chlamydia and hlamidofilezy - this group of infectious diseases etiologically related, anthroponotic and zoonotic nature, which are caused by chlamydia and hlamidofilami.
Chlamydia and hlamidofily - a kind of infectious gram-negative microorganisms 0.25-1.5 microns in diameter, occupying an intermediate position between the bacteria, rickettsia and viruses.Initially, they were referred to the virus because of the ability to multiply in the cytoplasm of cells and long persist in them, but in recent years set the proximity of these microorganisms to bacteria, which brings them together the presence of DNA, RNA, a bacterial membrane, the ability to divide, sensitivity to antibiotics.Chlamydia and hlamidofily have a similar life cycle, the same chemical composition, total generic group specific antigen (lipopolysaccharide complex), as well as species-specific and type-specific antigens.Hlamidofily and Chlamydia are obligate intracellular pathogens because not able to synthesize their own ATP and energy
Pathogens exist in two forms - in the form of elementary and reticular cells.Elementary bodies are sporopodobnoy form of the pathogen, have a rigid shell, infectious properties are stable in the environment, are not susceptible to antibiotics.cell wall strength is provided the outer and inner membranes.The inner cytoplasmic membrane contains lipopolysaccharide.The outer membrane embedded Mayor Outer Membrane Protein (MOMP or OMP-1) and Outer Membrane Protein (OMP-2).Reticular cells - is the intracellular form of breeding, sensitive to the action of antibacterial agents.
After infection, the cells elementary bodies of four possible consequences - the destruction of pathogens in phagolysosomes reproduction, persistence or L-like transformation.When the reproductive path elementary bodies are transformed into reticular cells, which are divided into binary 8-12 times.As a result, formed cytoplasmic inclusion - microcolonies chlamydia.After 36-48 hours, a new generation of elementary bodies, whose yield of cell leads to its death.The cycle of pathogens determines the duration of antibiotic therapy, which should correspond to 6-8 cycles of reproduction.
Under the influence of a number of factors (nutrient deficiency in the cell, the low level of interferon therapy is inadequate and others.) Reproduction can slow down and even suspended at a stage intermediate cells (persistence of the pathogen).This reduces the synthesis of the primary outer membrane protein MOMP and begins to form large amounts of heat shock protein with a molecular mass of 60 kD - HSP-60 (Hot Shok Protein HSP-60).It is an activator of macrophages produce proinflammatory cytokine that plays an important role in the pathogenesis of chronic inflammation of female infertility due to occlusion of the fallopian tubes, and fetal death.
As a result of an inadequate immune response, the use of antibiotics penicillin and chlamydia hlamidofily form L-shape, which is long parsistiruyut in the cells and can be transmitted to daughter cells at division.Upon termination of the transforming factors are reversed to its original form.
Chlamydia and hlamidofily have a tropism for cells of the columnar epithelium of the respiratory and urogenital tracts, alveolocytes, vascular endothelium, endocardium, macrophages, lymphoid tissue.
to human pathogens anthroponotic pathogens Chl.trachomatis and Chi.pneumoniae, as well as zoonotic intracellular pathogen Chl.psittaci.Quite often, especially in persons with immunosuppression, develops mixed infection with mycoplasma, herpes viruses, opportunistic bacteria, fungi.
has now been found that some members of the order Chlamydiales, pathogenic for animals, can cause disease in humans - conjunctivitis (Chl felis.), Abortion (Chi abortus.), Pneumonia and bronchiolitis (representative Simkaniaceae family, S. negevensis).
hlamidofily and Chlamydiae are sensitive to heat, ultraviolet light, 70% ethanol, 0.5% phenol solution, 2% Lysol solution, 0.1% solution of potassium iodide, 0.5%potassium permanganate solution and 6% hydrogen peroxide solution.Pathogens are resistant to exposure for 10 minutes with a 0.5% solution of chloramine, but treatment with a 2% solution for one minute leads to their death.
etiology. In modern classification (K. Everett, 1999) family Chlamydiaceae, which previously consisted of only one genus Chlamydia, is currently divided into two kinds - Chlamydia and Chlamydophila.The genus Chlamydia includes Chl.trachomatis, Chl.suis, Chl.muridarum, in the genus Chlamydophila - Chl.psittaci, Chi.pneumoniae, Chl.pecorum, Chi.abortus, ChI.caviae, Chl.felis.
diagnose chlamydia genitals can be difficult, especially for women, because the disease often has no symptoms.The lack of treatment in women may lead to inflammation of the fallopian tubes (salpingitis), leading to pelvic inflammatory disease.It increases the risk of scarring that can result in infertility and ectopic pregnancy or.In men, the lack of treatment leads to epididymitis.In underdeveloped countries, other forms of chlamydia cause an infectious eye disease (trachoma), which is the leading cause of blindness.View Chlamidia-pneumoniae is a common cause of mild pneumonia;There is also speculation that he is the cause of coronary heart disease.Psittacosis, which is a kind of pneumonia occur in people, many of colliding with a bird and working on poultry farms, develops thanks Chlamidia psittaci.
with genital diseases:
With the defeat of the eye:
When chlamydial pneumonia:
Diagnosis is based on the data of the complex accounting epidemiological history, clinical symptoms and laboratory tests.For laboratory diagnostics use a combination of direct and indirect methods of detecting the pathogen.
Serological markers of diagnosis and determine the forms of the disease are presented in Table.
Serological markers of diagnosis of chlamydia and hlamidofilezov
Differential diagnosis. for respiratory chlamydia and hlamidofileze leading clinical syndrome is the "Long paroxysmal cough."The differential diagnosis is carried out with the Infectious Diseases - pertussis, parakoklyushem, mycoplasmosis, cytomegalovirus;Noncommunicable diseases - with a foreign body, cystic fibrosis, tuberculosis bronhoadenitom, mediastinal tumor, bronchial asthma.Differential diagnosis is based on a comprehensive analysis of the medical history, clinical, laboratory and instrumental examination.
Epidemiology. chlamydia and hlamidofilezy characterized by a wide spread of the epidemic.Antibodies to Chi.pneumoniae was detected in 10-30% of children aged 1 - 15 years, 50% of persons aged 20 years and 70-80% of elderly people.The majority of the surveyed indicate they adjourned earlier the disease, but in 8-10% reflects the current infection.Established that Chi.pneumoniae is the causative agent of acute respiratory diseases in 10-30% of children in developed countries and 35-95% - in the countries of Asia and Africa.In adverse social and economic conditions pnevmohlamidofileza frequency is increased by 2-3 times, with the disease of the other family members - in 4-5 times.Hlamidofilez caused by Chl.pneumoniae, it is found in the form of sporadic diseases and epidemic outbreaks.Observed epidemic rises once every four or five years.
Every year in our country recorded 1 million patients with urogenital chlamydiosis caused by Chl.trachomatis.This disease affects 10-20% of women of childbearing age, which is the reason for the high rate of intrauterine chlamydia.
For ornithosis characteristic of sporadic incidence and small outbreaks among persons exposed to sick birds.Antibodies to Chl.psittaci was detected in 8% of children, 24.5% of workers in poultry farms and 37.5% of people with pet birds at home.A survey of adults with pneumonia showed that 10-20% of the disease has ornitoznoy etiology.
source of infections caused by Chl.pneumoniae and Chl.trachomatis, is a sick person, the sources psittacosis - sick birds, perhaps a sick man.Chl.trachomatis is transmitted sexually, kontaktnobytovym and vertical paths, Chl.pneumoniae - airborne, Chl.psittaci - the airborne (airborne dust, airborne), contact-household and nutritional ways.Infection often occurs on children sick parents ( "family chlamydiosis").
pathogenesis. in the pathogenesis of chlamydial infection and hlamidofilezov distinguish several stages.
classification. Due to a variety of clinical manifestations of a common classification of chlamydia and hlamidofilezov not.Clinical forms of chlamydial infections are hlamidofilnoy and psittacosis, urogenital chlamydiosis, oftalmohlamidioz, inguinal lymphoma, Reiter's syndrome, erythema nodosum, the pathology of the respiratory, nervous and cardiovascular systems, intrauterine chlamydia.
Clinic. pathology of respiratory.Infants often associated with Chl.trachomatis, in children older than one year - with Chl.pneumoniae.Established that Chl.pneumoniae is the causative agent of acute pharyngitis and otitis media in 5% of children aged 5-14 years, tonsillitis - 20%, sinusitis - 15%, laryngotracheitis - 15%, bronchitis - at 20-25% of community-acquired pneumonia - at10% of patients.The vast majority of patients have the association of chlamydia and mycoplasma with hlamidofilov, respiratory viruses, herpes viruses, bacteria (streptococci, staphylococci, branhamellami, hemophilia, Klebsiella, E. coli, and others.) Fungi.
clinical forms of respiratory disease are rhinopharyngitis, tonsillitis, sinusitis, otitis, laryngotracheitis, bronchitis, pneumonia, bronchial asthma.
With the defeat of the upper respiratory tract or develop nasopharyngitis faringotonzillit.Against the backdrop of moderate symptoms of intoxication appear muco-purulent nasal discharge, scratchy and sore throat.When pharyngoscope detect oropharyngeal mucosa hyperemia, enlargement of the tonsils.There have conjunctivitis, increased submandibular, cervical, supraclavicular, axillary and cubital lymph nodes.In the future, some children joined pathology LOP-bodies of the lower respiratory tract and lungs.The disease is characterized by a prolonged course, possible relapses.
Otitis and sinusitis begin gradually.Symptoms of intoxication and local symptoms are mild.The disease takes a long time - for a few weeks and months, the standard antibiotic therapy is ineffective.In the absence of timely diagnosis and treatment of pathology of the upper respiratory tract and LOP-organ becomes chronic, developing mixed infection.As a result, patients are transferred to the group of sickly children.
laryngotracheitis is characterized by a triad of symptoms - barking cough, hoarseness, inspiratory dyspnea on a background of moderate symptoms of intoxication.The disease is prolonged, there may be relapses.
bronchitis develops after 4-12 weeks after infection, often as an extension of the upper respiratory tract inflammation.It is characterized by gradual onset, mild symptoms of intoxication.A distinctive feature is the dry paroxysmal pertussoid without reprises ( "Staccato").Auscultation listen to dry, coarse and srednepuzyrchatye crackles.Half of the children develop bronchial obstruction.Later the cough becomes wet.Recovery occurs within 10-14 days, but in half of patients have a protracted and recurrent course of the disease.
Some patients develop SARS.The disease begins gradually with dry cough and mild symptoms of intoxication.Subsequently becomes paroxysmal cough, but unlike pertussis, is not accompanied reprises.At the end of the first week of dyspnea, cyanosis, physical data (dry and mixed wet rales, crepitation).There is a distinct dissociation between local signs of pneumonia and mild symptoms of intoxication.On radiographs reveal multiple cellular shade of low intensity without clear boundaries, swelling of the lung tissue, increased pulmonary pattern.One-third of children have lymphadenopathy and hepatosplenomegaly, possible dilution of the chair.In some patients with severe pneumonia occurs symptoms of intoxication up to an infectious-toxic shock and severe complications (lung abscess, pleural effusion, pneumothorax).The assay detected blood leukocytosis (up to 20 x 109 l), eosinophilia (10-15%), with a shift to neutrophilia stab, a significant increase in ESR (40-60 mm / h).The disease is characterized by a prolonged course, resistant to standard antibiotic therapy.
Quite often, especially in chronic lesions of the respiratory system, there are vnerespiratornye symptoms (lymphadenopathy, reactive arthritis, dystonia, dyskinesia biliary tract, pyelonephritis), indicating that the systemic nature of the pathological process.
In recent years, found that a third of children with asthma disease associated with infection with Chl.pneumoniae.This pathogen is involved in the formation of chronic inflammation and remodeling of the airways of mucous, increases bronchi hyperreactivity, induces the production of IgE.Symptoms bronhobstruktsii appear in the autumn-winter period on the background of the symptoms of lesions of various parts of the respiratory tract.In adult patients, studying the role of Chl.pneumoniae in the development of chronic bronchitis, chronic obstructive pulmonary disease and emphysema.
Psittacosis - is an infectious disease caused by Ch.psittaci, transmitted from infected birds mainly by the airborne route.
The incubation period lasts from 7 to 14 days (sometimes up to 25 days).
In 1/5 of patients for 2-4 days there are prodromal symptoms of malaise, general weakness, weakness, loss of appetite, nausea and arthralgia.In the remaining patients, the disease begins suddenly.
height of the disease characterized by an increase in body temperature to 39-40 ° C, chills, weakness, fatigue, headache, dizziness, pain in the chest, muscles, joints.Appetite is reduced.In some patients the nausea, vomiting, and pain in the throat when swallowing.
On examination determined by injection of vascular sclera and conjunctiva, hyperemia.The skin sometimes appears maculopapular rash or roseolous.In 1/4 patients the nosebleeds.Catarrhal symptoms (runny nose, nasal congestion, sore throat, hoarseness, oropharyngeal mucosa congestion) are mild.
On 3-5th day of illness on a background of febrile fever and intoxication join lung disease symptoms - mild dry cough, chest pain.Physical findings in the early days of meager.Later on auscultation in some areas can be identified weakened or hard breathing, dry and finely wheezing, crepitations.Pneumonic lesions mainly localized in the lower lobes.The right lung is affected more often than the left.Radiological pneumonia occurs as interstitial (50% of patients), small focal (30%), while large (10%) and lobar (10%).
Noteworthy is the discrepancy between the relatively small changes in the lungs and pronounced symptoms of intoxication.
By the end of the first week of the disease in most patients the liver increases.
Regression of clinical symptoms ornitoznoy pneumonia most patients occurs slowly over 3-4 weeks.However, some patients have radiographic abnormalities persist for 4-5 months.In 20% of patients relapse.
atypical course of acute ornithosis may be accompanied by the development of serous meningitis occur without lung disease.The rare atypical forms include ornitozny hepatitis, endocarditis.
Psittacosis can occur in the form of chronic pneumonia or chronic ornithosis without lung lesions.
For ornithosis characteristic leukopenia or normocytosis (leukocytosis observed in the stratification of bacterial infections), increased ESR.
Complications are rare.