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Microbiology - Chlamydia trachomatis

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Sandra Kreitem

on 6 November 2015

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Transcript of Microbiology - Chlamydia trachomatis

Chlamydia trachomatis
More Incidence & Prevalence Worldwide (Ages 15-49, 2008)
European Region -
Incidence: Females - 37.1 per 1000 Males - 54.2 per 1000
Prevalence: Female - 3.9% Males - 3.8%
Incidence & Prevalence Worldwide (Ages 15-49, 2008)
African Region -
Incidence: Females - 22.3 per 1000 Males - 20.9 per 1000
Prevalence: Females - 2.6% Males - 2.1%
What is a Clinical Lab Scientist?
ID infectious agents
Blood analysis to detect disorders such as immunodeficiency
Measures presence of antibodies in the sample
Vital information
Incidence & Prevalence
Chlamydia trachomatis

Disease: Chlamydia
General Characteristics
Gram-negative bacterium
Pathogenic bacterium
Shape: Coccobacilli
Lacks Peptidoglycan wall
Incidence - the number of new cases of a disease that develops during a specific time period, like a year
Prevalence - the number of cases of a disease that are present in a particular population at a given time
South America -
Incidence: Females - 72.6 per 1000 Males - 38.2 per 1000
Prevalence: Females - 7.6% Males - 2.9%
South East Asia -
Incidence: Females - 9.2 per 1000 Males - 6.2 per 1000
Prevalence: Females - 1.1% Males - 0.6%
Eastern Mediterranean region -
Incidence: Females - 9.8 per 1000 Males - 10.9 per 1000
Prevalence: Females - 1.1% Males - 0.9%
Incidence & Prevalence in United States
Incidence - In 2013, a total of 1,401,906 infections were reported
Prevalence - Due to this disease being asymptomatic and other factors, information on the cases is often too inconsistent to have true prevalence
Reservoir? Zoonosis?
Chlamydia trachomatis
is only found in humans and affects the genitals, eyes and throat
Is not a zoonosis type disease
Mode of Transmission
Transmitted through sexual activity between humans
Controlling Spread of Disease
There is currently no vaccine for this disease on the market, so here's what you should do if you have Chlamydia:
Step 5) Already pregnant with the disease? Consider Cesarean section so child doesn't get infected with disease through traditional birth
Step 1) Get tested....... You're positive?
Step 2) Avoid all forms of sexual activity (vaginal, anal, oral)
Step 3) Inform partner of the news
Step 4) Have your partner tested too
"Chlamydia - CDC Fact Sheet." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Dec. 2014. Web. 20 July 2015.
Schmid, George, Julie Samuelson, and Jane Rowley. "Prevalence and Incidence of Selected Sexually Transmitted Infections." World Health Organization, 2005. Web. 20 July 2015.
About a total of 101 million new cases are added annually worldwide!
Land, J., J. Van Bergen, S. Morre, and M. Postma. "Epidemiology of Chlamydia Trachomatis Infection in Women and the Cost-effectiveness of Screening." Oxford Journals. Oxford University Press, 21 Aug. 2009. Web. 22 July 2015.
"The Journal of Infectious Diseases." Chlamydia Public Health Programs and the Epidemiology of Pelvic Inflammatory Disease and Ectopic Pregnancy. Oxford University Press, 7 Aug. 2012. Web. 21 July 2015.
"Pathogen Safety Data Sheet - Infectious Substances" Chlamydia Trachomatis. Public Health Agency of Canada, Dec. 2011. Web. 23 July 2015.
Causes Disease By?
- Vertical transmission
Mother to baby during vaginal birth
- Horizontal transmission
Oral, vaginal, anal sex
Hand to eye contact
What Gets Colonized?
- Cervix
- Rectum
- Urethra
- Nasopharynx
- Conjunctiva
- No, but does make enzymes and proteins

Immune System
- Proteins made to prevent antibodies
- Enzymes stop inflammatory response








Signs and Symptoms
No symptoms-80%
Abnormal vaginal discharge
Burning sensation when urinating
No symptoms- 50%
Penile discharge
Burning sensation when urinating
Pain & swelling in on or both testicles (less common)
rectum, eyes, throat, & mouth
Rectal pain, discharge, bleeding, itchiness

"Chlamydia: STD Facts." Centers for Disease Control and prevention (2014). Retrieved from http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm

"Chlamydia" National Institute of Health (2015). http://www.nlm.nih.gov/medlineplus/ency/article/001345.htm

"Chlamydia and Genital Discharge" Retrieved from http://www.genitaldischarge.com/p/chlamydia-tric.html

"Chlamydia Can Return" Medical Daily (2013). Retrieved from http://ww.medicaldaily.com/chlamydia-can-return-even-after-antibiotic-treatment-because-it-survives-stomach-268896

"Chlamydia" STD + (2005). Retrieved from http://www.std-gov.org/stds/chlamydia.htm
Can be cured with the right treatment!

Antibiotics work if entire Rx is completed

More than 95% of people will be cured if they take antibiotics correctly.
As long as Rx is completed and once again, taken correctly.

Clinical Lab Scientist

Chlamydia trachomatis
Obligate, Aerobic, Intracellular parasite

Alternating Life Cycle
Elementary body (EB)
Infectious stage
Non replicating
Small cocci - 0.3 micrometer
Reticulate body (RB)
Divides every 2-3 hours
Larger - 1.0 micrometer
Gram-negative bacteria (closely related)
Unique cell wall
Cytoplasmic membrane + outer layer
Lacks peptidoglycan layer
Both DNA and RNA
Major Outer Membrane Protein

Team of Experts
- Ellen Dinh
- Sandra Kreitem
Clinical Lab Scientist
- Daniela Porri
- Courtney Conlan
Source:CDC CA STD/HIV Prevention Training
• Swab from male urethral or female endocervical canal
• Maintain Quality
• Transport
Sucrose Phosphate Buffer Medium to stabilize
Refrigerate immediately 2-8°C
Process < 48 hrs
Freezing possible -70°C

Handling of Clinical Specimens
Isolation and Growth
Definitive Method for Diagnosis of Chlamydial Infection
Admissible in Court
• Can NOT be grown in artificial medium
• Inoculated in Hen eggs
• Animal cell lines (HeLa or McCoy)
• Use a protein synthesis suppressor
• Incubated at 37°C for 48-72 hours

Direct Fluorescent Test (DFA)
• Considered “Gold Standard”
• 70-80% specific
• Uses fluorescin-conjugated monoclonal antibodies that bind
• EB - green RB- red with halo 3x larger
• Expensive and Labor Intensive
• Most labs are not equipped

More Common Methods
Nucleic Acid Amplification Test (NAAT)
• Most Important Advancement
• Highly Sensitive and Specific
• Urine sample or Eye Swab
• Detects for polymerase chain reactions (PCR)
• Chlamydia antigens and DNA
• Need for Secondary testing due to False-Positives

Nucleic Acid Hybridization Test (Nucleic Acid Probe)
• Can not differentiate between C. trachomatis and N. gonorrhoeae

Giemsa Smear - Ocular
Uses Microscopy
Air dried
Detects mono-, polynuclear cells, epithelial cells and plasma cells

Point-of-Care Tests
• Rapid test done in clinic or office
• Cost is High
• Specificity and Sensitivity is low

Serological Tests Not Recommended
• Not accurate detection of systemic immune response

Containment Requirements
• BSL-2 - Biosafety Level 2 Lab practices and containment
• BSL-3 - Biosafety Level 3 Activities with high potential for droplet or aerosol production

Do not rub eyes while handling chlamydia-infected materials
No special Hazards
Decontaminate by autoclave, chemical disinfection, gamma radiation and incineration

Leeuwen, J. M Van. "Reaching Homeless Youths for Chlamydia Trachomatis and Neisseria Gonorrhoeae Screening in Denver, Colorado." Sexually Transmitted Infections 78.5 (2002): 357-59. Web.

"Silent disease"

Malhotra, Meenakshi, Seema Sood, Anjan Mukherjee, Sumathi Muralidhar, and Manju Bala. "Genital Chlamydia Trachomatis: An Update." The Indian Journal of Medical Research. Medknow Publications & Media Pvt Ltd, n.d. Web. 22 July 2015.

Watson, P. G., and B. H. Wilson. "Dual Sampling for the Detection of Female Chlamydia Trachomatis Infection with a Polymerase Chain Reaction Test." International Journal of STD & AIDS 15.3 (2004): 189-91. Web.
"Microbiology." What Is a Clinical Laboratory Scientist? – Microbiology. University of Wisconsin La Crosse, n.d. Web. 22 July 2015.
"Free Safety Data Sheet Index." Infectious Disease Index. Office of Laboratory Security, PHAC, Nov. 99. Web. 22 July 2015.


Test of cure:

Prevention=Abstinence or Condoms
Obligate intracellular parasite (can't reproduce outside host cell)
Cell wall, DNA, RNA and Ribosomes
Infection can return with vengeance post treatment!
Repeated exposure after dormancy
Survives in the stomach
Can remain persistent in individual
26% reinfected rate
4 weeks after treatment is complete
Mainly for high risk group: Infants, children, pregnant women
False-color transmission- electron microscope
Daniela Porri
Sexually Transmitted Infection (STI)
Known as the Silent STI
First isolated in China in 1957
The Disease: Chlamydia
"Cell Line." Farlex Partner Medical Dictionary. 2012. Farlex 23 Jul. 2015

Chlamydia is the most common STI reported in the world!!
Ellen Dinh
Fun Fact: Why are women more prone to Chlamydia than men?
Answer: Cervical Ectopy/Ectropion
Inside of cervix (endocervix) has columnar cells
Outside of cervix (exocervix) has squamous cells
Cervical ectopy - finding columnar cells on exocervix = susceptibility to infections
Lee, V., JM Tobin, and E. Foley. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, Apr. 2006. Web. 28 July 2015. <http://www.ncbi.nlm.nih.gov/pubmed/16824301>.
Lab Test Online. “Chlamydia”. http://www.labtestsonline.org/understanding/analytes/chlamydia/test.html
WebMD. “Chlamydia Test” 2007. http://www.webmd.com/sexual-conditions/chlamydia-tests
Sandra Kreitem
Testing and Diagnosis
Most common
Hammerschlag, Margaret, Dr. "Chlamydia - Infectious Diseases." Merck Manuals Professional Edition. N.p., Feb. 2014. Web. 22 July 2015.
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