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A method of cell culture using HeLa 229 cells is described for the isolation of Chlamydia trachomatis. From 40 patients with non-specific urethritis (NSU) attending a venereal disease clinic, the isolation rate was 60 percent and 78 percent from neonates with sticky eyes from which no other organism could be isolated.
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One goal of every prenatal care should be the diagnosis of a cervical infection with Chlamydia trachomatis and the prevention of its transmission to the neonate. Therefore, we studied the questions (1) at which gestational age a screening would be most meaningful and (2) whether the woman's medical history, a vaginal smear or cervical cerclage suggests any risk of infection. 11 of 121 pregnant women (9.1%) had a positive test for cervical infection with Chlamydia trachomatis at their booking visit. More than half of them had a spontaneous remission at the follow-up visit. Practically, all newborns to infected mothers (at follow-up visits) had a positive test as well. We did not find any relationship between the medical history, vaginal smear or cervical cerclage and the incidence of Chlamydia trachomatis infection. In conclusion, we propose a screening for Chlamydia trachomatis infection of all pregnant women between the 34th and 38th week of gestation and treatment of infected individuals with erythromycin (4 x 500 mg t.i.d.).
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In vitro proliferation assays of whole peripheral blood mononuclear leukocytes (PBML) and PBML depleted of suppressor T cells were performed in cynomolgus monkeys after they had received one, two, or repeated ocular inoculations with Chlamydia trachomatis. Whole PBML responded only weakly to chlamydial antigen, and responses to concanavalin A were depressed for 12 wk following ocular infection. Depletion of the suppressor T cell population did not result in increased chlamydia-specific proliferation until 14-20 wk after initial antigen contact, suggesting that circulating suppressor T cells are not responsible for the initiation of the chronic state.
Chlamydia trachomatis serotype D-K is one of the most important pathogens of communicable diseases. 3 to 5 million new infections are observed annually in the USA. 10% to 30% of young sexually active persons in the age group 15 to 20 years are affected. The organism was isolated from 20% to 30% of patients attending dispensaries for sexually transmitted diseases, 5% to 10% of gynaecological outpatients, 1% to 8% of pregnant women and 0% to 5% of asymptomatic control persons. In men, C. trachomatis was found in 30% to 70% of patients with urethritis (15% to 25% simultaneously with gonorrhoea), in 30% to 60% of persons suffering from nongonoccocal urethritis and in 65% to 70% with postgonoccocal urethritis. 20% of newborns from mothers with positive cultures develop pneumonia and 37% conjunctivitis. Complications such as endometritis, salpingitis, periappendicitis, perihepatitis, ectopic pregnancy, premature birth, proctitis, cystitis, deferenitis, epididymitis, reactive arthritis, morbus Reiter, conjunctivitis, pneumonia (in infants and adults) may cause long lasting disease and may leave behind irreversible sequelae. Treatment with tetracyclines or erythromycin is always effective.
Chlamydia trachomatis is an obligate intracellular parasite responsible for many clinical syndromes, including neonatal conjunctivitis and pneumonia. The gold standard of diagnosis has been isolation in cell culture. However, this requires days of processing. Several rapid diagnostic tests are available. Giemsa staining of conjunctival smears, enzyme immunoassay, and the fluorescein-conjugated monoclonal antibody test. Both the EIA and the FA tests show promise as ideal rapid diagnostic tests. Treatment of chlamydial conjunctivitis must focus upon the eradication of nasopharyngeal carriage as well as cure of ophthalmic symptoms. The need for nasopharyngeal eradication is underscored by the fact that it is the source for chlamydial pneumonia as well as for conjunctival re-infection. Clinical studies have shown that oral erythromycin estolate or ethylsuccinate suspension 50 mg/kg/day twice-daily or four times a day for 14 to 21 days are the therapeutic regimens of choice. Neonatal ocular prophylaxis is currently under study. One per cent silver nitrate does not prevent chlamydial conjunctivitis but preliminary studies do show favorable results with topical erythromycin. Nevertheless, neither 1 per cent silver nitrate nor topical erythromycin eradicate nasopharyngeal carriage, elimination of which is necessary for the prevention of neonatal chlamydial pneumonia.
Chlamydial conjunctivitis was diagnosed in a 5-day-old male newborn. Under treatment with erythromycin the clinical picture of intense swelling of the lid and the copious purulent discharge abated during the following 2 days. Chlamydia trachomatis has become worldwide the most prevalent causative agent of neonatal conjunctivitis.
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This study emphasizes the importance of accurate diagnosis and therapy. Modern laboratory techniques were used to scan conjunctival swabs from 287 patients with 305 red eyes between 1.1. 1985 and 1.6. 1985. 17 patients (5.9%) showed Chlamydia infection. The main bacterial organism found was Staphylococcus, mostly of a resistant strain. Allergic conjunctivitis and typical viral infections were not considered in this study. As reported in the recent literature eye infections caused by Chlamydia trachomatis are increasing in number.
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