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[Clinical significance of interaction between Chlamydia infection (Chlamydia pneumoniae) and free radical processes during ischemic heart disease].

AIM: To determine occurrence and activity of chlamydial infection (CI) as well as activity of free radical processes in clinical course of different forms of ischemic heart disease. MATERIAL AND METHODS: 34 coronary heart disease (CHD) patients entered the study. 23(67.6%) of them had effort angina and unstable angina, 11(32.4%) patients had non-Q myocardial infarction (19 men and 15 women). 14 healthy donors served control. CI was detected with enzyme immunoassay. The examinations were made in exacerbation and 2 weeks later in clinical improvement. Chlamydia pneumoniae infection in the tissues of the aorta and left coronary artery was studied in 15 dead bodies using the polymeric chain reaction. Generation of active oxygen forms by leukocytes was tested by luminol-dependent chemiluminescence method. In addition, the patients and donors were examined for malonic dialdehyde. RESULTS: Titers of IgA and IgG of C. pneumoniae antibodies were high in CHD exacerbation. IgM antibodies were not found in the diagnostic titers. Follow-up values of IgA and IgG titers lowered. C. pneumoniae was found in 12 of 15 autopsy specimens. Basal and stimulated indices of leukocytic generation of active oxygen forms in patients with CHD exacerbation were higher than in donors. Later, the generation declined. Malonic dialdehyde was also elevated in the exacerbation and lowered in clinical improvement. A correlation exists between IgA and IgG antibodies titers and chemiluminescence intensity in CHD exacerbation. CONCLUSION: In progression of atherosclerotic process including CHD and its exacerbations CI and free radical processes activate. These may be related showing a feasibility of C. pneumoniae involvement in development of atherosclerosis.

Antibodies, Bacterial↗

[The biological diagnosis of Chlamydia infections].

Chlamydia infections are becoming more and more common. The diagnosis can be confirmed in the laboratory by direct demonstration of the inclusion or by Giemsa'a technique, which is long and associated with false positive results. Much better is the technique of immunofluorescence which has been made specific and precise by the use of monoclonal antibodies. Cell culture has the advantage of being able to identify the strain, but it is long and expensive. Measuring antibody titres by immunofluorescence or by the ELISA technique can be performed in all laboratories. It is very valuable in the diagnosis of upper gynecological infections, such as salpingitis and sterility and in the diagnosis of neonatal pneumonia.

Antibodies, Bacterial↗

Cytologic investigations in Chlamydia infection.

Chlamydia is an extremely common genital infection. It can cause serious disseminated disease and can infect the neonate and the sexual partner. Morphologically, Chlamydia infection was identified in routine Fast smears obtained from 160 women. Chlamydia infection manifests as intracytoplasmic coccoid and inclusion bodies in the metaplastic cells. Infected cells also reveal cytomegaly and multinucleation. Immunofluorescence studies, electron microscopy, tissue studies, histochemical techniques and tissue cultures were undertaken to establish the diagnosis of Chlamydia infection as observed in Papanicolaou-stained material. Detailed cytomorphology of Chlamydia infection is described. Clinical implications of such a diagnosis are discussed.

Chlamydia Infections↗

[Characteristics of the immune status of female cattle breeders with chlamydia infections].

Chlamydia urogenital infections cause significant changes in the immune status which can be regarded as immunopathologic disorders. Taking into account the wide prevalence of infections of this kind, particularly among female agriculture workers, as well as their pathogenicity and health-related consequences, Chlamydia Trachomatis cases must be properly revealed in women affected with inflammatory diseases of genitalia with subsequent etiotropic treatment.

Agricultural Workers' Diseases↗

Keeping up with new technology: new approaches to diagnosis of Chlamydia infection.

Chlamydia trachomatis infections are among the most common sexually transmitted infections in the US today. One of the keys to the prevention of C. trachomatis infection rests on the ability to make this diagnosis on the basis of accurate laboratory testing. For many years the standard for diagnosis of C. trachomatis infections has been isolation in tissue culture. Numerous nonculture methods, including enzyme immunoassay, have been used as an alternative to cell culture. The performance characteristics of these tests have all been compared with a standard, cell culture, which at best will detect 90% of positive specimens. Nucleic acid amplification techniques, including PCR and ligase chain reaction, have been recently introduced. The advantage of these tests is their ability to detect 10-20% more positive specimens when compared with culture or confirmed nonculture methods performed with a single specimen. The sensitivity of amplified tests also allows us to test specimens from multiple sites (endocervix, urethra, urine), which expands our standard from an infected sample to detection of an infected patient. Tests based on amplified nucleic acid technology have greatly improved our ability to diagnose urogenital C. trachomatis infection. The use of an expanded standard will help us accurately define the true performance and clinical utility of nonculture Chlamydia diagnostic tests.

Chlamydia Infections↗

Therapeutic approaches to Chlamydia infections.

Chlamydia trachomatis ocular and urogenital infections represent major public health problems, whereas Chlamydophila pneumoniae is a common aetiological agent of community-acquired pneumonia. The obligate intracellular lifestyle of these established pathogens poses challenges to both their diagnosis and treatment. Tetracyclines, macrolides and quinolones remain the antimicrobials of choice for the treatment of infections due to Chlamydiaceae.

Anti-Bacterial Agents↗

[Identification of latent forms of Chlamydia trachomatis in the conjunctiva signifying "new interpretation of ocular chlamydia infections"].

Chlamydia trachomatis (CT) sérovar D through K was demonstrated with electron microscopy and biology in 114 patients with bilateral dry eyes. Long time ago latent CT was recognised in conjunctival epithelium of vernal kerato conjunctivitis patients. CT was found in conjunctival section of patients with an extinct trachoma. Aberrants forms of chlamydia bear the responsibility of this long lasting infection. Reticuled body does not product elementary bodies. It becomes an aberrant body which could remain latent during years. DIF and others classical investigations are negatives because abberrant chlamydiae have lost most part of their MOMP albeit keeping immunopathogenicity.

Antibodies, Bacterial↗

[Chlamydia infections].

Chlamydia trachomatis is a pathogen with an intracellular developmental cycle. Sexually transmitted infection with serotypes D to K can lead to cervicitis, endometritis, salpingitis and urethritis, however, symptoms are commonly mild. Newborns of mothers with cervical infection or colonisation can acquire inclusion conjunctivitis and atypical pneumonia. An efficient prophylaxis is not available so far. Antimicrobial therapy should be initiated as soon as chlamydial infection is confirmed, e.g. with tetracyclines or erythromycin. Partner treatment is mandatory.

Chlamydia Infections↗

[Genital Chlamydia infections].

Chlamydia trachomatis represents an important infectious agent for sexually transmitted diseases. In the USA more than 3 million new cases are recorded per year. The clinical picture and late complications are similar to those of gonorrhea; however, infections from C. trachomatis have relatively mild symptoms. This group of diseases may therefore be overlooked, and complications and late sequelae due to C. trachomatis thus occur more frequently in comparison to N. gonorrhoeae. From the viewpoint of general health in a population, chlamydial infections seem to be more important than the classic venereal diseases. The number of infections may be underestimated as infected individuals may be asymptomatic and are therefore not diagnosed and the disease recorded. Knowledge about chlamydial infections has increased significantly, and C. trachomatis today can easily be diagnosed by routine laboratory methods; this report deals with current knowledge regarding the epidemiology, clinical symptoms, complications, diagnosis, and treatment of genital chlamydial infections.

Anti-Bacterial Agents↗

Immunological aspects of genital chlamydia infections.

Chlamydia trachomatis ascends from the cervix to the Fallopian tubes where it forms a persistent infection. The immune response to this infection results in tubal occlusion and infertility. In its persistent formC. trachomatis produces high levels of a 60-kDa heat shock protein (c-hsp60). There is a human hsp60 (h-hsp60) which shares a 50% amino acid sequence homology with the c-hsp60. Therefore, a chlamydial Fallopian tube infection can induce the development of autoantibodies to h-hsp60. H-hsp60 is one of the first proteins synthesized following fertilization. It is also expressed by epithelial cells in the decidua. Therefore, expression of h-hsp60 in early pregnancy can reactivate the c-hsp60-sensitized lymphocytes, leading to immune rejection of the embryo. The role of C. trachomatis in male infertility requires clarification. Because most C. trachomatis infections occur without defined symptoms, only the screening of sexually active women will reveal whether a woman is infected with this organism. Detection and treatment of a recently acquired infection can prevent development of h-hsp60 autoantibodies and tubal occlusion, preserve fertility, and prevent complications such as ectopic pregnancy.

Autoantibodies↗

[Chlamydia infections].

Chlamydia trachomatis represents one of the most common causative agents of sexually transmitted diseases. Clinically, genital chlamydial infections are similar to gonorrhoea. Although the clinical symptoms in chlamydial infections are usually milder than those in gonorrhoea, late complications are more common and more dangerous, because the carriers may easily escape notice. The knowledge of chlamydial infections has increased during the last few years. The present report deals with recent developments in this field.

Bacteriological Techniques↗

[Contribution of recent methods to the diagnosis of Chlamydia infections].

Chlamydia trachomatis is the most common cause of non- and/or post-gonococcal urethritis in men. The infection is often silent in women, but may be complicated by salpingitis followed by tubal sterility. The direct diagnosis: Since the availability of monoclonal antibodies, the microscopic examination of a smear of the sample is once again a current technique. By using an immuno-fluorescent technique, it is possible to demonstrate the elementary corpuscules in the form of free extracellular particles. This methods is rapid and easy to perform. Culture: Nevertheless, culture remains the reference technique despite the fact that it only reveals "inclusions": clumps of reticulated particles. The technique is simplified by using microculture in flat bottomed microtitration plates, which enables a large number of isolations to be performed in one step. The visualisation by means of monoclonal antibodies is in perfect agreement with classical staining techniques. The serological diagnosis: Micro-immuno-fluorescence (MIF) is still the reference technique. ELISA occasionally fails to correlate with MIF. These discordances can be explained by the different antigens used: protein extracts bound to a support, in the case of ELISA, and whole live particles, in the case of MIF.

Antibodies, Monoclonal↗

Rifalazil pretreatment of mammalian cell cultures prevents subsequent Chlamydia infection.

Chlamydia species are widely disseminated obligate intracellular pathogens that primarily cause urogenital, ocular, and respiratory infections. In these studies, we show that exposing mammalian cells to antibacterial agents prior to Chlamydia inoculation protects the host cells against subsequent challenge by chlamydiae (the protective effect [PE]). Rifalazil exhibited a considerably stronger PE than did azithromycin, rifampin, doxycycline, and ofloxacin. Specifically, 0.002 microg/ml rifalazil incubated for 1 day with a monolayer of McCoy cells was sufficient to protect against a challenge 2 days later with Chlamydia trachomatis serovar D (UW-3). The PE was observed with five different mammalian cell lines and with a variety of C. trachomatis and Chlamydia pneumoniae isolates. The duration of the PE was 6 to 12 days for rifalazil (depending on the cell line), a maximum of 3 days for azithromycin, and less than a day for the other drugs tested. For rifalazil, the PE was shown to be mediated by inhibition of the chlamydial RNA polymerase since mutants with altered RNA polymerases had correspondingly altered PEs. These results suggest that rifalazil may be unique in its ability to prevent infection with obligate intracellular pathogens for a considerable time after treatment. This characteristic may be of particular public health value in reducing reinfection with chlamydiae.

Anti-Bacterial Agents↗

Urinary tract infection and Chlamydia infection in adolescent females.

STUDY OBJECTIVE: To examine whether clinical or laboratory findings could distinguish Chlamydia trachomatis (CT) from urinary tract infection (UTI) among adolescent females in whom providers tested for both. DESIGN, SETTING, PARTICIPANTS: A laboratory database at an urban teen health center was reviewed to identify females who had both urine culture and ligase chain reaction (LCR) test for CT ordered at the same visit. History and physical findings were abstracted from the medical record. There were 81 visits with retrievable laboratory results and chart documentation. MAIN OUTCOME MEASURES: UTI was defined as >1000 colony-forming units on culture, and CT was defined as positive LCR test. Pearson's Chi-squared test was used to assess strength of the hypothesized associations. RESULTS: UTI was diagnosed in 20 (24%) and CT in 18 (22%) of 82 visits. Concurrent CT was diagnosed in 6 of 20 subjects with UTI. Symptoms and physical signs did not differentiate UTI from CT. Positive urinary nitrites were associated with UTI, but did not exclude CT. Similarly, wet prep evidence of trichomonas or white blood cells was associated with CT, but did not exclude UTI. Clinical diagnosis of CT or UTI was 50% sensitive and 70% specific. CONCLUSIONS: Adolescent females who are screened for both CT and UTI have high rates of concurrent disease. Urinary or vaginal symptoms do not differentiate well between these infections. Clinical diagnosis is imprecise, suggesting that adolescent females with vaginal or urinary symptoms should be tested for both CT and UTI.

Adolescent↗

A decision analysis to guide antibiotic selection for Chlamydia infection during pregnancy.

OBJECTIVE: To analyze the cost and effectiveness of different antibiotic combinations for the treatment of infection with Chlamydia trachomatis in pregnant women. METHODS: Using availability treatment effectiveness rates from the literature, a decision analysis model was constructed to determine the effectiveness and cost of therapy with 4 antibiotics shown to be useful for Chlamydia infection during pregnancy. Women who were still infected after initial therapy were then treated with a second antibiotic. Outcomes included the total cost of the treatment (including pretreatment and posttreatment cultures and antibiotic cost) and treatment failure rates. RESULTS: The lowest failure rates could be achieved with the use of amoxicillin followed by azithromycin for treatment failures or azithromycin followed by clindamycin hydrochloride. When costs were compared, a strategy starting with amoxicillin followed by azithromycin for nonresponders was favored, with costs approximately 15% lower than starting with azithromycin followed by amoxicillin. Strategies using clindamycin were significantly more expensive. The drug combination recommended by the Centers for Disease Control and Prevention (erythromycin followed by amoxicillin in nonresponders) was more expensive than amoxicillin-azithromycin and had one of the highest failure rates. Variation in the cost of the medications and in the effectiveness of the antibiotics under consideration did not significantly alter the findings. CONCLUSIONS: For pregnant women infected with Chlamydia, initiating treatment with amoxicillin, 500 mg 3 times a day for 7 days, followed by a single 1-g dose of azithromycin for nonresponders is the most cost-effective strategy for treatment.

Adult↗

Immunology of Chlamydia infection: implications for a Chlamydia trachomatis vaccine.

Sexually transmitted Chlamydia trachomatis infections are a serious public-health problem. With more than 90 million new cases occurring annually, C. trachomatis is the most common cause of bacterial sexually transmitted disease worldwide. Recent progress in elucidating the immunobiology of Chlamydia muridarum infection of mice has helped to guide the interpretation of immunological findings in studies of human C. trachomatis infection and has led to the development of a common model of immunity. In this review, we describe our current understanding of the immune response to infection with Chlamydia spp. and how this information is improving the prospects for development of a vaccine against infection with C. trachomatis.

Animals↗