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Severe persistent inclusion conjunctivitis in a young child.

A 14-month-old girl had inclusion conjunctivitis although there had been no signs or symptoms that required medical attention in her first year. By 2 1/2 years of age, the child had extensive pannus and corneal scarring that severely reduced vision. The infection was caused by a genital strain of Chlamydia trachomatis, TRIC type E, that was probably acquired at birth. Although genitally transmitted chlamydial strains normally cause a self-limiting inclusion conjunctivitis in areas where trachoma is not endemic, this case illustrates that they may occasionally cause severe trachoma. Possibly local idoxuridine (IDU) treatment (administered to this patient before the correct diagnosis was made) contributed to the severity of this infection.

Child, Preschool

Humoral immunity in the resolution of genital infection in female guinea pigs infected with the agent of guinea pig inclusion conjunctivitis.

Female guinea pigs infected in the genital tract with the chlamydial agent of guinea pig inclusion conjunctivitis were selectively immunosuppressed by varying regimens of cyclophosphamide (Cy) treatment. Temporary suppression of both humoral and cell-mediated immunity by daily treatment of Cy (25 mg/kg) for 13 days resulted in a prolonged infection, whereas daily treatment for the duration of the experiment totally prevented the development of humoral and cell-mediated responses and produced an intense and prolonged infection which did not resolve. When humoral immunity alone was suppressed by treatment with Cy (250 and 150 mg/kg) at 9-day intervals, the infection again did not resolve. Treatment with 100 mg of Cy per kg at 9-day intervals resulted in an extended infection which resolved concomitantly with the development of antibody to guinea pig inclusion conjunctivitis. These data indicate that humoral immunity is essential for the recovery of female guinea pigs from guinea pig inclusion conjunctivitis genital infection. A market weight loss was observed which could not be attributed to Cy treatment alone. Edematous and ulcerative changes of the external genitalia were also noted.

Animals

Guineapig inclusion conjunctivitis (GPIC) in a commercial colony.

Serological findings in a commercial colony of Hartley guineapigs revealed that about 70% had antibodies to Chlamydia psittaci as detected by the microimmunofluorescence method. Conjunctivitis was evident in 14% of 86 guineapigs examined. Chlamydial antigen was detected in conjunctival scrapings by a direct immunofluorescence test using Chlamydia-specific monoclonal antibody; however, C. psittaci was not demonstrated by other methods.

Animals

Monoclonal antibodies to Chlamydia psittaci guinea pig inclusion conjunctivitis (GPIC) strain.

Monoclonal antibodies to a strain of Chlamydia psittaci isolated from guinea pig inclusion conjunctivitis (GPIC) were developed. Only five of the 15 hybridomas isolated produced antibodies specific for the GPIC strain, while seven others produced antibodies which cross reacted with other strains and another species. Strain-specific and species-specific monoclonal antibodies were isotyped as IgG2a and IgG3, respectively. It appears that the GPIC strain has at least two epitopes, one of which is specific for the strain and the other common to the species. These monoclonal reagents may be used to immunotype GPIC agents, better than available methods and may be of potential use in the development of vaccines against chlamydial infections.

Animals

The effect of cyclophosphamide on the recovery from a local chlamydial infection. Guinea-pig inclusion conjunctivitis (GPIC).

The immune mechanism involved in the recovery from and resistance to guinea-pig inclusion conjunctivitis (GPIC) was studied. Guinea-pigs were injected with a dose of cyclophosphamide (CY) (300 mg/kg wt) that inhibits antibody synthesis. Such treatment was shown to produce a cellular depletion in the B-cell area without producing an appreciable change in the T-cell area of the spleen and lymph nodes. CY treatment markedly delayed the appearance of secretory immunoglobulin A antibody to GPIC in the tears, and other classes of antibodies to GPIC and sheep erythrocyte in the serum. Furthermore, recovery from infection was impaired and a subsequent injection of CY prolonged the duration of infection. The results indicate that B cells may play an important role in the control of this infection.

Animals

Staphylococcal infection superimposed on guinea pig inclusion conjunctivitis.

We have studied the effect of superimposed staphylococcal infection on guinea pigs who had inclusion conjunctivitis. Although the acute phase of the inclusion disease was slightly more intense in the superinfected group, the course and duration were unaltered. We did not find any reactivation of the inclusion disease from the subconjunctival injection of glucocorticoid.

Acute Disease

Infectivity titration of guinea-pig inclusion conjunctivitis agent in irradiated McCoy cells.

Estimation of the infectivity of the agent of guinea-pig inclusion conjunctivitis for irradiated McCoy cells, assayed as inclusion-forming units, was influenced by the age of cells after irradiation, the maturation time of the inclusions, the centrifugal force and the centrifugation temperature. Agent passaged through irradiated McCoy cells or guinea-pig conjunctivae showed a greater capacity to infect irradiated McCoy cells without centrifuging than agent grown in a chick embryo. The nature of the change and the mechanism of infectivity enhancement by centrifuging are discussed.

Animals

Animal model studies of genital chlamydial infections. Immunity to re-infection with guinea-pig inclusion conjunctivitis agent in the urethra and eye of male guinea-pigs.

A previous report demonstrated that male guinea-pigs could be infected in the urethra with guinea-pig inclusion conjunctivitis (GPIC) agent and that the infection was transmitted during mating from infected males to females. In the experiments reported here, inoculation of male guinea-pigs in the urethra with GPIC organisms resulted in infection which subsided spontaneously in about 2 weeks. Males were demonstrated to be completely resistant to urethral challenge with 10(3)ID50 when tested 6 weeks after urethral infection. These guinea-pigs, immune to re-infection of the urethra, remained susceptible to infection of the eye, but this ocular infection was shorter in duration than that in previously uninfected control animals. Infection in the eye resulted in immunity to both ocular and urethral infection when animals were challenged 6 weeks after the ocular infection.

Animals

Experimental chlamydial salpingitis in immunosuppressed guinea pigs infected in the genital tract with the agent of guinea pig inclusion conjunctivitis.

At necropsy indication of spread of infection to fallopian tubes was found in 25 of 41 (60%) female guinea pigs infected in the genital tract with the chlamydial agent of guinea pig inclusion conjunctivitis and immunosuppressed with cyclophosphamide. Eighteen were examined histologically, and the diagnosis of acute salpingitis was confirmed in 10, based on inflammatory reaction, detection of guinea pig inclusion conjunctivitis in tissue, and formation of cysts (pyosalpinx and hydrosalpinx). Infection of fallopian tube tissue was confirmed by indirect immunofluorescence and electron microscopy. Infection of endometrial tissue and peritoneum was also recognized. Data suggested that the immunosuppression mediated by cyclophosphamide resulted in a prolonged genital tract infection and concomitant ascending infection leading to salpingitis.

Animals

Immunity to vaginal reinfection in female guinea pigs infected sexually with Chlamydia of guinea pig inclusion conjunctivitis.

Guinea pig boars were inoculated intraurethrally with the chlamydial agent of guinea pig inclusion conjunctivitis (GPIC). At the heights of their urethral infections, they were caged with sows in estrus. Whereas some of the sows had not been previously exposed to GPIC agent, others had received an intravaginal inoculation 5 to 8 weeks earlier. Those sows for which infected boars provided the first exposure were challenged by intravaginal inoculation 5 to 8 weeks later. Vaginal and conjunctival scrapings were taken regularly and stained for chlamydial inclusions. Titers of serum anti-GPIC antibodies and of vaginal secretory IgA anti-GPIC antibodies were determined by immunofluorescence. Our results show for the first time that a sexually acquired vaginal GPIC infection induces immunity to manual reinfection of the vagina. Because of the high incidence of secondary conjunctival infections among the vaginally infected sows, we could not provide a sound statistical basis for our tentative conclusion that manual infection of the vagina induces immunity to sexual reinfection. The results of our antibody titrations confirm previous work showing that vaginal GPIC infection induces formation of both serum antibody and vaginal secretory immunoglobulin A antibody.

Animals

Limited survey of genital infection by guinea pig inclusion conjunctivitis agent.

Cervical or urethral scrapings were collected from 245 guinea pigs that had clinical signs of guinea pig inclusion conjunctivitis (GPIC) or were parents of newborn young having clinical signs of GPIC. Giemsa-stained smears were examined for cytoplasmic inclusion bodies, and samples were passaged in 6-day-old embryonating eggs. Complement-fixation tests were performed on 44 samples passaged through eggs in an effort to detect the presence of GPIC antigen. Unequivocal evidence of chlamydial infection of the genital tract was not found.

Animals

Resistance to reinfection with a chlamydial agent (guinea pig inclusion conjunctivitis agent).

Although most chlamydial infections are chronic or recurrent, infection of the guinea pig's eye with guinea pig inclusion conjunctivitis (GPIC) agent induces a marked resistance to reinfection. To characterize this resistance to GPIC agent, we compared the disease and infection in previously infected guinea pigs with that in animals infected for the first time. In animals experiencing primary infection, even the lowest dose (10 egg-lethal doses [ELD50]) produced the disease and chlamydial inclusions in conjunctival smears, but the incubation period became progressively shorter with the highest inocula (10(4) and 10(5) ELD50). In animals with previous infection only these two highest inocula produced disease and infection, but the disease was short-lived, and replication of the agent was severely limited. The mechanism of this resistance may be due to secretory antibody in the tears, cellular immunity, or other local factors.

Animals

Target tissues associated with genital infection of female guinea pigs by the chlamydial agent of guinea pig inclusion conjunctivitis.

Female guinea pigs were experimentally infected in the genital tract with the strain of Chlamydia psittaci that causes guinea pig inclusion conjunctivitis. Chlamydiae were found frequently in superficial squamous epithelial cells of the exocervix, along with heavy involvement at the squamocolumnar junction. In this zone chlamydiae were observed in columnar cells, but inflammation and chlamydial inclusions were not observed in true endocervical epithelium. These observations were supported by results of immunofluorescence microscopy. Electron micrographs revealed typical chlamydiae within surface epithelial cells at the squamocolumnar junction; various stages of the growth cycle (elementary, reticulate, and intermediate bodies) were also present. Cytopathologic features were not remarkable, but peripheral distribution of organelles, rarefaction of the cytoplasm, and loss of microvilli were observed.

Animals

Ultrastructural studies on the intracellular fate of Chlamydia psittaci (strain guinea pig inclusion conjunctivitis) and Chlamydia trachomatis (strain lymphogranuloma venereum 434): modulation of intracellular events and relationship with endocytic mechanism.

Previous observations on the highly infectious LGV strain 434 of Chlamydia trachomatis and the guinea pig inclusion conjunctivitis (GPIC) strain of C. psittaci (which requires centrifugation of inocula with host cell monolayers for maximum infectivity) indicated that infectivity differences were expressed, not at entry, but at an intracellular stage affecting multiplication. Centrifugation increased the potential of internalized chlamydiae to undergo productive infection. Here, analysis of the intracellular fate of chlamydiae by ultrastructural methods indicates that strain GPIC exhibits two patterns of behaviour depending on the mode of inoculation. Strain GPIC showed limited entry, with 47% of intracellular organisms becoming associated with thorotrast-labelled lysosomes, following static incubation with monolayers. In contrast, with centrifugation, entry was not limited and association with lysosomes was reduced to 12%; strain 434 behaved similarly but independently of the mode of inoculation. The different results for strain GPIC correlated with distinct entry mechanisms. Entry during static incubation was unimpaired either by treatment with cytochalasin D or by temperature reduction to 20 degrees C, suggesting that it was pinocytic. Entry during centrifugation was markedly impaired by both treatments, suggesting that it was phagocytic. The data lead to two novel conclusions: first, that chlamydiae can apparently enter cells by both pinocytic and phagocytic mechanisms; second, that the entry mechanism influences intracellular fate. It is suggested that entry mechanism is linked to selection of the vesicle membrane forming around the internalizing chlamydiae. This, in turn, may influence both intracellular translocation and subsequent inhibition or promotion of multiplication of the internalized parasite.

Animals

Recurrent T.R.I.C. kerato-conjunctivitis: treatment with tetracycline.

Trachoma inclusion conjunctivitis agent infections have a spectrum of clinical presentations which in their more chronic forms are often difficult to recognize. Patients with epithelial erosions of the upper cornea, episodic E.K.C. type subepithelial infiltrates, pannus or micropannus, and with or without lid scarring, merit conjunctival scrapings as an aid to diagnosis. Since the agents which produce these infections have a genital reservoir, as the prevalence of venereal diseases increases, the incidence of this type of keratoconjunctivitis will also increase. If the diagnosis is suspected treatment with systemic tetracycline is effective and relatively safe. Simultaneous treatment of sexual consorts of inclusion conjunctivitis patients and families of trachoma patients should decrease recurrences.

Adult