Medical Microbiology

Chlamydia 339

begrownincellcultures.Thetherapeuticmethodofchoiceissystemicand

localapplicationoftetracyclinesoveraperiodofseveralweeks.

Inclusionconjunctivitis.Thisisanacute,purulentpapillaryconjunctivitis

thatmayaffectneonates,children,andadults(swimming-poolconjunctivi-

tis).Newbornchildrenareinfectedduringbirthbypathogenscolonizingthe

birthcanal.Leftuntreated,apannusmayformasintrachoma,followedby

cornealscarring.Laboratorydiagnosisandtherapyasintrachoma.

Genitalinfections.C.trachomatisisresponsiblefor 30 – 60 %ofcasesofnon-

gonococcalurethritis(NGU)inmen.Possiblecomplicationsincludeprosta-

titisandepididymitis.Thepathogensarecommunicatedbyvenerealtrans-

mission.Thesourceofinfectionisthefemalesexualpartner,whooftenshows

noclinicalsymptoms.

Inwomen,C.trachomatiscancauseurethritis,proctitis,orinfectionsofthe

genitalorgans.Ithasevenbeenknowntocausepelvioperitonitisandperi-

hepatitis.Massiveperinatalinfectionofaneonatemayleadtoaninterstitial

chlamydialpneumonia.

Therelevantdiagnostictoolsinclude:

1. Detectionunderthemicroscopeinsmearmaterialusingdirectimmuno-

fluorescence(seeundertrachoma).

2. DirectidentificationbymeansofamplificationofaspecificDNAsequence
   insmearmaterialandurine.


3. Growinginspecialcellcultures.
   Lymphogranulomavenereum.Thisvenerealdisease(syn.lymphogranulo-
   mainguinale,lymphopathiavenerea(Favre-Durand-Nicolasdisease)not
   tobeconfusedwithgranulomainguinale,seep.305)isfrequentlyobserved
   intheinhabitantsofwarmclimaticzones.Aherpetiformprimarylesionde-
   velopsatthesiteofinvasioninthegenitalarea,whichthenbecomesanulcus
   withaccompanyinglymphadenitis.Laboratorydiagnosisisbasedonisolating
   theproliferatingpathogenincellculturesfrompurulentmaterialobtained
   fromtheulcusorfrommattedlymphnodes.Theantibodiescanbeidentified
   usingthecomplementbindingreactionorthemicroimmunofluorescence
   test.Tetracyclinesandmacrolidesarethepotentiallyusefulantibiotictypes.

Chlamydiapneumoniae

Thisnewchlamydialspecies(formerlyTWARchlamydiae)causesinfections

oftherespiratoryorgansinhumansthatusuallyrunamildcourse:influenza-

likeinfections,sinusitis,pharyngitis,bronchitis,pneumonias(atypical).Clini-

callysilentinfectionsarefrequent.C.pneumoniaeispathogenicinhumans

only.Thepathogenistransmittedbyaerosoldroplets.Theseinfectionsare

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Kayser, Medical Microbiology © 2005 Thieme