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Chlamydia and Chlamydophila (Chlamydia). Family: Chlamydiaceae. Genus: Chlamydia C. trachomatis - Urogenital infections, trachoma, conjunctivitis, pneumonia and lymphogranuloma venerium (LGV) Genus: Chlamydophila C. psittaci - Pneumonia (psittacosis)

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family chlamydiaceae
Family: Chlamydiaceae
  • Genus: Chlamydia
    • C. trachomatis - Urogenital infections, trachoma, conjunctivitis, pneumonia and lymphogranuloma venerium (LGV)
  • Genus: Chlamydophila
    • C. psittaci - Pneumonia (psittacosis)
    • C. pneumoniae - Bronchitis, sinusitis, pneumonia and possibly atherosclerosis

Note: New taxonomy, previously three species in one genus - Chlamydia

chlamydiaceae microbiology
Chlamydiaceae- Microbiology
  • Small obligate intracellular parasites
  • Contain DNA, RNA and ribosomes (so not viruses)
  • Inner and outer membrane (like Gram - bacteria)
  • Lipopolysacchride (LPS) but no peptidoglycan
    • Cell wall not well characterized
    • LPS has weak endotoxin activity
  • Energy parasites
    • Can’t make ATP
physiology and structure
Physiology and Structure
  • Elementary bodies (EB)
    • Small (0.3 - 0.4 µm)
    • Extracellular form
    • Rigid outer membrane
      • Major outer membrane protein (MOMP) unique to species and variations result in serovars
      • Disulfide linked proteins (OMP2), highly conserved in family, gives stability
    • Resistant to harsh conditions (spore-like)
    • Non-replicating, non-metabolically active form
    • Infectious form
      • Bind to columnar epithelial cells (and macrophages in LGV)
physiology and structure5
Physiology and Structure
  • Reticulate bodies (RB)
    • Larger (0.8 - 1 µm)
    • Intracellular form
    • Fragile membrane
      • Fewer disulfide bonds (missing OMP2)
    • Metabolically active form
    • Replicating form
    • Non-infectious
developmental cycle of chlamydia
Developmental Cycle of Chlamydia
  • EB bind to host cells
    • Epithelial cells
    • Macrophage (LGV)
  • Internalization
    • Endocytosis
    • Phagocytosis
  • Inhibition of phagosome-lysosome fusion (if EB outer membrane intact)
  • Reorganization into RB
    • Breakdown of disulfide bonds
  • Growth of RB (binary fission)
developmental cycle of chlamydia7
Developmental Cycle of Chlamydia
  • Reorganization into EB
  • Inclusion bodies (one way to distinguish between species)
  • Release of EB
    • Lysis -C. psittaci
    • Extrusion - C. trachomatis and C. pneumoniae
chlamydia trachomatis
Chlamydia trachomatis
  • Trachoma
  • Inclusion conjunctivitis
  • Infant pneumonia
  • Ocular lymphogranuloma venerium
  • Urogenital infections
  • Reactive arthritis (Reiter’s syndrome)
  • Lymphogranuloma venerium
c trachomatis
C. trachomatis
  • Biovars - biological variants
    • Trachoma
    • LGV
    • Mouse pneumonitis (mouse model of disease)
  • Serovars - serological variants
    • Different Major outer membrane proteins
    • A through L
c trachomatis serovars and associated disease

C. trachomatis - Serovars and associated disease

Serovars Diseases

A, B, Ba, C Trachoma (trachoma biovar)

D - K Urogenital tract disease (trachoma biovar)

L1, L2, L2a, L2b, L3 Lymphogranuloma venereum (LGV biovar)

c trachomatis pathogenesis and immunity
C. trachomatis-Pathogenesis and Immunity
  • Infects nonciliated columnar, cuboidal, and transitional epithelial cells (and macrophages in LGV)
  • Down regulation of Class I MHC
  • Infiltration of PMNs and lymphocytes
  • Lymphoid follicle formation
  • Fibrosis
  • Disease results from destruction of cells and host immune response
  • No long lasting immunity; reinfection results in inflammatory response and tissue damage
c trachomatis epidemiology
C. trachomatis - Epidemiology
  • Ocular infections - Biovar: trachoma
    • Worldwide
    • Poverty and overcrowding
    • Endemic in Africa, Middle East, India, SE Asia
    • United States - American Indians
    • Infection of children
    • Transmission: droplets, hands, contaminated clothing, flies, contaminated birth canal
    • Damage to eyes is not seen immediately
c trachomatis epidemiology13
C. trachomatis - Epidemiology
  • Genital tract infections
    • Biovar: trachoma
      • Most common STD in US
        • 2006: USA = 1,030,911; SC = 22,351
        • 2007: USA = 1,025208; SC = 31,086 (612 reported /100,000 population in SC, only MS, AL, DC had higher rates)
      • ~ 50 million new cases/year worldwide
    • Biovar: LGV
      • Humans are only natural host
      • Prevalent in Africa, Asia and South America
      • Sporadic in USA
        • 300 -500 cases/year
        • Male homosexuals are major reservoir
clinical syndrome trachoma c trachomatis biovar trachoma
Clinical Syndrome -trachoma(C.trachomatis biovar: trachoma)
  • Chronic or repeated infection (A - C serovar)
    • Follicle formation on conjunctiva
    • Scarring of the conjunctiva
clinical syndrome trachoma
Clinical Syndrome -Trachoma
  • Eyelids turn in and abrade cornea
    • Ulceration
    • Scarring
    • Blood vessel formation
clinical syndrome trachoma16
Clinical Syndrome -Trachoma
  • Flow of tears impeded
    • Secondary infections occur
clinical syndrome trachoma17

Clinical Syndrome -Trachoma

From: G. Wistreich, Microbiology Perspectives, Prentice Hall

clinical syndrome inclusion conjunctivitis c trachomatis biovar trachoma
Clinical Syndrome - Inclusion Conjunctivitis(C. trachomatis biovar: trachoma)
  • Associated with genital chlamydia (Serovars D -K)
  • Mucopurulent discharge
  • Corneal infiltrates, vascularization and scarring can occur
  • In neonates infection results from infected birth canal
    • Apparent 5-12 days after birth
    • Ear infection and rhinitis often accompany ocular disease
clinical syndrome infant pneumonia c trachomatis biovar trachoma
Clinical Syndrome - Infant Pneumonia (C. trachomatis biovar: trachoma)
  • Associated with genital chlamydia (serovars D - K)
  • Infection arises from contaminated birth canal
  • Wheezing cough and pneumonia but no fever
  • Often preceded by conjunctivitis
clinical syndrome ocular lymphogranuloma venereum c trachomatis biovar lgv
Clinical Syndrome - Ocular Lymphogranuloma Venereum (C. trachomatis biovar: LGV)
  • Associated with LGV serovars (L1 - L3)
  • Conjunctivitis and associated lymphadenopathy (can infect macrophages)
clinical syndrome urogenital infections c trachomatis biovar trachoma
Clinical Syndrome - Urogenital Infections (C.trachomatis biovar: trachoma)
  • Females
    • Asymptomatic (80%)
    • Cervicitis, urethritis and salpingitis (fallopian tubes)
    • Postpartum fever
    • Increased rate
      • Premature delivery
      • Ectopic pregnancy
clinical syndrome urogenital infections c trachomatis biovar trachoma24
Clinical Syndrome - Urogenital Infections (C.trachomatis biovar: trachoma)
  • Males
    • Symptomatic (75%)
    • Urethritis, dysuria and pyuria
    • Cause of nongonococcal urethritis (35 - 50%)
    • Common cause of postgonococcal urethritis (might have both bacteria and so both will need to be treated)
clinical syndrome reactive arthritis
Clinical Syndrome - Reactive arthritis*
  • Conjunctivitis, polyarthritis and genital or gastrointestinal inflammation
  • Associated with HLA-B27 (MHC class I surface antigen associated with certain autoimmune diseases)
  • 50 - 65% have C. trachomatis infection
  • 80% have antibodies to C. trachomatis

*AKA Reiter syndrome. Why replace with reactive arthritis? See Panush et al. (2007) Arthritis and Rheumatism, 56:693-694.

clinical syndrome lymphogranuloma venereum c trachomatis biovar lgv
Clinical Syndrome - Lymphogranuloma VenereumC. trachomatis (biovar: LGV)
  • First stage
    • Small painless vesicular lesion at infection site
    • Fever, headache and myalgia
  • Second stage
    • Inflammation of draining lymph nodes
    • Fever, headache and myalgia
    • Buboes (rupture and drain)
    • Proctitis
    • Ulcers or Elephantiasis
patient with lgv

Patient with LGV

Bilateral inguinal buboes (arrows)

c trachomatis diagnosis
C. trachomatis - Diagnosis

Iodine-stained inclusion bodies

  • Cytology
    • Iodine-staining inclusions (glycogen)
    • Need tissues to see this not just pus
    • Not sensitive
  • Culture
    • Iodine staining inclusions
    • Infect cell lines
    • Most specific
c trachomatis diagnosis30
C. trachomatis - Diagnosis
  • Antigen detection (ELISA or IF)
    • Group specific LPS
    • Strain specific outer membrane proteins (to identify serovar)
  • Serology
    • Can’t distinguish between current or past infection
    • Detection of high titer IgM antibodies can be helpful to diagnose current infection
  • Nucleic acid probes
    • Several kits available
    • May eventually replace culture
c trachomatis treatment and prevention
C. trachomatis - Treatment and Prevention
  • Tetracycline, erythromycin, and sulfonamides
  • Vaccines are of little value since there is no immunity with infection
  • Treatment coupled with improved sanitation
  • Safe sexual practices
  • Treatment of patients and their sexual partners
chlamydophila psittaci
Chlamydophila psittaci
  • Psittacosis (Parrot fever)
  • Ornithosis (since all birds can carry)
pathogenesis c psittaci
Pathogenesis - C. psittaci
  • Inhalation of organisms in bird droppings
    • Person to person transmission is rare
  • Hematogenous spread to spleen and liver
    • Local necrosis of tissue
  • Hematogenous spread to lungs and other organs
  • Lymphocytic inflammatory response
    • Edema, infiltration of macrophages, necrosis and occasionally hemorrhage
    • Mucus plugs may develop in alveoli
  • Cyanosis and anoxia
  • Atypical type of pneumonia
epidemiology c psittaci
Epidemiology - C. psittaci
  • 50 - 100 cases per year in USA
  • Organisms present in birds (symptomatic or asymptomatic)
    • Tissue, feces, feathers
  • Primarily an occupational disease
    • Veterinarians, poultry workers, zoo keepers, pet shop workers
clinical syndrome ornithosis uncomplicated infection
Clinical Syndrome - OrnithosisUncomplicated Infection
  • Incubation period
    • 1-2 weeks
  • Fever, chills, headache, nonproductive cough, mild pneumonitis
  • Recovery
    • 5-6 weeks
clinical syndrome ornithosis complicated infection
Clinical Syndrome - OrnithosisComplicated Infection
  • Incubation period
    • 1-2 weeks
  • Fever, chills, headache, nonproductive cough, mental confusion, pneumonitis, cyanosis, jaundice
  • Prolonged Recovery
    • 7-8 weeks
laboratory diagnosis c psittaci
Laboratory Diagnosis - C. psittaci
  • Serology (Complement fixation test)
    • fourfold rise in titer
    • requires paired samples
treatment and prevention c psittaci
Treatment and Prevention - C. psittaci
  • Tetracycline or erythromycin (sulfonamides do not work)
  • Quarantine of imported birds
  • Control of bird infection
    • Antibiotic supplementation of food but this may lead to resistant strains
chlamydophila pneumoniae
Chlamydophila pneumoniae
  • TWAR agent
    • Two isolates that ended up being identical: Taiwan (TW-183) and acute respiratory isolate (AR-39)
  • Atypical pneumonia
  • Atherosclerosis ?
pathogenesis c pneumoniae
Pathogenesis - C. pneumoniae
  • Person to person spread
    • Respiratory droplets
  • Bronchitis, sinusitis, and pneumonia
epidemiology c pneumoniae
Epidemiology - C. pneumoniae
  • Common infection (200,000 - 300,000 cases per year)
  • Primarily in adults
  • Most infections are asymptomatic
  • Associated with crowded conditions
    • Schools, military bases, etc.
  • Association with atherosclerosis
    • Organisms in arterial lesions
    • Antibodies to C. pneumoniae
clinical syndrome c pneumoniae
Clinical Syndrome - C. pneumoniae
  • Mild or asymptomatic disease
  • Pharyngitis, bronchitis, persistent cough, and malaise
  • Atypical pneumonia may develop
    • Usually a single lobe
laboratory diagnosis c pneumoniae
Laboratory Diagnosis - C. pneumoniae
  • Serology
    • Fourfold rise in titer in paired samples
treatment and prevention c pneumoniae
Treatment and Prevention - C. pneumoniae
  • Tetracycline or erythromycin (not sulfonamides)
  • Difficult to prevent transmission
  • No vaccine