Chlamydia trachomatis infections in neonates and young children

In 1911, Lindner and colleagues identified intracytoplasmic inclusions in infants with a nongonococcal form of ophthalmia neonatorum called inclusion conjunctivitis of the newborn (ICN). Mothers of affected infants were found to have inclusions in their cervical epithelial cells, fathers of such infants had inclusions in their urethral cells, and the epidemiology of sexually transmitted chlamydial infections was revealed. Fifty years later, chlamydial isolation procedures were developed, and studies again demonstrated Chlamydia trachomatis as an etiology of ICN and the female birth canal as the reservoir. In the late 1970s, a report by Beem and Saxon described respiratory tract colonization and a distinct pneumonia syndrome in infected infants. Genital chlamydial infection is recognized as the world's most common sexually transmitted disease, with estimates of greater than 4 million new infections occurring annually in the United States. Although most C. trachomatis infections in men and women are asymptomatic, infection can lead to severe reproductive complications in women. The high prevalence in women of child-bearing age results in exposure of an estimated 100,000 neonates in the United States annually. Many of these infants develop conjunctivitis, pneumonia, or both in the first few months of life. Clinical features, diagnosis, treatment, and approaches to prevention of conjunctivitis and pneumonia in the newborn and young infant are reviewed here. Appropriate testing for chlamydial infection in a pediatric victim of sexual assault and the implications of identifying C. trachomatis in suspected cases of childhood sexual abuse also are reviewed.     

Chlamydia trachomatis infections in children

Based of literature data, the authors present informations on epidemiology, pathogenesis, clinical picture, diagnostics and treatment of Chlamydia trachomatis urogenital infections in children.     

Chlamydia trachomatis infections: a health problem of infants

As a result of chlamydia epidemic in the adult population, the incidence of Chlamydia trachomatis in infants is increasing. Certain population groups are at risk for development of an infection. This article discusses the epidemiology, microbiology, symptomatology, and management of this problem.     

Delayed appearance of Chlamydia trachomatis infections acquired at birth

To determine the delay in detectability of Chlamydia trachomatis infections acquired at birth, we serially evaluated 120 infants born vaginally to infected women. Specimens for isolation of Chlamydia were taken from several anatomic sites. Results were analyzed for the age and site of the initial positive culture from each infant. Of 112 infants tested in the first month of life, 22% were culture-positive in the conjunctiva and 25% were positive in the pharynx. Initial positive rectal and vaginal cultures were obtained only in the third and fourth months of life, and all initial vaginal cultures were associated with positive rectal cultures. The latency of C. trachomatis in infants exposed at birth is often more than 1 month and can be longer than 97 days. This latency might be caused by suppression of the growth of the organism by antibodies acquired in utero.     

Role of Chlamydia trachomatis in male urogenital infections and its complications

Based on a literature review, the authors present data on the epidemiology, pathogenesis, clinical picture, diagnostics and treatment of Chlamydia trachomatis urogenital infections and its complications in males.     

Chlamydia trachomatis conjunctivitis in the newborn]

Infections of the conjunctiva are frequent in the neonatal period. While Neisseria gonorrhoea and chemical agents were considered as the main etiologies of ophtalmiae neonatorum in the past, Chlamydia trachomatis is today a major cause of neonatal conjunctivitis. Thus in a study of 180 uni-or bilateral neonatal conjunctivitis the authors found a prevalence of Chlamydia trachomatis infection of 41%. The importance of the etiological diagnosis of neonatal conjunctivitis is emphasized, in order to define a specific treatment. Etiological diagnosis of Chlamydia trachomatis infection is based upon immunofluorescence and molecular diagnosis techniques (PCR, LCR). Prevention of neonatal Chlamydia trachomatis conjunctivitis relies upon screening and treatment of Chlamydia trachomatis infections in pregnant women and their partners. Treatment requires oral macrolides, the topical treatment being ineffective.     

Clinical predictors of Chlamydia trachomatis endocervicitis in adolescent women. Looking for the right combination

Chlamydial disease in adolescent women is a serious public health problem, but secondary preventive efforts through early detection and treatment are encumbered by the cost and complexity of mass screening. This study was undertaken to identify clinical predictors of infection that might narrow the scope of screening adolescent populations. Demographic/clinical data and endocervical smears for the direct-specimen fluorescein-conjugated monoclonal antibody test for Chlamydia trachomatis were collected from 244 consecutive women, 21 years of age or less, attending an adolescent health clinic. Positive direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results were associated with a past history of chlamydial infection, multiple sexual partners, sexual contact with men with urethritis, nonuse of condoms, metrorrhagia, exocervicitis, mucopurulent endocervical discharge, abnormal cervical cytologic features, and isolation of Neisseria gonorrhoeae from the endocervix. These variables were entered into a discriminant analysis to predict direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results. The discriminant function was statistically significant but explained only 17% of between-group variance. Two variables alone, exocervicitis and partners with urethritis, correctly predicted direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results in 79% of all cases (negative predictive value 90%; positive predictive value 35%). When routine screening with reliable laboratory tests is not feasible, selective testing or empirical treatment of adolescent women with either risk factor may be cost-effective alternatives.     

Direct fluorescent monoclonal antibody stain for rapid detection of infant Chlamydia trachomatis infections

A method of direct fluorescent antibody staining for rapid diagnosis of Chlamydia trachomatis infections in infants is described. This method utilized a fluorescein-conjugated species-specific monoclonal antibody to C trachomatis for detecting chlamydial elementary bodies in smears of the conjunctiva, nasopharynx, oropharynx, anus, and vagina. The sensitivity of direct fluorescent antibody staining was compared with isolation of the organisms in McCoy cells. Thirty-nine infants with purulent conjunctivitis were studied. Diagnosis of C trachomatis conjunctivitis was correctly made by smear in all 16 infants when inflamed eyes were sampled. Positive smears were obtained from 12/14 culture-positive and 4/16 culture-negative nasopharyngeal specimens from infants with chlamydial conjunctivitis. All nasopharyngeal cultures and smears from infants with nonchlamydial conjunctivitis were negative. These results indicate that the direct smear test is a sensitive and specific test for diagnosing C trachomatis infection of the eye and nasopharynx in infants, and this test can be completed within one hour of specimen collection.     

Burden and determinants of undernutrition among young pregnant women in Ethiopia

Undernutrition is a major public health concern due to its association with the mortality and disease burden of women and children. This study aimed at identifying the extent and determinants of undernutrition among young pregnant women in Ethiopia. A multivariable regression analysis was fitted to identify determinants of undernutrition and anaemia in a sample of 1,393 pregnant women. Risk ratios (RRs) with 95% confidence interval (CI) were estimated. All the analyses were performed using STATA version 14 and adjusted for clustering. The study revealed that 38% of the women were undernourished and 22% were anaemic. Improved maternal education, RR = 0.94, 95% CI [0.89, 0.98]; higher wealth status, RR = 0.72, 95% CI [0.47, 0.95]; higher minimum dietary diversity for women, RR = 0.87, 95% CI [0.77, 0.98]; increased maternal height, RR = 0.96, 95% CI [0.94, 0.98]; and protected water source, RR = 0.93, 95% CI [0.86, 0.96], have decreased the risk of undernutrition while using unimproved toilet, RR = 1.31, 95% CI [1.06, 1.63], and depression, RR = 1.33, 95% CI [1.14, 1.55], increased the risk of anaemia. Animal source food consumption decreased both the risk of undernutrition, RR = 0.85, 95% CI [0.77, 0.94], and anaemia, RR = 0.91, 95% CI [0.85, 0.95]. The burden of undernutrition is still high. Although improved socio‐economic status and dietary practices decreased the risk of undernutrition, poor health and environmental conditions were still significant risk factors. These findings suggest the need to target this set of important determinants to significantly decrease the burden of undernutrition among young pregnant women.     

婴幼儿沙眼衣原体肺炎的诊治体会

目的应用PCR法诊断婴幼儿沙眼衣原体(CT)肺炎并探讨不同年龄阶段婴幼儿CT肺炎的临床特点。方法将2007年1月-2009年4月收治的986例0～3岁婴幼儿肺炎作为研究对象,根据年龄分组,对各组婴幼儿均通过咽拭子获取标本,进行CT-DNA测定;总结分析CT-DNA阳性病例。结果986例标本中,CT-DNA阳性64例;其中小婴儿CT肺炎往往无发热,常伴有结膜炎是其特征,而X线多表现为支气管肺炎,其临床表现无特异性。结论CT是婴幼儿肺炎的病原体之一;CT肺炎在3个月内婴幼儿检出率最高;PCR法是检测CT-DNA可靠快捷的方法;大环内酯类抗生素治疗CT肺炎疗效确切。     

Illnesses in infants born to women with Chlamydia trachomatis infection. A prospective study

Chlamydia trachomatis is known to cause infant pneumonitis and conjunctivitis and is a suspected cause of otitis media and gastroenteritis. To identify infections associated with exposure to C trachomatis, infant illnesses were studied through a "blinded" review of medical records of 244 infants born to women cultured antenatally for cervical C trachomatis, 25% of whom had C trachomatis-positive cultures. Compared with unexposed infants, infants exposed to C trachomatis had twice the rate of both pneumonitis and recurrent otitis media in the first six months. Infants who were exposed to C trachomatis and who had pneumonitis had higher subsequent rates of gastroenteritis than either unexposed infants or exposed infants without pneumonitis. These results suggest that appreciable outpatient infant morbidity may be associated with maternal infection with C trachomatis, and that it may either cause or promote the occurrence of early, recurrent otitis media and gastroenteritis.