater than 0.05). We concluded that the above findings add to the evidence that Chlamydia trachomatis infection is a major cause of tubal ectopic pregnancy.

Adult↗
PubMed1990

[Chlamydia trachomatis infection in women].

A random specimen of 288 women was examined by the use of the indirect immunofluorescent test (IIF) for the proof of the Chlamydia trachomatis antigen in endocervical swabs (by the help of monoclonal antibodies), and with the ELISA test for the proof of IgG antibodies against Chlamydia trachomatis in serums, and the complement--fixation reaction for the proof of antibodies against the Chlamydia-group antigen. These women were previously examined anamnestically and clinically in detail. The Chlamydia trachomatis infection was determined in 29.51% of cases, with a high percentage of positive results in all age groups. These infections were more frequently proved, to a considerable extent, in women with the diagnosis of sterility than in all other examined women, and in relation to all other inflammatory processes it was most frequently diagnosed in women with uterine cervix changes (endocervicitis and erythroplasia). A high percentage of Chlamydia positive subjects (40.91%) was established in those examined women which had pathological pregnancies and births in their past medical histories. The humoral immune response to the presence of Chlamydia trachomatis infections was proven in 70.59% of cases. Presented and analyzed are the diagnostic possibilities of the used diagnostic tests, where the combination of the IIF and ELISA test has shown to be the best.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Chlamydiae. 1].

Throughout the animal kingdom the Chlamydiae are among the most common and ancient pathogens, but only in the 1966 they were classified by Page in the same genus because of different nosological pictures that they cause, while more recently were identified as bacteria. Chlamydiae have been divided into two species: C. trachomatis and C. psittaci. In 1986 Grayston et al. proved the etiological role of a "new chlamydial strain", named TWAR (Taiwan-Acute Respiratory), in human pneumonia and bronchitis; TWAR is distinguishable from other Chlamydiae and possibly represents a new entity. The Chlamydiae are non-motile, metabolically poor bacteria, completely lacking of any enzimatic system for energy production (ATP) and for this reason are obligate intracellular parasites; they poses group-specific, species-specific and type-specific antigens. Four series of surface proteins were identified as responsible for their pathogenic properties, while many Authors consider a particular lipopolysaccharidical acid, group antigen, as a real LPS. These bacteria poses an unique developmental cycle with production of two type of particles different for metabolic and infecting characters: elementary body and reticulate body. The Chlamydiae have a broad spectrum of host. They cause persistent or chronic infections and their survival is insured by the elementary body. The Chlamydiae stimulate the humoral and the cellular-mediate immunity system and are capable of survival in the monocytes and macrophages.

Adult↗
PubMed1989

[The frequency of Chlamydia detection in gynecologic and obstetrical patients and newborns].

Chlamydia trachomatis is said to play an important role in the pathogenesis of gynecologic, perinatal and neonatal infectious morbidity. Chlamydia trachomatis is responsible for several infectious syndromes in non-pregnant women, mothers and their offspring. We investigated the incidence of Chlamydia trachomatis in 353 non-pregnant and pregnant women without complaints and in 50 newborn. Chlamydia trachomatis was isolated from 6% of genital carcinoma, about 20% of different gynecological diseases and pregnant women within the first and third trimenon, 35% of puerperas and 10% of newborns. The prevalence of Chlamydia trachomatis antibody occurred in 34 to 55% of the non-pregnant and pregnant women and in 38% of the newborns. We propose a screening for Chlamydia trachomatis infection in high-risk patients and in pregnancy and a treatment of infected individuals.

Antibodies, Bacterial↗
PubMed1989

[Role of Chlamydia trachomatis in tubal pathology (acute salpingitis and tubal sterility). Microbiological study of 175 samples of peritoneal fluid].

The study was carried out on 175 patients who underwent laparoscopy together with search for chlamydia in the peritoneal fluid when they were having investigations for sterility or for pelvic pain. These patients are classified into three groups according to the clinical and laparoscopic features: 50 cases of acute salpingitis. 104 cases of tubal sterility and 21 control cases who were normal on laparoscopy. The mean age was 25.7 years for acute salpingitis and 30.4 years for tubal sterility. The purpose of this study was to work out the role played by chlamydia trachomatis in tubal phatology and two techniques were used at the same time: The identification of chlamydia trachomatis in 175 samples of peritoneal fluid taken during a laparoscopy; Research for anti-chlamydia antibodies in serum using an indirect micro-immunofluorescent technique. Cell cultures were performed after the peritoneal fluid had been centrifuged. It had been in transport medium 2 SP and frozen. Our technical methods for isolating chlamydia (microplaque culture on Hela lines, incubation in the presence of cycloheximide and research for chlamydial inclusion bodies using direct immunofluorescence with monoclonal antibodies and 2 successive passages of the cells) have allowed us to confirm that chlamydia was present in 44% of cases of acute salpingitis and in 37% of cases of tubal sterility. The search for anti-chlamydial antibodies in the serum in indirect immunofluorescence with a single antigen (of L2 serotype) gave positive results which were comparable to those in other studies, i.e. 50% of positive serological results in acute salpingitis and 63% in tubal sterility.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1973

Chlamydiae as agents of human and animal diseases.

A brief review is given of the properties, occurrence, and public health significance of chlamydiae in man and animals and of the diagnosis and control of chlamydial infections. Chlamydiae occur naturally in a large number of avian and mammalian species. Man is the primary host of chlamydiae causing trachoma, inclusion conjunctivitis, genito-urinary tract infection, and lymphogranuloma venereum. In animals chlamydial infections have been recognized as a cause of pneumonia, encephalitis, abortion, arthritis, diarrhoea, and conjunctivitis. Chlamydial infections have been recognized in a wide range of avian hosts. Sporadic psittacosis/ornithosis in man is associated with close exposure to birds and may occur as an occupational disease. Transmission studies suggest that mammalian chlamydial strains are not very host-specific and that diseases and even chains of infection may develop in secondary hosts. There are a few well-documented cases of human infection with chlamydiae of mammalian origin. Although various chlamydial isolates have specific antigenic components, no routine test for identifying different serotypes has been generally accepted. Further investigation of the host range of chlamydiae and of their antigenic properties is essential for a more accurate assessment of the potential danger of chlamydia-infected animals to human health. The frequent occurrence of inapparent or latent infections makes it imperative to establish adequate laboratory facilities for the effective surveillance and control of chlamydial infections.

Animals↗
PubMed1982

Pelvic infection after elective abortion associated with Chlamydia trachomatis.

Two groups in Denmark and Sweden, totalling 943 healthy women in the first trimester of pregnancy who were undergoing elective abortion, were examined in a prospective study. Group 1 consisted of 432 women from Denmark, all examined prior to and 2 weeks after the operation. At the first examination, samples were taken from the cervix for the isolation of chlamydiae and gonococci. Chlamydia trachomatis was isolated from 23 (5.3%) of the women. Postoperatively, 15 patients developed acute pelvic inflammatory disease (PID). Five of these patients harbored C trachomatis before the operation, and all 5 developed a significant change in the titer of immunoglobulin G microimmunofluorescence antibodies to the organism. In group 2, 25 (4.9%) of the 511 women from Sweden harbored C trachomatis before the intervention. Patients with chlamydiae were treated, before or in conjunction with the operation, with antibiotics active against chlamydiae. None of the women with cultures positive for chlamydiae showed signs of PID postoperatively. The difference in the postoperative frequency of PID in chlamydia-positive patients between groups 1 and 2 was significant (2P = .0393, Fisher exact test). Gonorrhea was diagnosed in 1% of the women in both groups. Only 1 of these patients developed PID postoperatively, but no pili antibodies to Neisseria gonorrhoeae were found during the course of the disease. It is concluded that women applying for abortion should be examined and treated not only for gonorrhea but also for infection with C trachomatis either before or, at the latest, in conjunction with the abortion.

Abortion, Induced↗
PubMed1994

A comparison of diagnostic methods in adolescent girls with and without symptoms of Chlamydia urogenital infection.

OBJECTIVE: To evaluate the clinical utility of various diagnostic tests, two enzyme immunoassays and a chemiluminescent DNA probe were compared with cell culture (with monoclonal antibody confirmation) for the diagnosis of endocervical Chlamydia trachomatis infection. DESIGN: The clinical performance of four diagnostic methods for Chlamydia trachomatis urogenital infections were compared, using specimens generated from consecutive pelvic examinations. SETTING: Subjects were recruited from an urban adolescent clinic that provides primary and referral care. PARTICIPANTS: A total of 479 adolescent female subjects were enrolled. The order of sample collection was randomized. Subjects were stratified according to whether they were asymptomatic (n = 228) or symptomatic (n = 251). MEASUREMENTS AND RESULTS: Discrepant analysis was performed when culture was negative and nonculture technique was positive. The subject was considered to have chlamydia if culture was positive, or if one or more nonculture techniques, with that test's confirmatory assay, were positive (consensus-positive). Prevalence of chlamydia was 11.0% in the asymptomatic, and 20.7% in the symptomatic, group. Overall, 32.5% of the infected subjects were asymptomatic. Sensitivity of diagnostic methods varied from 52% to 80% in the asymptomatic subjects, compared with 65% to 81% in symptomatic subjects. Culture sensitivity was 75% to 80%. The specificities of all tests were 96% or greater. Accuracy of nonculture methods varied from 89.5% (DNA probe, symptomatic subjects) to 96.9% (enzyme immunoassay asymptomatic subjects). CONCLUSIONS: There are significant differences in symptomatic subjects when evaluating accuracy of test outcome, using a consensus-positive criterion. Asymptomatic infections account for nearly one third of adolescent females infected with chlamydia. The prevalence of chlamydia urogenital infections are underestimated by any single diagnostic test, particularly in the asymptomatic patient.

Adolescent↗
PubMed1993

Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. Centers for Disease Control and Prevention.

In 1985, CDC published Policy Guidelines for Prevention and Control of Chlamydia trachomatis infections. Those guidelines highlighted the prevalence and morbidity of chlamydial infections and stressed the need to include antibiotics effective against chlamydia when treating patients for urethritis, mucopurulent cervicitis, and pelvic inflammatory disease. The recommendations presented in this report update the 1985 guidelines. In addition, these recommendations propose a national strategy for reducing the morbidity of chlamydial infections by detection and treatment and through the prevention of transmission to uninfected persons. Such an effort is now possible because of a) expanding educational efforts stimulated by the epidemic of acquired immunodeficiency syndrome and other sexually transmitted diseases, and b) the availability of chlamydia tests that are easy to use, economical, and accurate, thereby allowing health-care providers to diagnose and treat infected persons and their sex partners. Education, screening, and sex partner referral require coordination of the activities of several professionals, including educators, clinicians, microbiologists, outreach workers, and program managers. Because chlamydial infections are common among adolescents and young adults throughout the United States, health-care providers and other agencies serving these groups should become more involved if a sufficiently large proportion of the chlamydia-infected population is to be reached. Health departments should establish consortia of these organizations to pool resources and to coordinate activities. To facilitate such collaborations, this document outlines the elements of a chlamydia prevention program. These recommendations were developed by CDC after consultation with experts attending a chlamydia prevention workshop held in Atlanta, Georgia, March 26-28, 1991. Commentary from additional public health, medical, and laboratory practitioners also was considered in developing these recommendations.

Adolescent↗
PubMed1993

[Chlamydia trachomatis infection in young men with acute epididymitis and their sexual partners].

Untreated infection of female partners by men with chlamydial epididymitis may have serious effects on the partners' fertility. To assess the need for detailed microbiological investigation, 32 patients, 35 years old or younger, with epididymitis and their sexual partners were examined. The patients underwent thorough evaluations, including chlamydia isolation, microscopy of urethral swab, bacterial culture, and chlamydia serologic testing. An infective cause was identified in 56% of the patients. The most common microorganism was Chlamydia trachomatis. This microorganism was identified from urethral swabs in 11 patients (34%). A total of 18 sexual partners were traced and investigated for chlamydia antigen by cervical swab, urinary bacterial culture, and chlamydia serologic testing. Of the 18 female sexual partners screened, 9 were partners of patients with chlamydial epididymitis; 78% of these women had the same infection. Young men with epididymitis, as well as their partners, should undergo full microbiological evaluation including Chlamydia trachomatis for adequate treatment of this infection.

Acute Disease↗
PubMedDate not supplied

Chlamydia trachomatis in routine cervical smears. A microscopic and ultrastructural analysis.

This study examined cervical smears for cytologic evidence of Chlamydia trachomatis in 380 women seen for routine gynecologic examination or follow-up for an abnormal cervical smear. Cervical smears and Chlamydiazyme samples were obtained. Fifteen patients tested Chlamydiazyme positive and were considered to be Chlamydia positive. Cellular samples meeting the screening criteria were examined carefully for evidence of Chlamydia, including type II (central target inclusions) and type III (granular inclusions or nebular inclusions). Electron microscopy was performed on representative inclusions from both Chlamydia-positive and -negative patients. Inclusions were identified in 6 of the Chlamydia-positive and 31 of the -negative patients. Electron microscopy of type II and III inclusions, from both positive and negative patients, revealed chlamydial organisms to be present only in nebular inclusions. Intracytoplasmic inclusions, other than nebular inclusions, result from inflammatory changes and, as such, may be induced by a chlamydial infection but are not specific to Chlamydia.

Adult↗
PubMed1993

Nonocular Chlamydia infection and risk of ocular reinfection after mass treatment in a trachoma hyperendemic area.

PURPOSE: The presence of nasal discharge on a child's face increases the risk of active trachoma, suggesting that Chlamydia trachomatis in nasal secretions may be a possible source of ocular reinfection. The prevalence of chlamydia in nasal secretions and the risk of reinfection after mass treatment was investigated in a hyperendemic area of Tanzania. METHODS: In one village a total of 232 children aged 1 to 7 years were followed before and after mass treatment. Clinical trachoma, and microbiologic evidence of chlamydia, were assessed at baseline, 2 and 4 weeks into mass treatment, and 4 weeks after treatment stopped. The presence of chlamydia in ocular and nasal secretions was determined by polymerase chain reaction-enzyme immunoassay techniques. RESULTS: Of the 232 children, 59% had clinical trachoma and 27% had nasal specimens positive for chlamydia. Children with positive ocular chlamydia specimens and/or clinical trachoma were significantly more likely to have positive nasal specimens. At the end of mass treatment, only 4% of children had positive ocular specimens. However, 1 month after treatment stopped, the incidence of new infection was 21%. The rate of new ocular infections in those who had negative ocular specimens after treatment was similar between those who had positive and those who had negative nasal specimens at baseline. Positive ocular specimens at baseline was not a predictor of risk of new infection after treatment (odds ratio = 1.18, 95% confidence interval = 0.58, 2.40), suggesting these new infections were not the result of latent or persistent organism. CONCLUSIONS: These data do not support a role for nasal secretions in causing reinfection after treatment. One mass topical treatment alone is unlikely to be effective in trachoma hyperendemic areas as shown by the rapid re-emergence of infection.

Base Sequence↗
PubMed1995

[Immunohistochemical determination of Chlamydia psittaci/pecorum and C.trachomatis in the piglet gut].

The jejunum, ileum, caecum and colon of 200 piglets were investigated immunohistochemically for the presence of Chlamydia psittaci and C. trachomatis using a vitelline IgY. Positive samples were later labelled using a commercial C. trachomatis polyclonal antiserum. Chlamydia were present in 33 (16.4%) of the animals, and 30 out of 33 were labelled by C. trachomatis polyclonal antiserum. Inclusions occurred predominantly (67%) in the large intestine. The serological results (CFT, ELISA) did not correlate well with immunohistochemical labelling in the gut. The incidence of Chlamydia rose from 6.9% in animals up to 4 weeks, to 41.8% in those over 4 weeks of age. A correlation between chlamydia and enteric disease was not obvious. Besides chlamydia, most of the diseased animals harboured other additional agents. In conclusion, intestinal chlamydiae in piglets, predominantly C. trachomatis, exist in Switzerland, although their pathogenic potential seems to be low.

Animals↗
PubMed1995

[Seroprevalence of Chlamydia trachomatis infection in STD consultants in Morocco].

We have conducted a seroepidemiological survey of Chlamydia trachomatis infection among 400 STD consultants in comparison with 400 blood donors. The study was performed by using the indirect microimmunofluorescence technique with Chlamydia trachomatis, Chlamydia psittaci and Chlamydia pneumoniae as antigens. The overall seroprevalences were 60% and 46% for STD consultants and blood donors respectively. The seroprevalences of Chlamydia trachomatis alone were 12.5% for STD consultants and 7.5% for blood donors. No differences were observed according to age in the two groups and people of 20-29 and 30-39 years old, of both sexes were the most concerned. We conclude that Chlamydia trachomatis infection remains an important problem in Morocco.

Adult↗