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Chlamydia trachomatis and inflammatory bowel disease--a coincidence?

Serological tests of 35 patients suffering from inflammatory bowel disease were compared to those of 35 healthy controls. The tests were performed using the indirect immunoperoxidase assay. Ninety-three per cent of 15 patients with Crohn's disease had IgG antibodies against Chlamydia, compared to 26% in the control group. In the 20 patients with ulcerative colitis, 45% had IgG antibodies against Chlamydia, compared to 10% in the control group. High serum titres of IgG antibodies were found in most of the patients with inflammatory bowel disease, mainly with Crohn's disease, while weak reactions appeared in most of the controls in which antibodies were detected. These results suggest a high incidence of Chlamydia infection in the studied patients with inflammatory bowel disease, especially in those with Crohn's disease. The possible association between Chlamydia trachomatis and inflammatory bowel disease is discussed.

Antibodies, Bacterial↗

Retrospective review of the correlation of symptoms, signs and microscopy with the diagnosis of Chlamydia trachomatis in men.

We have investigated the correlation of symptoms, signs and microscopy on the detection of Chlamydia trachomatis infection in men attending our clinic. One hundred and eleven men diagnosed with chlamydia over an 11-month period in our clinic were reviewed. Of these, 70 (63%) were symptomatic and 41 (37%) were asymptomatic. 84% (59/70) of symptomatic and 51% (21/41) of asymptomatic patients met the UK clinical criteria for diagnosis of non-gonococcal urethritis (NGU) and received treatment appropriate for chlamydia and NGU at their initial clinic visit. Our findings show that 19% (21/111) of men with Chlamydia trachomatis infection would leave the clinic untreated if a urethral smear preparation was not performed on those who were clinically asymptomatic at presentation. We feel that this is a sufficient argument to warrant continuing the current practice of testing asymptomatic men attending GUM clinics for NGU.

Adolescent↗

Intestinal lesions caused by a strain of Chlamydia suis in weanling pigs infected at 21 days of age.

The objective of this study was to determine whether a strain of Chlamydia suis shown previously to be an intestinal pathogen in gnotobiotic piglets could cause diarrhea and intestinal lesions in young weanling pigs. Pigs from 2 sows were randomly assigned to 2 groups. Group 1 included 13 pigs that were weaned at 24 hours of age and then housed in isolator units and fed milk replacer and unmedicated starter ration. Group 2 included 8 pigs that nursed their respective sows, consumed unmedicated starter ration, and were weaned at 21 days of age. Ten pigs in group 1 and 6 pigs in group 2 were inoculated orally with 4 x 108 inclusion-forming units of C. suis strain R27 at 21 days of age. Control pigs were inoculated with sham inoculum. The pigs were necropsied 5-14 days postinoculation (DPI). None of the Chlamydia-infected pigs developed diarrhea. Villus atrophy was seen histologically in sections of ileum from Chlamydia-infected pigs in both groups 5 and 7 days DPI. Lymphangitis and multiple lymphohistiocytic and neutrophilic aggregates were seen in the submucosa, tunica muscularis, and serosa of the distal jejunum, ileum, and colon from Chlamydia-infected pigs in both groups 5-14 DPI. Immunostaining of sections of distal jejunum, ileum, and colon from infected pigs revealed chlamydial antigen in intestinal epithelium and in foci of lymphangitis/inflammation. The results indicated that C. suis strain R27 can cause intestinal lesions in young weanling pigs, and the lesions are similar to those seen in gnotobiotic piglets. The results also indicated that strain R27 causes asymptomatic intestinal infections in young weanling pigs, at least under the conditions of this study.

Animals↗

Persistent Chlamydiae and chronic arthritis.

Urogenital infection with Chlamydia trachomatis can lead to development of an acute inflammatory arthritis, and this acute disease becomes chronic in some individuals. Research indicates that the organism is present in synovial tissue of patients with chronic disease in a persistent, rather than an actively growing, form. Importantly, metabolic and other characteristics of persistent Chlamydia differ from those of actively growing bacteria. Other studies suggest that Chlamydia pneumoniae can be found in a persistent state in the synovium and that it too may be involved in joint pathogenesis. These and other observations suggest a more complex role for the Chlamydiae in joint disease than previously recognized. This realization should engender a realignment of thinking among clinicians and researchers concerning both mechanisms of chlamydial pathogenesis in the synovium and design of new treatments for the disease.

Arthritis, Infectious↗

Localization of intracellular Ca2+ stores in HeLa cells during infection with Chlamydia trachomatis.

Chlamydia trachomatis elementary bodies (EBs) enter epithelial cells within membrane-bound endosomes that aggregate with each other in a calcium-regulated process, but avoid fusion with lysosomes. Annexin III but not I translocates to chlamydial aggregates and inclusions. In this study, we localize the intracellular Ca2+ stores during the course of infection by analyzing the distribution of three intracellular Ca2+ store proteins: calreticulin, type-1 inositol-1,4, 5-trisphosphate receptor (IP3-R), and Sarcoplasmic/Endoplasmic Reticulum Ca2+ ATPase type 2 (SERCA2) in HeLa cells infected with C. trachomatis serovar L2. In uninfected cells, immunofluorescence staining of the proteins showed a fine granular distributed pattern for all three proteins. After infection with C. trachomatis, calreticulin was found at the periphery of chlamydial aggregates and inclusions from 3 to 48 hours post-infection. In infected cells, SERCA2 was intimately associated with chlamydial inclusions after 3 and 24 hours, but not after 48 hours. Moreover, IP3-R was translocated to and colocalized with EB aggregates and chlamydial inclusions and had a distribution very similar to that of SERCA 2. After 24 hours incubation with chlamydiae, there was a local accumulation of [Ca2+]i (105+/-17 nM) in the proximity of chlamydial inclusions, compared to 50+/-13 nM in other parts of the cell cytoplasm. In the absence of extracellular Ca2+, this local accumulation of Ca2+ increased to 295+/-50 nM after adding 50 microM ATP, and to a similar extent after adding 100 nM thapsigargin (Tg). These data indicate that during infection of HeLa cells with chlamydiae, intracellular Ca2+ stores are redistributed, causing local accumulation of Ca2+ in the vicinity of chlamydial inclusions. These changes may trigger the association of certain proteins such as annexins with chlamydia-containing vesicles, and thereby regulation of membrane-membrane interaction during endosome aggregation and inclusion formation.

Adenosine Triphosphate↗

Association of seropositivity for antibody to Chlamydia-specific lipopolysaccharide and coronary artery disease in Japanese men.

Recent studies suggest an association between Chlamydia pneumoniae infection and coronary artery disease (CAD). To examine this relationship in Japanese men, serum IgA and IgG antibodies to Chlamydia-specific lipopolysaccharide were measured by enzyme-linked immunosorbent assay in 507 patients with CAD and 200 age-matched controls. CAD patients were divided into (1) 269 patients with myocardial infarction (MI) and (2) 238 patients with chronic coronary heart disease (CCHD). Compared with the control group, the CAD group did not differ in the prevalences of both antibodies (IgA: 23.7 vs 18.0%, p=0.10; IgG: 52.7 vs 51.0%, p=0.6). The index of IgG antibody was not significantly different between CAD and control groups (median 1.19 vs 1.18, p=0.3), whereas the index of IgA antibody was significantly higher in CAD than control group (median 0.60 vs 0.46, p<0.0001). Compared with the control group, the MI group had a significantly higher prevalence of IgA antibody (28.6 vs 18.0%, p=0.007); however, there was no difference in the prevalence of IgG antibody (58.0 vs 51.0%, p=0.13). The CCHD group did not differ in the prevalences of both antibodies (IgA: 18.1 vs 18.0%, p=0.9; IgG: 45.6 vs 51.0%, p=0.2). After the adjustment for coronary risk factors, odds ratios (ORs) of seropositive antibodies for CAD were 1.59 [95% confidence interval (CI): 0.88-2.87, p=0.12] for IgA seropositivity and 0.92 (95%CI: 0.58-1.47, p=0.7) for IgG seropositivity in all cases. In the MI and control groups, ORs of seropositive antibodies for MI were 2.67 (95%CI: 1.32-5.38, p=0.007) for IgA seropositivity, and 1.36 (95%CI: 0.79-2.36, p=0.2) for IgG seropositivity. This study discovered that IgA antibody to Chlamydia was significantly associated with CAD, especially with MI, in Japanese Men and the findings suggest that chronic infection of Chlamydia may be linked to the pathogenesis of MI.

Aged↗

Opportunistic chlamydia screening; should positive patients be screened for co-infections?

This study examines the requirement for testing patients for other sexually transmitted infections (STIs) and bacterial vaginosis (BV) when diagnosed with genital chlamydia during opportunistic screening. Data were collected on all patients participating in the Department of Health chlamydia screening pilot study in Portsmouth. One thousand two hundred and forty-five women and 490 men with genital chlamydia were seen in Portsmouth genitourinary medicine (GUM) department. Of the women screened in GUM, 28% had coexisting STIs and 21% had BV. The corresponding figures for those initially screened in the community were 4% and 17%. An increased number of female sexual partners of male patients (76%) and male partners of female patients (55%) of the GUM group had co-infections; 58% of male partners from the community group had another STI. The increased morbidity associated with these infections warrants screening of all patients with chlamydia for other STIs and BV.

Adolescent↗

Which treatment for genital tract Chlamydia trachomatis infection?

A national opportunistic chlamydia screening programme, mainly targeting young sexually active women, is gradually being introduced across the UK and in future will predominantly occur in primary care sites. The relative efficacy of recommended antibiotic treatments for chlamydia has been poorly studied and especially that of single dose azithromycin. In Portsmouth, 1536 patients treated for chlamydia, with four different antibiotic regimens, during the Department of Health pilot study, were asked to return for test of cure. No difference in treatment outcome was found using doxycycline, oxytetracycline, erythromycin or azithromycin. Directly observed therapy with azithromycin may be especially helpful in treating young chlamydia-positive patients.

Adolescent↗

Aerobic bacteria, Chlamydia trachomatis, Pneumocystis carinii and Cytomegalovirus as agents of severe pneumonia in small infants.

The authors studied 58 infants hospitalized for pneumonia in a semi-intensive care unit. Age ranged from 1 complete to 6 incomplete months. The infants were sent from another hospital in 20 cases and from home in a further 38. Pulmonary involvement, which was alveolar in 46 cases and interstitial in 12, was bilateral in 31 children. The investigation was carried out prospectively on the etiological agents associated with respiratory infection to look for evidence of aerobic bacteria (blood cultures), Chlamydia trachomatis and Cytomegalovirus (serology), and Pneumocystis carinii (direct microscopy of tracheal aspirated material). The following infectious agents were diagnosed in 21 children (36.2%): Aerobic bacteria (8), Chlamydia trachomatis (5), Pneumocystis carinii (3), Cytomegalovirus (3), Cytomegalovirus and Chlamydia trachomatis (1), Aerobic bacteria and Cytomegalovirus (1). Seven cases of infection by Chlamydia trachomatis and/or Cytomegalovirus were diagnosed out of the 12 cases with pulmonary interstitial involvement.

Age Factors↗

Knowledge of genital Chlamydia trachomatis infection in family planning clinic attenders.

The purpose of this study was to determine the level of awareness of genital Chlamydia infection and level of knowledge related to this infection in family planning (FP) clinic attenders. Clients attending FP clinics during a 3 month study period were invited to complete an anonymous self-administered questionnaire. Five hundred and sixteen questionnaires from female attenders were analysed. Results showed that 54% of respondents had heard of Chlamydia. Subjective knowledge assessment for Chlamydia was low compared to that for other infections. Mean knowledge scores relating to genital chlamydial infection were low. There was no significant age-related trend in knowledge scores. The implications of these findings are discussed in relation to increased Chlamydia screening activity in FP clinics.

Adolescent↗

Implementation of chlamydia screening in a general practice setting: a 6-month pilot study.

OBJECTIVE: To determine whether screening for asymptomatic Chlamydia trachomatis infection could be undertaken in the context of a smear clinic or other sexual health consultation in general practice. METHODS: A prospective, opportunistic, cohort study was undertaken in a general practice setting. The participants were asymptomatic women aged 16-24 years and men aged 16-34 years who were screened for Chlamydia trachomatis by testing endocervical swabs or first-voided urine samples. The main outcome measure was the uptake of the screening offer and the presence or absence of chlamydia infection as indicated by the test result. RESULTS: A total of 115 patients (109 women and six men) were offered screening. Eighty-one (70%) patients accepted, with five positive results, giving an overall prevalence of 6.2% (5/81, 95% CI 1-11%). Of those offered screening when having a smear, 8.3% (3/36, 95% CI 0-17%) were positive. CONCLUSION: Screening for chlamydia can be undertaken in the context of existing services offered in general practice (e.g. a smear clinic or consultation) where contraception/sexual health is discussed.

Adolescent↗

Chlamydia screening in general practice: views of professionals on the key elements of a successful programme.

OBJECTIVES: Chlamydia trachomatis is a common sexually transmitted infection with serious consequences if not treated. Chlamydia screening pilots in England have established feasibility in primary care but there are currently no examples of good practice in general practice. The objectives of the study were to understand issues of using general practice as a setting for chlamydia screening and to explore ways of implementing a successful screening strategy. METHODS: Based on findings of a literature review, a semi-structured schedule was constructed to interview a purposive sample of policymakers, consultants in sexual and reproductive health and primary care professionals. A thematic framework was used for qualitative analysis. RESULTS: Twenty-two themes were identified and were ranked in order of word count. The topic that generated most discussion was heterogeneity of knowledge, attitudes and skills in general practice. When broken down by professional group, this topic ranked the highest for practice nurses and consultants in sexual health; general practitioners (GPs) and the chlamydia screening coordinator spoke most about financial incentives while the public health consultant spoke most about access. CONCLUSIONS: Most believed screening can and should be done and general practice can offer better population coverage. It needs to have little impact on clinicians' workload, for example, by using urine tests and self-taken vaginal swabs. Financial recognition needs to reflect the administrative costs and the impact on reception staff, but this and the innovative tests might add to the cost of the screening programme. Incentives have to be handled sensitively to reduce inequity among GPs and other services offering screening.

Attitude of Health Personnel↗

[Chlamydia trachomatis--a possible cause of premature labor].

INTRODUCTION: The aim of this study was to investigate the incidence of urogenital infection with Chlamydia trachomatis in patients with preterm delivery in relation to those with term delivery. MATERIAL AND METHODS: The investigation included a random sample of 116 parturients. Direct immunofluorescence (DIF) test was used to diagnose Chlamydia trachomatis. RESULTS: In the investigated group (N = 53), positive finding of Chlamydia trachomatis in the urogenital tract was established in 6 (11.32%) patients in cervix and in 5 (9.43%) patients in the urethra, whereas in the control group there were 3 (4.76%) positive findings in the cervix and 1 (1.59%) in the urethra. The control group included patients with term delivery (N = 63). DISCUSSION AND CONCLUSION: Results of investigation point to the necessity of diagnostics and treatment of Chlamydia trachomatis in prevention of preterm delivery, particularly in women with previous unsuccessful pregnancies.

Chlamydia Infections↗

Prevalence of genital Chlamydia trachomatis infection among women in a Swedish primary health care area.

The objective of this study was to estimate the prevalence of genital chlamydial infection in an unselected population of young women by offering a screening investigation to all women between the ages of 15 and 34 in a primary health care area. Specimens were taken from both the urethra and the cervix in all participating women, and data regarding the participants' symptoms, sexual habits, contraceptive use and socioeconomic factors were also collected. The specimens were analyzed with a primary enzyme immunoassay (Syva MikroTrak) and a confirmatory direct immunofluorescence test (Syva MikroTrak). A total of 543 women were invited to the study and 374 women (68.9%) participated. 10/374 women (2.7%) were chlamydia positive and only 2 of these 10 chlamydia infected women were less than 25 years of age. The chlamydia infected women had positive tests either from the urethra (4 women) or from the cervix (6 women), and in no case the tests were positive from both locations. No statistically significant differences between the chlamydia positive and negative women were found concerning any clinical or anamnestic factor.

Adolescent↗

The prevalence of Chlamydia trachomatis in the cervix of puerperal women, and its consequences for the outcome of pregnancy.

During a five-month period all puerperal women at the Department of Obstetrics, University Hospital of Trondheim, Norway, were screened for Chlamydia trachomatis (C. trachomatis) from the cervix uteri on the 4-6th day postpartum. Outcomes of the pregnancies were examined. The prevalence of C. trachomatis in the total population of 599 eligible women was 5.8% (35:599), while 3.0% (18:599) of the cultures were inconclusive. The prevalence of C. trachomatis in women aged less than 20 years was 25.8%; aged 20-24 years, 8.9% and greater than 24 years, 2.3%. The prevalence of C. trachomatis among women living alone was 17.2%; among women in cohabitation, 9.2% and among married women, 3.2%. There was no relationship between the presence of C. trachomatis and preterm birth, birth weight and birth weight for gestation, stillbirth or neonatal death. During the first fourteen postpartum days no puerperal infections were seen among chlamydia-positive mothers. The chlamydia-positive women and their partners were then treated with erythromycin stearat 1,000 mg daily for 12 days. Samples for cervix 14 days after completion of the treatment were chlamydia-negative for all 35 women. Screening all pregnant women under the age of 25 years would detect 80% of the pregnant population harbouring C. trachomatis in the cervix uteri. Based on findings from this study and from cost-benefit analyses, we recommend screening of all pregnant women under the age of 25 years in our attachment area.

Adult↗

Chlamydia-induced septic polyarthritis in a dog.

A systemic disease associated with pyrexia, lymphadenopathy, and arthropathy of several joints of the appendicular skeleton in a dog is described. Chlamydia-like organisms were detected on light-microscopic examination of a smear made from joint fluid aspirated from one of the affected joints. A group-specific lipopolysaccharide antigen shared by all Chlamydia spp. was demonstrated by direct fluorescent antibody staining of joint fluid, which also proved positive for chlamydia by means of the relevant polymerase chain reaction test. An indirect fluorescent antibody test on serum was also positive, although the complement fixation test was negative. Attempts to grow the organism from joint aspirates in the yolk sac of embryonating hens' eggs and on appropriate tissue cultures, however, failed. Chlamydia spp. are considered to have played an aetiological role in this case, making it the first substantiated case of naturally-occurring arthropathy in a dog due to chlamydiosis. The origin of the infection could not be traced.

Animals↗

Chlamydia trachomatis antigen detection in pregnancy and its verification by antibody blocking assay.

PURPOSE: To detect the prevalence of genital infection caused by Chlamydia trachomatis in pregnant women and also to confirm the positive results using blocking antibody assay. METHODS: Endocervical specimens were collected from 200 symptomatic and asymptomatic pregnant women attending the ANC OPD at M P Shah Medical College, Jamnagar. The samples were tested for presence of Chlamydia trachomatis antigen using the monoclonal antibody. Blocking antibody assay was used to further verify the positive results. RESULTS: Out of 200 pregnant women, 38 (19%) were found positive for Chlamydia trachomatis antigen. Out of the 68 symptomatic patients, C. trachomatis antigen was detected in 26.4%. After verification of the positive samples 13.6% of the asymptomatic pregnant women were found to be harbouring the infection in their genital tract. Two (5.2%) out of the 38 positive samples, on verification with the blocking antibody assay, were found to be false positive by IDEIA,TM thus the specificity of the IDEIATM being 94.8%. In patients with previous history of abortions, 27.7% were tested positive for C. trachomatis infection. CONCLUSIONS: Significant number of pregnant women shad C. trachomatis antigen in their endocervical canal, which can be easily diagnosed by this simple enzyme immuno assay having a specificity of 94.8%. Verification of positive results by antibody blocking assay can further improve the specificity of this non-culture test. Asymptomatic patients should also be screened for the infection. History of previous abortions places the patient at a higher risk for C. trachomatis infection thus such patients should be definitely tested for chlamydia infection.

Abortion, Induced↗

Chlamydia trachomatis in the pharynx and rectum of heterosexual patients at risk for genital infection.

Although urogenital infections with Chlamydia trachomatis are well recognized, less is known about infection at other body sites in adults. Pharyngeal specimens obtained from 706 heterosexual men and 686 women, and rectal specimens obtained from 1223 women who were at risk for chlamydia infection were cultured for C. trachomatis. Urogenital specimens were obtained from all patients. Chlamydia trachomatis was isolated from the pharynx in 3.7% of men and 3.2% of women. Recovery of chlamydiae was not associated with the presence of pharyngeal symptoms, but in women, but not men, it was associated with a history of oral-genital sex. The organism was also recovered from the rectum of 5.2% of the women. Rectal isolation did not correlate with a history of rectal symptoms or rectal sex but did correlate with concurrent genital infection. Infection at these sites may be important in the transmission or persistence of C. trachomatis infections.

Adolescent↗