CHLAMYDIA

R.Varidianto Yudo T., dr

 CLASSIFICATION
Kingdom : Bacteria
Phylum : Chlamydiae
Order : Chlamydiales
Family : Chlamydiaceae
Genus : Chlamydia
Species :
C. trachomatis
C.psittaci

C.pneumoniae
 MORPHOLOGY
There are two morphologically distinct forms
of chlamydiae, termed elementary body (EB)
and reticulate body (RB)
The EB is a small, dense spherical body 0.2 to
0.4 m in diameter that rivals mycoplasma for
the smallest of the procaryotes.
It is the infectious form of the organism that is
responsible for attaching to the target host cell
and promoting its entry.
 Chlamydiae in various stages of intracellular development.
(EB, elementary body particles with cell walls; RB, reticulate
body)
A. Attachment of elementary body (EB) to the microvilli of a
susceptible eucaryotic cell. B. Localization of an EB in a
coated pit.
 C. A developing inclusion containing actively growing
reticulate body (RB). D. Freeze-fracture preparation of
Chlamydia revealing surface projections
E. A C. psittaci inclusion. F. A C. trachomatis inclusion
 CHARACTERISTIC
Chlamydiae are obligate intracellular parasites, they
cannot be cultured outside of host cells, leading to
many difficulties in research.
C. trachomatis species is subdivided into two biovars
(biological variants): LGV and trachoma. Each biovar
contains a number of serologically distinct types of
serovars. There are three serovars of biovar LGV
(LGV l, 2, and 3) and 12 serovars of the trachoma
biovar (A-K).
 DISEASE
C. trachomatis
Trachoma
(C. trachomatis serotipe A,B,C)
Inclusion Conjunctivitis
(C. trachomatis serotipe D-K)
Chlamydial Urogenital Infection
(C. trachomatis serotipe D-K)
Lymphogranuloma Venereum (LGV)
(C.trachomatis serotipe L1, L2, L3)
 C.psittaci
Psittacosis
C.pneumoniae
Atypical Pneumoni
 PATHOGENESIS
Chlamydiae replicate intracellularly, within a
membrane-bound structure termed an
inclusion. It is inside this inclusion, which
somehow avoids lysosomal fusion and
subsequent degradation, that the metabolically
inactive "elementary body" (EB) form of
chlamydia becomes the replicative "reticulate
body" (RB). The multiplying RBs then become
EBs again and burst out of the host cell to
continue the infection cycle
 Schematic diagram of the developmental cycle of
chlamydiae. EB, elementary body; RB, reticulate body.
The developmental cycle of three chlamydia species
 C. trachomatis replicates preferentially on
mucosal surfaces within columnar or
transitional epithelial cells. They stimulate a
brisk infiltration of polymorphonuclear cells,
especially early in infection. Submucosal
lymphocytic infiltration is also impressive and
leads to lymphoid follicle formation and
fibrotic changes.
 LGV serovars arc more invasive than are other
serovars of C. trachomatis. The preferred site of
multiplication for biovar LGV is the regional lymph
nodes, whereas that of biovar trachoma is
squamocolumnar epithelial cells.
Chlamydia psittaci is transmitted by inhalation,
contact or ingestion among birds and to mammals.
Psittacosis in birds and in humans often starts with
flu-like symptoms and becomes a life-threatening
pneumonia
 LABORATORY DIAGNOSIS
The laboratory diagnosis of Chlamydiae infections
can be confirmed by :
1) direct examination of clinical specimens for chlamydial
inclusions or antigens
2) isolation of' the organisms tissue culture
3) detection of specific antibodies against these bacteria.
Because these procedures differ considerably in
sensitivity, depending on the type and handling of
individual specimens, selection of a practical
method must be carefully evaluated by the clinical
laboratory.
 TREATMENT
Antibiotics may be used topically and systemically.
Although systemically administered tetracyclines and
sulfonamides cause a regression of clinical
trachomatous activity, infection persists, and
subclinicd disease may continue to occur. Treatment
may limit complications and should be administered.
Vaccines that are efficacious and safe are not
available, and because the protection afforded by
most vaccines is of a relatively low order and
duration, vaccines are usually not used in programs to
control trachoma.
 Ultimate control of trachoma are good standards of
hygiene that accompany improvement in standards of
living.
Treatmen of LGV and urogenital infections may
include sulfadiazine or Tetracycline; penicillin has
proved effective when other drugs have failed.
Meticulous follow-up for relapse or the development
of complications is essential.
 Results of treatment of psittacosis are imperfect.
Tetracycline may be used with some success, and
although a good response has been achieved by the
use of erythromycin, pulmonary findings persist for
weeks. Asymptomatic persistence of infection in
psittacosis has not been well studied, but one patient
is reported to have shed the organism in his sputum
for 12 years.
 Prevention. Prophylactic treatment of psittacine birds
with antibiotic-supplemented feed reduces the risk of
disease in bird handlers. The recognition, however,
that C. psittaci may infect many avian and
mammalian species, sometimes causing subclinical
communicable disease with occasional outbreaks
involving human beings, widens the need for careful
epidemiologic investigation of each case. Workers in
poultry-processing plants should have stringent
environmental protection because they are especially
at risk of heavy exposure to this infection.