Study on vertical transmission of Chlamydia trachomatis using PCR and DNA sequencing

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宫颈沙眼衣原体感染

妇女衣原体筛查的指征 终止妊娠前年龄小于25岁，尤其那些性活跃的青春期少年；性伴侣超过1个；宫颈质地脆、同房后或月经间期出血高危组妇女放置宫内节育器前无并发症的官颈衣原体感染的处理 强力霉素100mg 1日2次，服用1周 告知性伴侣双方治疗后才能同房 考虑转诊到生殖泌尿专科门诊     

沙眼衣原体与泌尿生殖道感染

目的：了解沙眼衣原体在泌尿生殖道感染的情况。方法：采用ELISA法检测患者血清中的IgM抗体。结果：130例患者检出沙眼衣原体总阳性率为30．00％,其中男25．56％,女40．00％。结论：沙眼衣原体是泌尿生殖道感染的重要病原菌,应注意检查与防治。     

Progress in genotyping of Chlamydia trachomatis

Objective To review the common genotyping techniques of Chlamydia trachomatis in terms of their principles,characteristics,applications and limitations.Data sources Data used in this review were mainly from English literatures of PubMed database.The search terms were ＂Chlamydia trachomatis＂ and ＂genotyping＂.Meanwhile,data from World Health Organization were also cited.Study selection Original articles and reviews relevant to present review＇s theme were selected.Results Different genotyping techniques were applied on different occasions according to their characteristics,especially in epidemiological studies worldwide,which pushed the study of Chlamydia trachomatis forward greatly.In addition,summaries of some epidemiological studies by genotyping were also included in this work for reference and comparison.Conclusions A clear understanding of common genotyping techniques could be helpful to genotype C.trachomatis more appropriately and effectively.Furthermore,more studies on the association of genotypes of Ch/amydia trachomatis with clinical manifestations should be performed.     

Chlamydia trachomatis Infection and Photosensitive Dermatoses

Background

Photosensitivity to Chlamydia trachomatis has been described in almost 50% of chronic cases of lymphogranuloma venereum (LGV) caused by L1, L2 or L3 serovars. Photosensitivity in non LGV strains of C trachomatis has not been studied. We studied the association of various photosensitive dermatoses with C trachomatis infection in non LGV cases.

Methods

Sera of all the cases of photosensitivity, melasma, chronic actinic dermatitis (CAD), polymorphic light eruption (PLE), actinic prurigo (AP) and rosacea were tested for the presence of IgM, IgG and IgA antibodies to C trachomatis by ELISA method. The results were compared with 30 healthy controls.

Result

Seventeen (25.53%) of 57 cases of photosensitivity as against two (6.67%) controls were seropositive for IgM/IgG/IgA antibodies, a statistically significant difference (χ² 6.18, p 0.013). Similarly, significantly higher seropositivity was observed in 12 (25.53%) of 47 cases of melasma (χ² 4.38, p 0.0363) and six (46.15%) of 13 cases with CAD (χ² 6.91, p 0.0086). Although higher proportion of patients of rosacea [five (31.25%) of 16 cases] and PLE [four (25.0%) of 16 cases] were seropositive, the difference was not statistically significant (χ² 3.23, p >0.05, OR 6.36, CI 95% 0 to 48 and χ² 3.09, p 0.078, OR 4.67, CI 95% 5 to 41 respectively). There was no association of AP.

Conclusion

The observations suggest that C trachomatis infection in non LGV cases is an important cause of PS, melasma and CAD. It appears to be an important cause of rosacea and PLE. We recommend that all cases of photosensitivity, melasma, CAD, PMLE and rosacea and their spouses/sexual contacts be investigated for C trachomatis infection.Key Words: Photosensitivity, Melasma, Chronic actinic dermatitis, Polymorphic light eruptions, Rosacea, Actinic prurigo, Chlamydia trachomatis     

Chlamydia trachomatis infections in infants.

In recent years considerable progress has been made in understanding chlamydial infections. The spectrum of pediatric Chlamydia trachomatis infection includes neonatal inclusion conjunctivitis, infantile pneumonia, occasional respiratory or genital tract infections in older children and sexually transmitted diseases in adolescents. The role of maternal chlamydial infection in prematurity and in perinatal death is currently an area of active study. We outline the current knowledge of the biologic characteristics of C. trachomatis, the epidemiologic features of chlamydial infection, and the clinical aspects, diagnosis and treatment of neonatal chlamydial infections.     

生殖道沙眼衣原体感染致不育的相关研究

目的探讨生殖道沙眼衣原体感染与不育症的关系。方法对84例不育夫妇的精液及宫颈黏液进行沙眼衣原体PCR检测，并对其及精液常规、免疫学检测等指标进行统计学处理，以探讨其与不育症的关系。结果生殖道沙眼衣原体检出率与不育、精子数、抗精子抗体阳性率呈正相关关系。结论衣原体感染性不育症可能是衣原体对精子发生与成熟的干扰或直接作用，也可能是抗精子抗体使精子不能激活的结果。     

沙眼衣原体抑制宿主细胞凋亡的研究

目的探讨沙眼衣原体D血清型感染对宿主细胞凋亡的影响。方法沙眼衣原体D血清型感染的Hela229细胞经凋亡诱导剂依托泊苷（etoposide）作用后，Hoechst33．258染色、荧光显微镜观察核浓缩和凋亡小体，流式细胞仪检测凋亡率。结果经依托泊苷作用后，未感染的Hela229细胞有凋亡形态学特征，沙眼衣原体感染的Hela229细胞则无明显凋亡形态学改变，两者的凋亡率比较有统计学意义（P〈0．05）。结论沙眼衣原体感染后能抑制诱导剂诱导的宿主细胞凋亡。     

实时荧光定量PCR检测沙眼衣原体的研究

目的 采用TaqMan探针建立检测沙眼衣原体的实时荧光定量PCR(real-time PCR)方法.方法 根据沙眼衣原体外膜蛋白A的基因(ompA)序列设计引物和探针,以克隆的ompA部分基因片段作DNA模板,建立实时荧光定量检测方法.结果 建立的荧光定量PCR检测方法的最低检出限为5 copies/反应,检测线性范围100107线性关系良好(r2=0.997),比巢式PCR敏感100倍;且与鹦鹉热衣原体、淋球菌、解脲脲原体、大肠杆菌等病原菌DNA以及人基因组DNA均无交叉反应,表明该方法具有良好的特异性.以巢式PCR作参比,建立的荧光定量PCR法检测沙眼衣原体的阳性符合率为100.00％,阴性符合率为95.09％,总符合率为96.81％.结论 建立的检测沙眼衣原体实时荧光定量PCR具有特异性强和敏感性高的特点,可快速检测样本中微量沙眼衣原体DNA,适用于对沙眼衣原体进行大规模筛选.     

不同人群泌尿生殖道沙眼衣原体感染的分子流行病学研究

目的研究引起泌尿生殖道感染的沙眼衣原体流行基因型分布和不同人群间感染的差异。方法应用巢式PCR扩增沙眼衣原体omp1基因VS1-VS2序列,利用寡核苷酸芯片技术进行基因分型。结果166株沙眼衣原体感染标本中,通过基因分型共检出182株菌。包括9个基因型,总体优势流行型为E型(27.5%)、F型(22.0%)、D型(14.3%)、J型(15.0%)和H型(8.8%)。113例性病门诊病人中,以F(26.9%)、E(24.3%)、J(16.8%)、D(13.4%)和H(8.4%)型为主,混合型感染率为5.3%(6/113)。而53例卖淫女性标本中,发现混合感染8例(15.1%,8/53),以E(33.3%)、D(15.9%)、F(15.9%)和K(12.7%)型为主,混合感染率为15.1%(8/53)。F型在门诊病人中的流行率显著高于卖淫女性(!2=4.8,P<0.05),而混合型感染率和K型流行率卖淫女性显著高于门诊病人(!2=4.5,P<0.05;!2=7.4,P<0.01)。结论性病门诊患者和卖淫女性沙眼衣原体感染流行血清型存在差异。加强沙眼衣原体感染的分子流行病学研究对于有效控制性病传播有重要意义。     

生殖道沙眼衣原体感染的实验室诊断

沙眼衣原体（Chlamydia trachomatis,CT）感染目前已成为许多国家和地区常见的性传播疾病,其发病率呈明显上升趋势,日益引起人们的重视,检测技术也在不断进步,除了改进各种核酸扩增技术外,国外学者在标本取材上也进行了探索。随着检测技术的进展,CT感染的诊断也会不断地发生变化。     

Chlamydia trachomatis infections--the Royal Women's Hospital experience

During the 18-month period from December 1, 1985 to May 31, 1987 Chlamydia trachomatis was the most-common sexually-transmitted agent to be identified at the Royal Women's Hospital, Melbourne. It was isolated from 4% of all specimens for which such culture was requested and was found five-times more frequently than was Neisseria gonorrhoeae. A review of the clinical presentation and the management of the 100 public patient for this period whose cervical specimens were found to give positive results for the presence of chlamydiae revealed that 77% of the women were less than 25 years of age, 78% of the women were single and 65% of the women were nulliparous. Thirty-five women were asymptomatic carriers of chlamydiae. Of the remaining 65 patients with symptoms, 46% experienced pelvic pain, 39% experienced a vaginal discharge and 26% experienced irregular bleeding. The importance of abnormal bleeding is emphasized. In patients who presented for therapeutic abortions, morbidity occurred in 19% of those who were carriers of Chl. trachomatis; accordingly, screening for chlamydiae as routine is recommended in such patients. Furthermore, because of the risk of pelvic inflammatory disease and its consequences, it is important not only to treat female patients in whom chlamydiae have been isolated, but also to treat and to follow-up their sexual partners simultaneously.     

Chronic Chlamydia trachomatis infections in infants.

OBJECTIVE.--To study the natural history of Chlamydia trachomatis infections in infants. DESIGN.--Bacteriologic and serologic study of an inception cohort. SETTING.--University of Washington Medical Center, Seattle. PARTICIPANTS.--Twenty-two infants with C trachomatis infections either not treated early in life or recurring after antimicrobial treatment. MAIN OUTCOME MEASURES.--Persistence of infection in various anatomic sites, antibody responses to specific serovars (serologic variants) of C trachomatis, and serovars of isolates from mothers and infants. RESULTS.--The cumulative proportion of infants still infected at the age of 1 year was 35%. Infection persisted in the conjunctiva, nasopharynx, and oropharynx in one child for as long as 866 days (28.5 months), when she was cured by treatment. In none of the infants did serologic tests suggest acquisition of infection other than at birth. Isolates of C trachomatis from mothers and their respective infants were always of the same serovar. CONCLUSIONS.--Many infants infected with C trachomatis at birth remain infected for months or years in the absence of specific antimicrobial therapy. Such infections may be confused with those acquired by sexual abuse.     

Incident Chlamydia trachomatis Infections Among Inner-city Adolescent Females

Context.— Adolescents are at highest risk for infection with Chlamydia trachomatis, an important preventable cause of pelvic inflammatory disease and subsequent tubal factor infertility in US women. Current guidelines for delivery of adolescent primary care services recommend yearly chlamydia screening for those adolescent females considered to be at risk. Objectives.— To describe the epidemiology of prevalent and incident chlamydia infection among adolescent females to assess the appropriate interval for chlamydia screening and to define risk factors that would identify adolescent females to target for screening. Design.— Prospective longitudinal study. Patients.— A consecutive sample of 3202 sexually active females 12 through 19 years old making 5360 patient visits over a 33-month period, January 1994 through September 1996. Setting.— Baltimore, Md, family planning, sexually transmitted disease, and school-based clinics. Intervention.— Testing for C trachomatis by polymerase chain reaction. Main Outcome Measures.— Prevalence and incidence of C trachomatis infections; predictors of positive test result for C trachomatis. Results.— Chlamydia infection was found in 771 first visits (24.1%) and 299 repeat visits (13.9%); 933 adolescent females (29.1%) had at least 1 positive test result. Females who were 14 years old had the highest age-specific chlamydia prevalence rate (63 [27.5%] of 229 cases; P=.01). The chlamydia incidence rate was 28.0 cases per 1000 person-months (95% confidence interval, 24.9-31.5 cases). The median time was 7.2 months to a first positive chlamydia test result and 6.3 months to a repeat positive test result among those with repeat visits. Independent predictors of chlamydia infection—reason for clinic visit, clinic type, prior sexually transmitted diseases, multiple or new partners, or inconsistent condom use—failed to identify a subset of adolescent females with the majority of infections. Conclusions.— A high prevalence and incidence of C trachomatis infection were found among adolescent females. We, therefore, recommend screening all sexually active adolescent females for chlamydia infection every 6 months, regardless of symptoms, prior infections, condom use, or multiple partner risks.