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PubMed1976

Differential response of chlamydial and ureaplasma-associated urethritis to sulphafurazole (sulfisoxazole) and aminocyclitols.

91 men with non-gonococcal urethritis (N.G.U.) were randomly treated with either sulphafurazole (sulfisoxazole), 500 mg orally q.i.d. for 10 days, or an aminocyclitol (streptomycin or spectinomycin), 2 g intramuscularity for 1 to 3 doses at 12 h intervals. Initial urethral cultures were positive for Chlamydia trachomatis (C) in 36 (40%). Ureaplasma urealyticum (U) was isolated from the urethra or urine from20 (95%) of 21 White men in a first episode of N.G.U. who had negative chlamydia cultures. Sulphafurazole, active against C. trachomatis but not U. urealyticum in vitro, produced a clinical response in 7 of 7 men with C+U- N.G.U. and 5 of 19 with C-U+ N.G.U. (P less than 0-01). Aminocyclitols, active against U. urealyticum but relatively inactive against C. trachomatis in vitro produced a clinical response in 0 of 6 men with C+U-N.G.U., 9 of 11 men with C-U+N.G.U. from whom ureaplasma was eradicated (P less than 0-01), and 0 of 8 with C-U+ N.G.U. from whom ureaplasma was not eradicated. C+U+ N.G.U. responded poorly to both antimicrobials alone. These results support the aetiological importance of both C. trachomatis and U. urealyticum in N.G.U.

Administration, Oral↗
PubMed1979

Clinical characteristics of the afebrile pneumonia associated with Chlamydia trachomatis infection in infants less than 6 months of age.

Respiratory tract colonization with Chlamydia trachomatis commonly occurs in natally acquired chlamydial infection and is sometimes associated with a chronic, afebrile pneumonia that has relatively distinctive clinical characteristics. To further define the frequency and clinical characteristics of lower respiratory tract disease associated with C trachomatis, we grouped 56 infants aged less than 6 months with afebrile pneumonia according to nasopharyngeal shedding of Chlamydia and viruses and compared their illnesses. Forty-one (73%) were positive for C trachomatis (23 had C trachomatis only, while 18 had C trachomatis plus a virus [cytomegalovirus, respiratory synctial virus, adenovirus, rhinovirus, or enterovirus]), and 15 were C trachomatis negative (nine had a virus only, and six had neither C trachomatis nor virus). The 41 infants with C trachomatis alone or C trachomatis plus a virus were similar clinically and differed significantly from other infants in several ways: (1) onset of symptoms before 8 weeks of age; (2) gradually worsening symptoms; (3) presentation for care at 4 to 11 weeks of age; (4) presence of conjunctivitis and ear abnormalities; (5) chest roentgenograms showing bilateral, symmetrical, interstitial infiltrates and hyperexpansion; (6) peripheral blood eosinophils greater than or equal to 300/cu mm; and (7) elevated values for serum immunoglobulins M, G, and A. Pediatrics 63:192--197, 1979, Chlamydia trachomatis, pneumonia, afebrile pneumonia, interstitial pneumonia.

Chlamydia trachomatis↗
PubMed1976

Chlamydial infection of the male urethra.

Urethral specimens from 477 men were collected with endourethral swabs and examined for Chlamydia trachomatis by cell culture on McCoy cells pretreated with idoxuridine. Of these men, 141 had gonococcal urethritis, 262 non-gonococcal urethritis (NGU), and 74 showed no evidence of urethritis. Of 118 men with heterosexually acquired gonococcal urethritis, thirty (25 per cent.), and of 23 men with homosexually acquired gonococcal urethritis, five (22 per cent.), yielded C. trachomatis from the urethra. Urethral specimens from 240 heterosexual men with NGU were examined, and 118 (49 per cent.) yielded C. trachomatis. Of these 240 men, 140 gave a past history of gonococcal or nongonococcal urethritis and 67 (48 per cent.) of these were positive for C. trachomatis; no past history was given by 100 men, of whom 51 were positive for C. trachomatis. Of the 240 heterosexual men with NGU, 81 had had symptoms for 7 days or more before examination, of whom 48 (59 per cent.) yielded isolates of C. trachomatis, and 145 had had symptoms for less than 7 days, of whom 59 (41 per cent.) yielded isolates. Of fourteen asymptomatic men, three were positive for C. trachomatis. Of 22 homosexual men with NGU, seven (32 per cent.) yielded C. trachomatis. C. trachomatis was recovered from the urethra in three (5 per cent.) of sixty heterosexual men without urethritis, and none of fourteen homosexual men without urethritis yielded C. trachomatis.

Adult↗
PubMed1978

Chlamydia trachomatis as a cause of acute "idiopathic" epididymitis.

To assess the etiologic role of C. trachomatis and other micro-organisms in "idiopathic" epididymitis, 23 men underwent microbiologic studies, including cultures of epididymal aspirates in 16. Eleven of 13 men under the age of 35 years had C. trachomatis infection whereas eight of 10 over 35 had coliform urinary-tract infection. Cultures of epididymal aspirates yielded C. trachomatis alone in five of six men under 35, and coliform bacteria alone in five of 10 over 35. These results suggest that C. trachomatis is the major cause of "idiopathic" epididymitis, and coliform bacteria the major cause of epididymitis in older men. Expressible urethral discharge and inguinal pain were more common in the chlamydial cases, whereas concurrent genitourinary abnormality and scrotal edema and erythema occurred more commonly in the coliform cases. The morbidity attributable to C. trachomatis is as serious as that attributable to Neisseria gonorrhoeae.

Acute Disease↗
PubMed1978

Chlamydia trachomatis infant pneumonitis: comparison with matched controls and other infant pneumonitis.

We determined the prevalence of Chlamydia trachomatis infection in 30 consecutive hospitalized infants less than six months of age with pneumonitis and in 28 matched controls (nine of 30 vs. one of 28. P less than 0.05). In comparing 16 cases of pneumonitis due to C. trachomatis with 27 not due to that agent, we found several distinguishing clinical and laboratory features: C. trachomatis was highly correlated with radiographic hyperinflation, prolonged cough and congestion, greater than or equal to 400 eosinophils per cubic millimeter and serum lgG greater than or equal to 500 and lgM greater than or equal to 110 mg per deciliter. C. trachomatis was responsible for 13 of 21 cases seen at three to 11 weeks vs. three of 22 seen at other ages. Antibody to C. trachomatis in tears (13 of 14 vs. two of 27), nasopharynx (12 of 14 vs. one of 27) and blood (16 of 16 vs. two of 23) was specific for C. trachomatis pneumonitis. C. trachomatis is prevalent among hospitalized infants with pneumonitis. Conjunctival infection precedes C. trachomatis pneumonitis more commonly than has previously been thought.

Antibodies, Bacterial↗
PubMed1976

The lack of effect of ampicillin plus probenecid given for genital infections with Neisseria gonorrhoeae on associated infections with Chlamydia trachomatis.

Forty-six men were successfully treated with a single oral dose of ampicillin (2 g) plus probenecid (1 g) for urethral infections with Neisseria gonorrhoeae. Chlamydia trachomatis was isolated from cultures of cells obtained from 11 of these men both before and after treatment; C. trachomatis was isolated from one man before but not after treatment and from three men after but not before treatment. No isolates were obtained from the remaining 31 men either before or after treatment. Of the 15 patients whose cultures yielded C. trachomatis, 12 developed postgonococcal urethritis; of the 31 patients from whose cultures no isolate was obtained, five developed postgonococcal urethritis. Of 44 women successfully treated with ampicillin plus probenecid for cervical infections with N. gonorrhoeae, 18 had C. trachomatis isolated from the cervix both before and after treatment. C. trachomatis was isolated from five women before but not after treatment and from two women after but not before treatment. No isolates were obtained from the remaining 19 women either before or after treatment. Thus ampicillin plus probencide in the dosage used rarely eliminated C. trachomatis from the genital tract of either men or women. Whereas men with a persisting chlamydial infection will probably develop postgonococcal urethritis and thus receive appropriate treatment, such an infection in women is not likely to be suspected unless attempts are made to isolate C. trachomatis.

Ampicillin↗
PubMed1979

Acute epididymitis: etiology and therapy.

Fifty patients with acute epididymitis were evaluated prospectively by history, examination, and microbiologic studies, including cultures for aerobes, anaerobes, N. gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. E. Coli was the predominant pathogen isolated from the urine of men over 35 years old and C. trachomatis and N. gonnorrheae were the predominant pathogens isolated from the urethra of men under 35. The etiologic role of E. Coli and C. trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine of urethral cultures for these agents. C. trachomatis epididymitis accounted for two thirds of "idiopathic epididymitis" in men, and was often associated with oligozoospermia. Of nine female sexual partners of men with C. trachomatis infection, six had antibody to C. trachomatis, of whom two had positive cervical cultures for this organism, and the others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with C. trachomatis epididymitis, and should be offered to their female sex partner.

Adolescent↗
PubMedDate not supplied

Etiologies of postgonococcal urethritis in homosexual and heterosexual men: roles of Chlamydia trachomatis and Ureaplasma urealyticum.

Before treatment for urethral gonorrhea, Chlamydia trachomatis was isolated from 18% and Ureaplasma urealyticum from 37% of 121 men. C. trachomatis was recovered from none of 18 homosexual men who had gonorrhea and from 22 of 95 heterosexual men who had gonorrhea (P less than 0.05). After treatment with a penicillin, postgonococcal urethritis occurred significantly more often in heterosexual than in homosexual men (P less than 0.002). Postgonococcal urethritis developed in all men from whom C. trachomatis was isolated. Among men without U. urealyticum infection, postgonococcal urethritis was significantly associated with C. trachomatis infection (P less than 0.02). Among men without C. trachomatis infection, postgonococcal urethritis was less closely associated with U. urealyticum infection (0.1 greater than P greater than 0.05). Postgonococcal urethritis was least frequent among men who had neither C. trachomatis nor U. urealyticum infection.

Chlamydia Infections↗
PubMed1978

Prediction of efficacy of antimicrobial agents in treatment of infections due to Chlamydia trachomatis.

Although Chlamydia trachomatis is readily eradicated by systemic therapy in patients with acute urethritis, systemic therapy is less satisfactory in treatment of chronic trachoma. The activities of antimicrobial agents against C. trachomatis in cell cultures when the antimicrobial agents are added 1 hr after the C. trachomatis (minimal inhibitory concentration [MIC]) predicts efficacy of the drugs in the treatment of urethritis but does not necessarily predict efficacy in the treatment of chronic ocular trachoma. Concentrations of antimicrobial agents required to eradicate C. trachomatis when the agents were added 48 hr after inoculation of the cell cultures with C. trachomatis exceeded the MIC by several logarithms, and minocycline, doxycycline, and rifampin were markedly more active than tetracycline, erythromycin, or several other antimicrobial agents. Of the three most active antimicrobial agents, only doxycycline has been used systemically to treat ocular infections due to C. trachomatis, and it has been reported to be the most effective antimicrobial agent that has been utilized. In vitro testing of obligate intracellular pathogens such as C. trachomatis presents unique problems. Utilization of several methods of testing may help to identify antimicrobial agents with improved clinical efficacy, particularly in the treatment of ocular trachoma.

Anti-Bacterial Agents↗
PubMed1979

Experimental nasopharyngitis and pneumonia caused by Chlamydia trachomatis in infant baboons: histopathologic comparison with a case in a human infant.

Three infant male baboons were inoculated with a strain of CHLAMYDIA TRACHOMATIS ISOLATED FROM A HUMAN INFANT WITH PNEUMONITIS. One baboon, inoculated by intratracheal, nasopharyngeal, and oropharyngeal seeding, had rales, radiographic evidence of pneumonia, persistent nasopharyngeal C. trachomatis infection, and a four-fold rise in titer of antibody. At sacrifice 24 days after inoculation, nasopharynx, trachea, airways, and lung yielded C. trachomatis, and epithelial inclusions were seen by light and immunofluorescent microscopy. Histopathologic changes noted were nearly identical to those in a lung biopsy specimen from a human infant and pneumonitis and nasopharyngeal C. trachomatis. The second baboon was inoculated by tracheal seeding and maintained nasopharyngeal C. trachomatis until killed 30 days later. Autopsy revealed nasopharyngitis and patchy mild pneumonitis. The third baboon was inoculated by nasopharyngeal seeding and maintained nasopharyngeal C. trachomatis for 49 days. Both of the latter baboons seroconverted. Infant baboons appear to be useful animal models for C. trachomatis nasopharyngitis and pneumonia.

Animals↗
PubMed1978

A comparison of genital infections caused by chlamydia trachomatis and by neisseria gonorrhoeae.

Patients with culture-proven infections with Neisseria gonorrhoeae or Chlamydia trachomatis, or both, seen at the Olmsted County Health Department Sexually Transmitted Disease Clinic were evaluated for the presence of dysuria and exudate. Eighty-four patients (21%) had neither symptom. N. gonorrhoeae infection alone was most frequent (47%), but C. trachomatis predominated in men. Dysuria was most often detected in men infected with C. trachomatis, but exudate was most frequently found in men infected with N. gonorrhoeae alone or in mixed infections with C. trachomatis. The presence of both symptoms was more common in men than in women infected with N. gonorrhoeae or C. trachomatis. However, as the occurrence of dysuria and exudate was generally similar within the male and female groups, regardless of the organisms recovered, the type of infection cannot be accurately determined on the basis of symptomatology alone. The authors therefore believe that the diagnosis of genital infection by C. trachomatis or N. gonorrhoeae, or both, by culture technics is essential because effective treatment with antimicrobial therapy often requires this information.

Adolescent↗
PubMed1978

Role of Chlamydia trachomatis and HLA-B27 in sexually acquired reactive arthritis.

Inflammatory arthritis, tendinitis, and fasciitis after non-specific urethritis ("sexually acquired reactive arthritis" (SARA)) was studied prospectively in 531 men with non-specific urethritis, with particular reference to the frequency of isolation of Chlamydia trachomatis and the presence of HLA-B27. Satisfactory cultures were obtained from the urethral swabs from 384 patients; and HLA typing was performed on 482, of whom 30 (6%) were HLA-B27-positive. Arthritis developed in 16 patients, and five of the 14 (36%) with satisfactory cultures were positive for C trachomatis; 135 of the patients without arthritis were also positive for C trachomatis, an identical proportion. Seven of the 15 patients (40%) with arthritis who were HLA-typed were HLA-B27-positive. Six of the 30 patients with HLA-B27 developed peripheral arthritis in contrast to only nine of the 452 patients lacking the antigen, suggesting a tenfold increase susceptibility. C trachomatis, however, was no more prevalent in cultures from HLA-B27-positive men than from the others. Thus carriage of C trachomatis is unlikely to be influenced by HLA-B27. C trachomatis may be an important pathogen in some cases of SARA but does not appear to be an exclusive trigger factor for this condition.

Arthritis↗
PubMed1978

In vitro assays of the efficacy of antimicrobial agents in controlling Chlamydia trachomatis propagation.

The antimicrobial susceptibility of a low-laboratory-passage, slow-growing, genital Chlamydia trachomatis strain was studied by five different procedures with the use of McCoy cells pretreated with 5-iodo-2-deoxyuridine. The effects of antimicrobial agents when added to cultures on day 0 or day 2 after inoculation with C. trachomatis and the effects of washing and reincubating treated cultures in antimicrobial-free media were investigated. Tetracycline and erythromycin inhibited C. trachomatis growth at concentrations attainable in human serum, although their actions were reversible and significantly higher concentrations were needed to "cure" 48-h infected cultures. On a weight basis, spectinomycin was relatively ineffective in inhibiting C. trachomatis growth. The minimal inhibitory concentration of penicillin measured by our assay procedures was higher than that reported by other investigators. The five assay procedures used in this study were reproducible, and our results indicate that we can obtain more pertinent information about the efficacy of an antimicrobial agent in controlling C. trachomatis growth by using a combination of these assays than by simple minimal inhibitory concentration determinations, as had been previously described by other investigators. In addition, we failed to demonstrate changes in tetracycline susceptibility of C. trachomatis isolates from two patients who had received tetracycline therapy.

Animals↗
PubMed1977

Recovery of Chlamydia and Genital Mycoplasma transported in sucrose phosphate buffer and urease color test medium.

Urethral swabs from 75 males with urethritis were extracted into tryptose phosphate broth and then equal aliquots were dispensed into vials containing sucrose phosphate buffer (2SP) and urease color test medium (U-9). No antibiotics were present in the media. After transport to the laboratory, the recovery of Chlamydia trachomatis and Ureaplasma urealyticum was evaluated after inoculation into McCoy's cell cultures and agar medium, respectively. C. trachomatis was recovered from significantly more patients (17 versus 12, P = 0.03) with higher inclusion counts (P less than 0.01) in specimens transported in 2SP as compared with those in U-9 medium. No significant differences between the isolation rate of U. urealyticum and that of Mycoplasma hominis were found with the two media. The rate of inactivation of C. trachomatis and U. realyticum at 4 C was examined by means of reference strains. The inactivation of C. trachomatis was similar in both 2SP and U-9 media, but the number of inclusions was consistently greater in the 2SP medium. In contrast, the number of colony-forming units of U. urealyticum actually increased over a 24-hour period in both media. We conclude that 2SP is the best medium for the combined recovery of C. trachomatis and genital Mycoplasma. The use of one transport medium and hence a single swab culture has the obvious advantages of saving time and expense for both physician and laboratory, and for the patient it will eliminate the possible discomfort of having multiple cultures taken.

Bacteriological Techniques↗
PubMed1979

Chlamydia trachomatis in acute salpingitis.

In a study to evaluate the possible role of Chlamydia trachomatis and Neisseria gonorrhoeae in acute salpingitis, 26% of 106 patients with severe symptoms had positive culture results for C. trachomatis; 43% of the 72 patients from whom paired sera were obtained had either positive culture results for or seroconversion in the single antigen immunofluorescence test to C. trachomatis. Twenty-six per cent of patients harboured N. gohorrhoeae and 14% had gonococcal complement-fixing antibody titres greater than or equal to 8. Intrauterine devices were used by 48% of patients, no difference being found in the frequency of use between patients harbouring C. trachomatis or N. gonorrhoeae. The possible role of C. trachomatis should be considered in the treatment of acute salpingitis.

Acute Disease↗
PubMed1978

Chlamydia trachomatis in non-specific urethritis.

Chlamydia trachomatis was isolated from 58.5% of 159 patients with non-specific urethritis (NSU) using irradiated McCoy cell cultures. Patients with persistent Chlamydia-positive NSU remained Chlamydia-positive each time they were examined before treatment and patients with Chlamydia-negative NSU remained Chlamydia-negative during the course of the illness. Neither the duration of symptoms of urethritis nor a history of previous urethritis affected the chlamydial isolation rate significantly. Of 40 patients with severe discharge 30 (75%) harboured C. trachomatis. One-third of the Chlamydia-positive patients had a severe urethral discharge, while this was present in only 15% of Chlamydia-negative patients. Complications--such as conjunctivitis, arthritis, and epididymitis--were more severe in men with Chlamdia-positive NSU than in those with Chlamydia-negative NSU. Of 64 men matched for sexual promiscuity but without urethritis, none harboured C. trachomatis in his urethra. This differs significantly (P less than 0.001) when compared with patients with NSU. C. trachomatis was isolated from the urogenital tract in 24 (42%) out of 57 female sexual contacts of patients with NSU. The presence of C. trachomatis in the women correlated significantly (P less than 0.001) with the isolation of the agent from their male contacts. These findings give further evidence for the aetiological role of C. trachomatis in non-specific urethritis and its sexual transmission.

Adult↗
PubMed1977

Respiratory-tract colonization and a distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis.

To learn if Chlamydia trachomatis causes in young infants a distinctive penumonia characterized by chronic, afebrile course, diffuse lung involvement and elevated serum immunoglobulins G and M, 47 black infants four to 24 weeks of age were examined for nasopharyngeal shedding of C. trachomatis and serum immunofluorescent antibody to lymphogranuloma venereum Type I. Nasopharyngeal C. trachomatis was found in 18 of 20 with the pneumonia syndrome, two of 15 with various other illnesses and 10 of 12 with inclusion conjunctivitis but without lower respiratory illness. Chlamydial antibody titers of infants with the pneumonia syndrome were significantly elevated (geometric mean-1, pneumonia vs. conjunctivitis = 24,833 vs. 1024 P less than 0.001). No other commonly recognized respiratory pathogens were consistently associated with the pneumonia syndrome. We believe these findings demonstrate an association between the distinctive pneumonia syndrome and C. trachomatis. This, in turn, is a particular facet of a more general event consisting of frequent colonization of the respiratory tract by C. trachomatis in natally acquired infection.

Antibodies, Bacterial↗
PubMed1977

Spectinomycin hydrochloride in the treatment of gonorrhoea: Its effect on associated Chlamydia trachomatis infections.

Sixty-three heterosexual men were successfully treated with a single injection of spectinomycin hydrochloride 2 g for urethral infections with Neisseria gonorrhoeae. Chlamydia trachomatis was recovered from the urethra of 11 of these men both before and after treatment. In six men, the organism was isolated after but not before treatment. No isolates were obtained from the remaining men either before or after treatment. All 17 of the men who yielded C. trachomatis developed post-gonococcal urethritis. Eight of 46 men from whom no isolate was obtained in their cultures developed post-gonococcal urethritis. Seventeen of 50 women successfully treated with spectinomycin for cervical infections with N. gonorrhoeae yielded isolates of C. trachomatis both before and after treatment. The organism was isolated from five women before but not after treatment, and from four women after but not before treatment. In 24 women culture for C. trachomatis was negative both before and after treatment. Spectinomycin hydrochloride in the dosage used rarely eliminated C. trachomatis from the genital tract of either men or women; in this respect it resembled two other drugs commonly used for the treatment of gonorrhoea-pencillin and ampicillin.

Chlamydia Infections↗