1. Chlamydiaceae two genera, Chlamydia and Chlamydophilatwo genera, Chlamydia and Chlamydophila small enough to pass through 0.45-μm filterssmall enough to pass through 0.45-μm filters obligate intracellular parasitesobligate intracellular parasites possess inner and outer membranes similar to those of gram-negative bacteriapossess inner and outer membranes similar to those of gram-negative bacteria contain both DNA and RNAcontain both DNA and RNA possess prokaryotic ribosomespossess prokaryotic ribosomes synthesize their own proteins, nucleic acids, and lipidssynthesize their own proteins, nucleic acids, and lipids susceptible to antibiotics.susceptible to antibiotics.

2. Chlamydiaceae metabolically inactive infectious forms (elementary bodies [EBs]) metabolically active, noninfectious forms (reticulate bodies [RBs]) EBs are resistant to many harsh environmental factors

3. Table 39-2. Comparison of chlamydial elementary bodies and reticulate bodiesTable 39-2. Comparison of chlamydial elementary bodies and reticulate bodies CharacteristicElementary bodyReticulate body Size0.2-0.3 μm1 μm MorphologyElectron-dense core, rigid Fragile, pleomorphic Infectivity to hostInfectiousNon-infectious RNA: DNA ratio1:1 (condensed DNA core) 3:1 (increased ribosomes) Metabolic activityRelatively inactiveActive, replicating stage Trypsin digestionResistantSensitive Body_ID: T039002Body_ID: None p

4. Chlamydiaceae The growth cycle of Chlamydia trachomatis

5. Electron micrograph of a thin section of chlamydial inclusion showing small elementary body (single arrow) and reticulate body (double arrows)

6. Chlamydia trachomatis three biovars, trachoma, LGV (lymphogranuloma venereum), and mouse pneumonitis serovars-major outer membrane protein A, B, Ba, CPrimarily conjunctiva D-KPrimarily urogenital tract L1, L2, L2a, L3 Inguinal lymph nodes

7. Chlamydia trachomatis Most common sexually transmitted bacteria in United States Ocular trachoma worldwide (most common in Middle East, North Africa, India LGV highly prevalent in Africa, Asia, and South America

8. Table 39-1. Human infections caused by chlamydiaeTable 39-1. Human infections caused by chlamydiae Site of infectionDiseaseOrganism (serovars) EyeTrachomaC. trachomatis (A, B, Ba, C) Inclusion conjunctivitisC. trachomatis (D-K) Ophthalmia neonatorumC. trachomatis (D-K) Contact lens-associatedParachlamydia spp. Genital tract MaleNon-specific urethritis, proctitis, epididymitisC. trachomatis (D-K) FemaleCervicitis, urethritis, endometritis, salpingitis, PID, perihepatitis, peri-appendicitis, infertility with tubal occlusion C. trachomatis (D-K) Abortion, premature birthC. trachomatis (D- K) a Sheep-related abortionCh. abortus Male and femaleLymphogranuloma venereumC. trachomatis (L1- L3) Respiratory tractNeonatal atypical pneumoniaC. trachomatis (D-K) Pharyngitis, bronchitis, pneumoniaCh. pneumoniae Simkania negevensis a PneumoniaCh. abortus Psittacosis, ornithosisCh. psittaci Chronic diseasesAtherosclerosis, coronary diseaseCh. pneumoniae a Stroke, multiple sclerosis, sarcoidosis, Alzheimer's diseaseCh. pneumoniae b Body_ID: T039001 a Unproven association;

9. Trachoma: Chronic, inflammatory granulomatous process of eye surface, leading to corneal ulceration, scarring, pannus formation, and blindness. Active trachoma, characterized by the presence of lymphoid follicles on the conjunctiva and intermittent shedding of chlamydiae, is primarily a disease of children. By contrast, blindness occurs mainly in adults Adult inclusion conjunctivitis: Acute process with mucopurulent discharge, dermatitis, corneal infiltrates, and corneal vascularization in chronic disease. Most prevalent in sexually active young people, being spreadfrom genitalia to the eye.

10. Neonatal conjunctivitis Acute process characterized by a mucopurulent discharge. Develops in infants around 14 days after birth. The disease presents as a swelling of the eyelids and orbit, hyperaemia and a purulent infiltration of the conjunctiva. Acquired from the mother during birth. If untreated the infection usually resolves, but a substantial proportion of these infants develop chlamydial pneumonia about 6 weeks after birth

11. Genital infection Infection in men C. trachomatis serovars D-K are responsible for about 30% of cases of non-specific urethritis in men. This is one of the commonest sexually transmitted infections worldwide and repeat infections are common. The infection is often asymptomatic, with infected men serving as a reservoir of infection. In symptomatic patients, varying amounts of mucopurulent discharge are produced. Occasionally this progresses to epididymitis or prostatitis, especially in those aged less than 35 years. It is likely that chronic chlamydial epididymitis may eventually lead to occlusion of the tube and infertility due to azoospermia.

12. Genital infection Infection in women In symptomatic women, C. trachomatis serovars D-K cause mucopurulent cervicitis and urethritis. However, many women harbour the organism asymptomatically in their cervix. Not only a risk to their sexual partners or offspring, but also to themselves, as ascending infection frequently occurs. This results first in an endometritis, in which chlamydiae survive monthly menstrual shedding of the uterine lining, followed by infection of the fallopian tubes to cause acute salpingitis. Collectively, endometritis and salpingitis are known as pelvic inflammatory disease, which, in most developed countries, is largely caused by C. trachomatis. Chlamydial pelvic infection may lead to further abdominal involvement and the formation of pelvic adhesions. Perihepatitis (Fitz-Hugh-Curtis syndrome) and even peri-appendicitis may result.

13. Lymphogranuloma venereum Genital tract infection with C. trachomatis serovars L1-L3 may present as lymphogranuloma venereum. Commonest in the tropics, this condition is occasionally seen in developed countries. It usually begins with a genital ulcer followed by lymphadenopathy of the regional lymph nodes. Buboes are seen if infection persist, can spread to the gastrointestinal and genito- urinary tracts, causing strictures and, in rare cases, peno-scrotal elephantiasis.

14. Chlamydiaceae Lymphogranuloma Venereum 1 to 4 weeks a primary lesion inflammation and swelling of the lymph nodes buboes

15. Chlamydiaceae Patient with lymphogranuloma venereum causing unilateral vulvar lymphedema and inguinal buboes

16. Chlamydiaceae Reiter’s syndrome (urethritis, conjunctivitis, polyarthritis and mucocutaneus lesions)

17. LABORATORY DIAGNOSIS Cytology Culture Nucleic Acid Probes PCR, LCR Serology (MIF)

18. TREATMENT, PREVENTION, AND CONTROL LGV tetracycline for 21 days Ocular and genital infections in adults should be treated with one dose of azithromycin or doxycycline for 7 daysazithromycin doxycycline Newborn conjunctivitis and pneumonia should be treated with erythromycin for 10 to 14 days erythromycin

19. Chlamydiaceae Chlamydophila pneumoniae Respiratory secretions No animal reservoir Human pathogen Bronchitis, pneumonia, and sinusitis 50% of people have serologic evidence A significant cause of acute exacerbations of asthma Atypical pneumonias Alzheimer's disease, multiple sclerosis, stroke and sarcoidosis, but the evidence is even more slender than for heart disease

20. Chlamydophila pneumoniae MIF NAAT Macrolides (erythromycin, azithromycin, clarithromycin ), tetracyclines (tetracycline, doxycycline ), or levofloxacin administered for 10 to 14 dayserythromycin azithromycin clarithromycin doxycycline levofloxacin

21. Chlamydophila psittaci the cause of psittacosis-parrot fever human infections may be asymptomatic or mild exposure to an infected bird may not be suspected convalescent serum may not be collected so that the clinical diagnosis can be confirmed antibiotic therapy may blunt the antibody response

22. Chlamydophila psittaci The incubation period is about 10 days ranges from an 'influenza-like' syndrome, with general malaise, fever, anorexia, sore throat, headache and photophobia, to a severe illness with delirium and pneumonia. tetracyclines or macrolides Kuş ticareti yasaklanmalıııııı