Chlamydiosis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
A55 Lymphogranuloma inguinale (venereum) due to chlamydia
A56 Other sexually transmitted chlamydial diseases
A70 Chlamydia psittaci infections
A71 Trachoma
A74 Other diseases caused by chlamydia
J16.0 Chlamydial pneumonia
P23.1 Congenital pneumonia due to chlamydia
P39.1 Chlamydial conjunctivitis in the newborn
ICD-10 online (WHO version 2019)

Chlamydioses are infectious diseases caused by different chlamydia (certain types of bacteria ) . They affect the eye (as trachoma ), the airways and lungs (as pneumonia ), and the urogenital tract (urinary and reproductive organs) as a sexually transmitted disease .

Of genital chlamydia infections predominantly female and male adolescents and young adults aged 15 to 24 are affected. Urogenital chlamydial infections are often symptomatic . If left untreated, they can cause an infection ascending from the genital area in 10–40% of women. This can result in chronic pain and sticking of the fallopian tubes , which can lead to infertility or ectopic pregnancy .

Pathogens

Chlamydiosis is caused by infection with chlamydia. This refers to a group of gram-negative bacteria from the Chlamydiaceae family that belong to either the Chlamydia or Chlamydophila genus . It is typical for these bacteria that they can only multiply in the cell, as they depend on the energy metabolism (ATP synthesis) of the host cell . These species are primarily pathogenic for humans: Chlamydia trachomatis , Chlamydophila psittaci and Chlamydophila pneumoniae .

Diseases caused by Chlamydia trachomatis

The serotypes A to C of Chlamydia trachomatis is the pathogen of trachoma , serotypes D to K call infections of the urinary and reproductive organs produce, but also as Paratrachom called conjunctivitis (pink eye), even swimming pool conjunctivitis called. C. trachomatis serotypes L1 to L3 cause lymphogranuloma venereum .

Trachoma

Trachoma is a chronic infection of the conjunctiva and cornea of the eye and a common cause of blindness worldwide. The World Health Organization (WHO) estimates that around 21.4 million people have trachoma, of which 1.2 million are already blind and 2.2 million are visually impaired. Trachoma occurs almost exclusively in tropical countries with poor hygienic conditions. C. trachomatis serotypes A to C are the causative agents of this disease.

Genitourinary infections

distribution

According to the WHO, infection of the urogenital tract by C. trachomatis is the second most common sexually transmitted disease worldwide (after infection by Trichomonas vaginalis ). According to studies evaluated by the Robert Koch Institute (RKI), the prevalence (frequency of illness) in Germany is 4.4% in sexually active 17-year-old women, 4.5% in 18- to 19-year-old women and 4.9% estimated in 25 to 29 year old men. In girls and young women there is a lack of information regarding the transmission of sexually transmitted diseases; a screening in Berlin revealed a chlamydial infection in 10% of 17-year-olds. Around 100,000 cases occur annually. This makes an infection of the urogenital tract by C. trachomatis the most common sexually transmitted infection in Germany. In 2010, 1,085 cases were reported in Austria .

In the European Union , chlamydia is the most common cause of sexually transmitted diseases, in 2010 there were 344,491 reported cases (in 22 EU member states plus Iceland and Norway ). However, there are not confirmed data from all member states, as in some cases there is no obligation to report the disease . This applies to Germany, France , Italy , Portugal and the Czech Republic . The incidence rate in Europe is 186 cases per 100,000 population. Iceland had the highest incidence rate with 691 cases per 100,000 inhabitants, followed by Denmark and Norway with 505 and 464 cases per 100,000 inhabitants, respectively.

Most of the reported cases (around 75%) affect adolescents and young adults between the ages of 15 and 24; the incidence rate is 821 cases per 100,000 inhabitants. Young women are more affected than young men; this result can probably be attributed to the fact that the surveillance programs that have been introduced preferentially target young women - especially pregnant women . If data were collected on the transmission route , their evaluation confirms that it is a sexually transmitted disease. In 94.9% of the cases the transmission took place between heterosexuals , in 4.96% of the cases between homosexual men.

The early detection and treatment of chlamydial infections are important to prevent the possible serious sequelae. Since 1995, pregnant women and women before a planned abortion have been able to have a free chlamydia test carried out as part of a screening . Since 2008, all women under the age of 25 have been able to be tested for chlamydia voluntarily and free of charge. Since the introduction of the Infection Protection Act 2001, of the sexually transmitted diseases (also abbreviated as STD or STI), only syphilis and HIV are notifiable. In order to maintain an overview of the epidemiological situation of STIs in Germany, a sentinel surveillance system was started in 2002. For this purpose, health facilities were selected in all regions of Germany that collect data on STIs. These include health authorities , specialist outpatient departments and resident doctors. On behalf of the Federal Joint Committee , the Robert Koch Institute in 2010 has Chlamydia trachomatis - laboratory Sentinel established to the prevalence of chlamydia infections in Germany and the cover to estimate the screening for women under 25 years better. By the end of 2013, information on almost 2.5 million chlamydia tests from January 1, 2008 to March 31, 2013 had been evaluated.

Causes and Clinical Appearances

The pathogens (serotypes D to K of C. trachomatis ) can mainly be transmitted during sexual intercourse . The infection proceeds without symptoms in about 80% of women and about 50% of men.

If left untreated, chlamydia can cause an infection that ascends from the genital area in 10–40% of women. In women, inflammation of the urethra ( urethritis ) and Bartholin's glands can occur. In addition, the pathogen attacks the mucous membrane of the cervix and then travels the female sexual organs high above the uterus to the fallopian tubes . Inflammation of the cervix ( cervicitis ), the lining of the uterus ( endometritis ) and the fallopian tubes ( salpingitis ) can occur. Vaginal discharge is common with cervicitis .

Further complications are possible through the infections, through the salpingitis the fallopian tubes can stick together and thus lead to sterility (infertility) of the woman. Also, sticky fallopian tubes can prevent a fertilized egg from reaching the uterus. This favors so-called extrauterine pregnancies (pregnancies outside the uterus), e.g. B. Ectopic pregnancies . The spread of inflammation in the pelvis (PID, pelvic inflammatory disease ) also leads to chronic pain in the lower abdomen. A large-scale study in Uppsala ( Sweden ) shows that the risk of infertility after genital chlamydial infection is around 7%, the risk of PGD around 6% and that of an ectopic pregnancy around 3%.

Infections during pregnancy promote premature birth . If a mother genitally infected with C. trachomatis Serovar D to K gives birth to a child, she can infect her newborn during birth: conjunctivitis (compare paratrachoma) and pneumonia (pneumonia) are the result. Pneumonia is possible if the newborn aspirates vaginal secretions that contain pathogens during birth.

In men, inflammation of the urethra (urethritis), inflammation of the prostate ( prostatitis ) and the epididymis ( epididymitis ) occur with the possible consequence of sterility. Infected men usually experience painful urination and a purulent discharge. The acute infection can lead to arthritis in various joints, tendovaginitis (inflammation of the tendon sheath) and, in rare cases, Reiter's syndrome .

There is also evidence that an existing chlamydial infection can make it easier for you to get other sexually transmitted diseases, including HIV , through unprotected sex.

Unprotected oral or anal intercourse can also lead to a chlamydial infection of the throat ( pharyngitis ) or the rectum ( proctitis ). These infections usually proceed without symptoms and are therefore only very rarely discovered. The infections usually heal without complications after a few weeks, but until then they pose a risk of infection.

Investigation methods

The diagnosis is usually made by detecting specific DNA in smears or urine samples using the polymerase chain reaction (PCR). If necessary, smears from the rectal and throat mucosa must be examined. The direct cultivation of the pathogen is very complex. A simultaneous infection with other sexually transmitted diseases (for example with Neisseria gonorrhoeae ) is not uncommon, so that this should also be checked for.

treatment

Chlamydia infections can be easily treated with antibiotics . Tetracyclines ( doxycycline ) and macrolides such as erythromycin and azithromycin , and to a limited extent also quinolone antibiotics, are suitable for therapy . β-lactam antibiotics such as penicillin are completely ineffective due to the lack of a cell wall . The partner (s) must also be treated, if necessary also on suspicion, otherwise reinfection is inevitable. A further examination should be carried out a few weeks after the end of therapy as recurrences often occur.

prevention

Condoms also protect against infection with chlamydia, regular screening of pregnant women for chlamydiosis protects against preventable premature births and infection of the newborn.

The early detection and treatment of chlamydial infections are important to prevent the possible serious sequelae. Since 1995, pregnant women and women before a planned termination of pregnancy have been able to have a free chlamydia test carried out as a screening. Since 2008, all women under the age of 25 have been able to be tested for chlamydia voluntarily and free of charge. Rapid tests for a home exam are also available.

Paratrachoma

→ See also paratrachoma (inclusion body conjunctivitis)

C. trachomatis serotypes D to K can also cause conjunctivitis (conjunctivitis), which is also known as inclusion conjunctivitis. Pus develops in the conjunctiva, but it usually heals without complications. In Germany, in some cases, C. trachomatis of these serotypes caused acute conjunctivitis through transmission in bathing water. The name swimming pool conjunctivitis was coined for this. Inadequate chlorination of the water can cause chlamydia from the genital area of ​​bathers to survive. The patient's sexual habits are also suspected to be the cause of the infection.

This also includes conjunctivitis ( ophthalmia neonatorum ) that occurs in newborns if the infected mother infects her child in the birth canal during birth. For the treatment of inclusion conjunctivitis, antibiotics - mostly tetracyclines - are used locally.

Lymphogranuloma venereum

This is also a sexually transmitted disease. It is caused by the serotypes L1 to L3 of C. trachomatis . At the site of infection, a superficial ulcer ( primary lesion ) develops first , after 10 to 30 days there is painful swelling of the lymph nodes (bubo) in the groin area, which can break open. Scarring can lead to lymph node meltdown. If no treatment is given, the lymphatic tracts can become blocked with signs of congestion and even elephantiasis . This disease is very rare in Central Europe and is mainly common in Asia, Africa, South America and the Caribbean. As with genital infections, systemic therapy with antibiotics is used.

Diseases caused by Chlamydophila psittaci

Diseases caused by Chlamydophila psittaci are widespread around the world, they only occur rarely in Germany (2007: 72 diseases, 2008: 86 diseases). It is a zoonosis ; humans are infected by animals, in this case mainly birds . If the infection occurs via parrots (Psittaciformes), one also speaks of psittacosis (psittacose, parrot disease ).

Transmission from person to person has not yet been proven. The birds excrete the pathogen with their faeces , infected birds can be seriously ill, but they can also appear completely healthy. Humans are infected by inhaling dust containing pathogens, such as those produced when removing bird droppings. The site of infection is then the respiratory system ( respiratory tract ) and leads to atypical pneumonia (pneumonia), but other organs can also be affected by spreading . The severity of the disease ranges from very mild to fatal.

According to Section 7 of the Infection Protection Act, there is an obligation to report positive pathogen detection by the verifying laboratory with the patient's name. Diseases in cattle, sheep, goats and poultry (including pigeons) are also notifiable according to the ordinance on notifiable animal diseases (see animal disease ).

Diseases caused by Chlamydophila pneumoniae

Chlamydophila pneumoniae is a common cause of respiratory infections (diseases of the airways) in humans. The pathogen is spread worldwide, the pathogen reservoir is humans. 5 to 15% of all out-of-hospital (community) acquired pneumonia is caused by C. pneumoniae . Antibodies against C. pneumoniae can be detected inaround 60% of 51 to 60 year olds. It can be assumed that everyone has contact with the pathogen at least once in their life.

C. pneumoniae is transmitted from person to person by droplet infection . The result is usually a rather mild pneumonia. It can also cause inflammation of the sinuses (sinusitis), throat ( pharyngitis ) and bronchi ( bronchitis ) may occur. In principle, all symptoms can occur that are also caused by an infection with C. psittaci . The infection leads to the formation of antibodies, which can be detected for a long time. This does not result in longer lasting immunity .

Other diseases caused by chlamydia

In sheep and goats the pathogen causes Chlamydophila abortus the enzootic abortion . It is a zoonosis , human infection by animals is possible.

Chlamydophila felis is the bacterial pathogen that causes cat flu , more precisely feline chlamydiosis , which is transmitted to humans in individual cases.

Simkania negevensis is abacterial species discoveredin Israel in1999, which does not belong to the Chlamydiaceae family, but tothe Chlamydiales order and is therefore also counted among the Chlamydia from a medical point of view. The pathogen also occurs in respiratory infections in children and causes community-acquired pneumonia in adults. The pathogen has already been detected in Germany.

literature

  • Herbert Hof, Rüdiger Dörries: Dual Series: Medical Microbiology . 3. Edition. Thieme Verlag, Stuttgart 2005, ISBN 978-3-13-125313-2 .
  • Helmut Hahn, Stefan HE Kaufmann, Thomas F. Schulz, Sebastian Suerbaum (eds.): Medical microbiology and infectiology . 6th edition. Springer Verlag, Heidelberg 2008, ISBN 978-3-540-46359-7 .
  • David M. Ojcius, Toni Darville, Patrik M. Bavoil: The secret plague . In: Spektrum der Wissenschaft , No. 2, February 2006, pp. 28–35.

Web links

Individual evidence

  1. ↑ a b c d e f g h i j k Chlamydia infections in Germany (Epidemiological Bulletin 46/2013). In: Website Epidemiological Bulletin. November 18, 2013, accessed November 23, 2013 .
  2. ↑ a b c d e f g h i j k l Herbert Hof, Rüdiger Dörries: Dual series: Medical microbiology . 3. Edition. Thieme Verlag, Stuttgart 2005, ISBN 978-3-13-125313-2 , p. 447-451 .
  3. ↑ Priority eye diseases: trachoma. In: WHO website. Retrieved November 23, 2013 .
  4. ↑ a b c d e f g h i j Chlamydioses (Part 1): Diseases caused by Chlamydia trachomatis - RKI guide for doctors. (No longer available online.) In: Website of the Robert Koch Institute (RKI). December 21, 2010, archived from the original on December 6, 2013 ; Retrieved November 23, 2013 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.rki.de
  5. ↑ Prevalence and incidence of selected sexually transmitted infections. In: World Health Organization (WHO) website . WHO, Department of Reproductive Health and Research, 2011, accessed November 23, 2013 .
  6. ↑ The Secret Epidemic: Chlamydia Spreads Among Teenagers. In: Welt Online . January 22, 2007, accessed November 23, 2013 .
  7. ↑ Sexually transmitted diseases: Germany's dermatologists are sounding the alarm. (No longer available online.) In: kma-online. April 29, 2013, formerly in the original ; Retrieved November 23, 2013 .  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. @1@ 2Template: Dead Link / www.kma-online.de  
  8. ↑ a b c d ECDC: Epidemiological Annual Report 2012 with data for 2010 and 2011 (in English). (PDF; 10.0 MB) In: ECDC website . Retrieved November 20, 2013 .
  9. ↑ Six years of STD sentinel surveillance in Germany - facts and figures (Epidemiologisches Bulletin 03/2010). In: Website Epidemiological Bulletin. January 25, 2010, accessed November 23, 2013 .
  10. ↑ N. Low, M. Egger et al. a .: Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: the Uppsala Women's Cohort Study. In: Sexually Transmitted Infections . Volume 82, Number 3, June 2006, pp. 212-218, ISSN  1368-4973 . doi: 10.1136 / sti.2005.017186 . PMID 16731670 . PMC 2576723 (free full text).
  11. ↑ Sexually transmitted diseases: gonorrhea and chlamydia in men who have sex with men - lack of screening prevents detection (Epidemiological Bulletin 09/2006). In: Website Epidemiological Bulletin . March 3, 2006, accessed November 23, 2013 .
  12. ↑ Chlamydia Info. Retrieved November 23, 2013 .
  13. ↑ a b c d e Chlamydioses (Part 2): Diseases caused by Chlamydophila psittaci, Chlamydophila pneumoniae and Simkania negevensis - RKI guide for doctors. (No longer available online.) In: Website of the Robert Koch Institute. March 8, 2010, archived from the original on November 15, 2013 ; Retrieved November 24, 2013 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.rki.de
  14. ↑ Text of the Infection Protection Act (IfSG) at juris. Retrieved November 19, 2013.
  15. ↑ Text of the ordinance on notifiable animal diseases (TKrMeldpflV) 1983 at juris. Retrieved November 24, 2013.
  16. ↑ TRBA (Technical Rules for Biological Agents) 466: Classification of prokaryotes (Bacteria and Archaea) into risk groups. In: Website of the Federal Institute for Occupational Safety and Health (BAuA). April 25, 2012. Retrieved November 17, 2013 .
  17. ↑ JC Hartley, S. Stevenson et al. a .: Conjunctivitis due to Chlamydophila felis (Chlamydia psittaci feline pneumonitis agent) acquired from a cat: case report with molecular characterization of isolates from the patient and cat. In: Journal of Infection . Volume 43, Number 1, July 2001, pp. 7-11, ISSN  0163-4453 . doi: 10.1053 / jinf.2001.0845 . PMID 11597148 .