Spectrum of Disease of Chlamydia trachomatis
المؤلف:
Patricia M. Tille, PhD, MLS(ASCP)
المصدر:
Bailey & Scotts Diagnostic Microbiology
الجزء والصفحة:
13th Edition , p515-516
2025-09-11
264
As previously mentioned, infection with different C. trachomatis serovars can lead to several clinical syndromes. These infections are summarized in Table 1.
Table1. Primary Syndromes Caused by C. trachomatis
Trachoma. Trachoma is manifested by a chronic inflammation of the conjunctiva and remains a major cause of preventable blindness worldwide. The organism is acquired as a result of contact with infected secretions on towels or fingers or by flies. Early symptoms of infection include mild irritation and itching of the eyes and eyelids. There may also be some discharge from the infected eye. The infection progresses slowly with increasing eye pain, blurred vision, and photophobia. Repeated infections result in scarring of the inner eyelid that may then turn the eyelid in toward the eye (entropion). As the inner eyelid continues to turn in, the eyelashes follow (trichiasis), resulting in rubbing and scratching of the cornea. The combined effects of the mechanical damage to the cornea and inflammation result in ulceration, scar ring, and loss of vision.
Lymphogranuloma Venereum. Lymphogranuloma venereum (LGV) is a sexually transmitted disease rarely identified in North America but relatively frequent in Africa, Asia, and South America. It is reemerging in Europe, especially in homosexual males. C. trachomatis serovars L1, L2, L2b, and L3 are invasive causing LGV, in contrast to C. trachomatis serovars A-K, leaving the mucosa to spread to the regional lymph nodes. The disease is characterized by a brief appearance of a primary genital lesion at the initial infection site. This lesion is often small and may be unrecognized, especially by female patients. The second stage, acute lymphadenitis, often involves the inguinal lymph nodes, causing them to enlarge and become matted together, forming a large area of groin swelling, or bubo. During this stage, infection may become systemic and cause fever or may spread locally, causing granulomatous proctitis. In a few patients (more women than men), the disease progresses to a chronic third stage, causing the development of genital hyperplasia, rectal fistulas, rectal stricture, draining sinuses, and other manifestations.
Oculogenital Infections. C. trachomatis can cause acute inclusion conjunctivitis in adults and newborns. The organism is acquired when contaminated genital secretions get into the eyes via fingers or during passage of the neonate through the birth canal. Autoinfection rarely occurs. The organism can also be acquired from swimming pools, poorly chlorinated hot tubs, or by sharing eye makeup. Inclusion conjunctivitis is associated with swollen eyes and a purulent discharge. In contrast to trachoma, inclusion conjunctivitis does not lead to blindness in adults (or newborns).
Genital tract infections caused by C. trachomatis have surpassed gonococcal (Neisseria gonorrhoeae) infections as a cause of sexually transmitted disease in the United States. Similar to gonococci, C. trachomatis causes urethritis, cervicitis, bartholinitis (Bartholin glands or greater vestibular glands), proctitis, salpingitis (infection of the fallopian tubes), epididymitis, and acute urethral syndrome in women. In the United States, 60% of cases of nongonococcal urethritis are caused by chlamydiae. Both chlamydiae and gonococci are major causes of PID, contributing significantly to the rising rate of infertility and ectopic pregnancies in young women. Following a single episode of PID, as many as 10% of women may become infertile because of tubal occlusion. The risk increases dramatically with each additional episode.
Many genital chlamydial infections in both sexes are asymptomatic or not easily recognized by clinical criteria; asymptomatic carriage in both men and women may persist, often for months. As many as 50% of men and 70% to 80% of women identified as having chlamydial genital tract infections have no symptoms. Of significance, these asymptomatic infected individuals serve as a large reservoir to sustain transmission of the organism within a community.
When symptomatic, patients with a genital chlamydial infection will have an unusual discharge and pain or a burning sensation, symptoms similar to those for gonorrhea.
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