Concomitant Chlamydial Infection Research Articles

CLINICAL AND IMMUNOLOGICAL FEATURES OF THE COMBINED COURSE OF PERTUSSIS AND CHLAMIDYAL INFECTION IN CHILDREN

The article presents the analysis of clinical and immunological features of the combined course of pertussis and respiratory chlamydia in children. The study of the prodromal period and spasmodic cough symptoms showed that concomitant chlamydial infection did not significantly affect the severity of pertussis: 63.2% of patients had mild degree and 36.8% — moderate severity of the disease. However, in this case, the disease was delayed. Bronchitis and in some cases obstructive bronchitis was observed mainly in children under 1 year.The study of the lymphocytes subpopulation found that the content of NK cells decreased only in 10.5% of children, T helpers — in 21.1%, the ratio of CD4+ /CD8+ — in 26.3%. The function of cytokine network was characterized by more active production of such proinflammatory cytokines as IFN and TNF than their production during pertussis monoinfection. The levels of production of IL-8 and IL-6 were similar in all the studied groups. The production of IL-4 by lymphocytes in children with whooping cough in combination with chlamydial infection was weaker then in patients with pertussis monoinfection or in healthy children. These features are considered as immunological predictors of long reconvalescence in patients with association of pertussis and respiratory chlamydia.

Prevalance of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women

To prospectively investigate the prevalence of Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in the cervical canal and pouch of Douglas in unexplained infertile women and compare it to healthy controls in the Turkish population. A total of 31 women presenting with a history of infertility [n = 24 (77%) primary infertility, n = 7 (23%) secondary infertility] between 20 and 38 years of age and 31 women willing to have tubal ligation between 30 and 41 years of age were consecutively included into this study. Specimens were taken from intra-abdominal washings and from the cervical canal. CT, MH and UU were detected with polymerase chain reaction (PCR). Results of 62 women were analyzed. None of the participants met the criteria for salpingitis during laparoscopy. The most common infection in the cervical canal in both groups was UU, which was detected in 13 cases of infertile patients and 11 controls (P = 0.602). Cervical chlamydial and mycoplasmic infection was detected in one case each in infertile and control patients. Neither MH nor UU were obtained from the pouch of Douglas in both groups. Only CT was present in peritoneal fluid of an infertile woman who had also a concomitant chlamydial infection in the cervical canal. Demonstration of cervical colonization of CT by PCR may be a promising method for the detection of asymptomatic pelvic infection in patients with unexplained infertility. However, screening for MH and UU is not cost-effective due to similar low rates of detection.

Efficacy of azithromycin 1g single dose in the management of uncomplicated gonorrhoea

This paper describes the efficacy of azithromycin 1g single dose in the management of uncomplicated gonorrhoea either with or without chlamydial co-infection. Three hundred and one patients were treated for gonorrhoea between January 2000 and June 2001; 226/301 (75.1%) were treated with azithromycin 1g stat dose while the rest were treated with different regimens. Ninety-seven of 301 (32.2%) of all isolated strains were found to be resistant to at least one antibiotic where penicillin constituted the majority (23%). Chlamydial co-infection was found in 38.2% (115/301). Only 73.1% (220/301) attended for a test-of-cure, all but six patients had negative gonorrhoea cultures at their reviews. Among the six failures 3/32 (9.3%) were initially on amoxicillin, 2/170 (1.2%) on azithromycin and 1/22 (4.5%) on ciprofloxacin. Hence, azithromycin stat dose has proved to be a cost-effective treatment for uncomplicated gonorrhoea supported by the increased prevalence of penicillin-resistant organisms, concomitant chlamydial infection and the high failure rate in keeping review appointments.

Open study of the safety and efficacy of a single oral dose of azithromycin for the treatment of uncomplicated gonorrhoea in men and women.

An open, non-comparative study was undertaken to assess the safety and efficacy of a single 1 g oral dose of azithromycin in patients with uncomplicated gonorrhoea. One hundred and eighteen patients (105 male, 13 female) took part in the study. Only patients culture-positive for Neisseria gonorrhoeae were evaluated. The majority of male patients (84) had urethral gonorrhoea, but four had rectal and two pharyngeal infections. Four patients had positive cultures at more than one site (two urethral and rectal; two urethral and pharyngeal). All nine female patients had infection of the cervix only. Bacteriological eradication of N. gonorrhoeae was achieved in 76/82 (93%) patients with positive urethral cultures, 9/9 with positive cervical, 4/4 with positive rectal, and 2/2 with positive pharyngeal cultures. Twenty-two patients (18 males, four females) had concomitant chlamydial infection. Chlamydia trachomatis was eradicated in all patients who returned for follow-up assessment and in whom culture was done. Azithromycin was very well tolerated, with only two patients reporting mild-to-moderate side-effects. This study shows that single-dose azithromycin is effective in uncomplicated gonorrhoea and in mixed gonococcal and chlamydial infections.

Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin.

One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria. All gonococcal strains were isolated from appropriate pre-treatment swabs. Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates. In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15%. Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit. Seventy-three (100%) patients showed clinical cure and elimination of N. gonorrhoeae from the respective site of infection. Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females. No adverse reactions were reported by any patient. Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Isolation of Chlamydia trachomatis in men from the urethra in gonococcal urethritis.

In the present study 143 males, aged 14-70 years and being treated for gonococcal urethritis, were examined for concomitant chlamydial infection. C. trachomatis was isolated from cell cultures of the excretion of 24 (16.8%) of these patients. Chlamydia-positive men were treated with oxytetracycline 250 mg 4 times daily for two weeks and following treatment all cultures for C. trachomatis were negative.

EPIDEMIOLOGY OF OPHTHALMIA NEONATORUM IN KENYA

In a Nairobi hospital where ocular prophylaxis against ophthalmia neonatorum has been discontinued, 1019 women were screened for Neisseria gonorrhoeae and Chlamydia trachomatis during labour and 7 and 28 days postpartum. The prevalence of gonococcal infection was 7% and that of chlamydial was 29%. 52.4% of gonococcal isolates produced penicillinase. The incidence of ophthalmia neonatorum was 23.2 per 100 live births, and incidences of gonococcal and chlamydial ophthalmia were 3·6 and 8·1 per 100 live births, respectively. Of 181 cases of neonatal conjunctivitis, 31% were caused by C trachomatis, 12% by N gonorrhoeae, and 3% by both. In 67 babies exposed to maternal gonococcal infection and 201 exposed to maternal chlamydial infection, rates of transmission to the eye were 42% and 31%, respectively, and to the throat were 7% and 2%. Gonococcal transmission rate was higher in mothers with concomitant chlamydial infection (68%; p=0·01). Postpartum endometritis was associated with ophthalmia neonatorum (p<0·001). Ocular prophylaxis at birth for gonococcal ophthalmia should be reintroduced.

Is There Immunity to Chlamydial Infections of the Human Genital Tract?

Chlamydia trachomatis is commonly found in the urethra of men with gonococcal urethritis. Studies report a 20%-40% rate of double infection. A two-year study of men attending a venereal disease clinic in California showed that only 4% (4/99) or 7% (10/147) of men with gonorrhea had concomitant chlamydial infection, whereas 25-31% of the men with nongonococcal urethritis (NGU) had chlamydial infection. Men with gonorrhea seemed to have substantial recent exposure to chlamydial infection, since C. trachomatis was isolated from the cervix of 20% (36/180) of female contacts. Microimmunofluorescence (micro IF) tests showed that 93.6% (131/141) of the men with gonorrhea had IgG antibodies to Chlamydia and 36% (51/141) had IgM antibodies. IgG antibody rates were higher than those found among men who had NGU or no urethritis (83% and 65%, respectively), a fact which suggests that in this clinic setting the men with gonorrhea had very high antecedent exposure to C. trachomatis and may have been resistant to reinfection.