[Characteristics of perinatal visceral lesions caused by chlamydia trachomatis]

Twenty-three autoptic cases of perinatal chlamydiasis were analyzed. Its etiology was verified by immunofluorescence technique using monoclonal antibodies. The morphological characteristics of visceral lesions are given. Data on the possible routes of infection and evidence for the development of generalized chlamydiasis are presented. The kidney may be suggested to be the site of pathogen persistence.

Chlamydia during pregnancy: implications and impact on perinatal and neonatal outcomes

Chlamydia is the most prevalent sexually transmitted disease in the United States, with an estimated 3 million cases occurring annually. Untreated Chlamydia can cause severe, costly reproductive and other health problems with both short- and long-term consequences. When Chlamydia coexists with pregnancy, it can have negative consequences for the woman, the pregnancy, and the newborn. Nurses are in important positions to ensure safe health care practices for all pregnant women. Awareness of the perinatal implications and routine screening for Chlamydia in pregnant women will provide safer health care for the mother and her baby.

[Prevalence of Chlamydia trachomatis in newborn infants with respiratory problems]

The prevalence of C. trachomatis in neonates with respiratory distress was studied after 24 h of birth, nine patients were positive for C. trachomatis culture (12.9%). The chest radiographs showed six with hyaline membrane disease and two with pneumonia. One patient with treatment of ventilation mechanics developed bronchopulmonary dysplasia and was C. trachomatis positive in a second cell culture. Of the nine patients with C. trachomatis, eight were neonates preterm with low weight to the birth and with leukocytosis. Six patients were delivered by cesarean section. These results suggest that C. trachomatis can participate in an important way in the development of the distress respiratory in infants preterm.

[The clinico-metabolic characteristics of the course of a chlamydial infection in newborns]

A clinical and laboratory investigation was done in 68 full-term newborn babies, with clinical forms of Chlamydia infection having been identified. There have also been studied cellular and humoral links of immunity, hormonal profile, system of peroxidation, antioxidant defence. In Chlamydia infection in full-term newborns presenting with acute bronchopulmonary pathologies during the acute phase of the illness, signs are noted of activation of processes of free-radical lipid oxidation against the background of retardation of the antioxidant defense, with synthesis of hormones of the thyroidal, hypophyseal and adrenal systems being on the increase. Metabolic changes are directly related to immunologic responsiveness which is characterized by weakness of primary immune response. The degree the above changes make themselves known depend on the clinical form of Chlamydia-associated infection. The identified metabolic changes may be the basis of causative factors for change in capacity of newborn infants with chlamydial infection to adapt.

[Morphological diagnosis of intrauterine chlamydia infection and its clinico-anatomical characteristics]

Clinicomorphological characteristics of intrauterine chlamydiasis (IUC) are given. The authors describe a cottonwool-like meningochorioiditis the observation of which at necropsy allows IUC suspection. Chlamydial etiology of this condition is confirmed by means of electron microscopy and immunofluorescence. Fibroblast proliferation of the pia mater followed by intensive fibrillogenesis plays a most important role in morphogenesis of cottonwool-like nodules. The occurrence of IUC at the necropsies varies depending on the age of foetuses and newborns from 6.2 to 38.7%.

Role of Ureaplasma urealyticum and Chlamydia trachomatis in lung disease in low birth weight infants

Forty four ventilated premature infants from three Neonatal Intensive Care Units around Melbourne were evaluated prospectively for evidence of Ureaplasma urealyticum and Chlamydia trachomatis infection in the respiratory tract. No C. trachomatis was found and this probably reflects the low prevalence of genital carriage in antenatal patients in our population. Nine percent of babes were colonized at birth with Ureaplasma urealyticum and 5% acquired colonization. One child whose mother was bacteremic for ureaplasma, had evidence of persistent respiratory colonization and development of pneumonia at day 16 of life, supporting a role for this organism as a respiratory pathogen. Bronchopulmonary dysplasia (BPD) occurred in 39% of the infants. Ureaplasma carriage correlated significantly with BPD development, as 29% of infants with BPD were ureaplasma positive compared to 4% of those without development of BPD (p = 0.02).

[Chlamydia trachomatis infection in newborn infants]

The aim of our study was to examine the frequency of Chlamydia trachomatis infection in newborns by detecting specific antibodies, and to examine the Apgar score and the birth weight of Chlamydia trachomatis-antibody positive children. Fifty-two newborn infants were tested. High serum IgG chlamydial specific antibody titers had 11 (21%) newborns, while high serum IgM titers had 9 (17%) newborns. Our results showed that serum Chlamydia trachomatis-specific IgM antibodies were detected statistically more often in low birth weight newborns (<2500 g) (p < 0.05).

Immune status of newborns in perinatal chlamydial infection

PROBLEM

Thirty newborns, delivered by mothers with urogenital chlamydiosis, diagnosed on the 35th-36th weeks of gestation, and 10 newborns of healthy mothers were studied immunologically. CD3 (T-lymphocytes), CD19 (B-lymphocytes), CD4 (T-helpers-inductors), CD8 (T-suppressor-cytotoxic), T-lymphocyte response to PHA, levels of Ig G, A, M in umbilical blood were detected.

METHOD

Chlamydia trachomatis antibody's titers in umbilical blood were determined by indirect immunofluorescent method (with antigen C. trachomatis, serovar L2). Antibody titers found in umbilical blood were in 50% of cases higher than antibody level in mother's blood serum, and they later varied from 1:64 to 1:256. It was established that newborns delivered by mothers with urogenital chlamydiosis had imbalance of T-lymphocyte subsets, decrease in the numbers of T- and B- lymphocytes, and increased level of Ig M, while the level of Ig G did not change significantly. The exposed disproportion in immune status neonatal, born from mothers with urogenital chlamydiosis, in combination with high C. trachomatis antibody titers in umbilical blood may be prognostic of the development of neonatal chlamydial infections.

Sexually transmitted diseases in neonates and infants

With the current resurgence of sexually transmitted diseases (STDs), familiarity with the clinical manifestations of STDs in neonates and infants is essential to minimize the tragic consequences. The recognized routes of transmission of the diseases include transplacental, intrapartum, and postpartum exposure. This discussion will be confined to infections caused by syphilis, herpes simplex virus, human papillomavirus, gonorrhea, and chlamydia emphasizing clinical aspects in this population.

Chlamydia trachomatis infection in dizygotic twins delivered by caesarean section

Chlamydia trachomatis was isolated from the conjunctiva, pharynx, and rectum of one 10 day old twin delivered by caesarean section without prior rupture of the chorioamnion and from the pharynx of her brother. The means by which C trachomatis causes such infection is not known.

Perinatal infections with Chlamydia trachomatis

Much has been relearned and learned anew about perinatal chlamydial infections during the past 10 to 15 years. The adverse effects of infection on pregnancy outcome have been suggested but not fully documented or explained. Epidemiologic, biologic, and immunologic correlates of risk for infection and complications of pregnancy due to C. trachomatis are not yet fully understood. Increased appreciation of the importance of this organism in pregnancy, coupled with more facile methods for diagnosing infection and with further research using modern molecular techniques, promises to add greatly to the completeness of our knowledge and to our eventual complete control of this infection in pregnancy.

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.

Prospective study of perinatal transmission of Chlamydia trachomatis

During a five-year period, 262 (4.7%) of 5,531 pregnant women had positive cervical cultures for Chlamydia trachomatis, and 131 of their infants were followed up prospectively to ascertain the outcome of chlamydial exposure during the birth process. Culture-confirmed inclusion conjunctivitis of the newborn was seen in 23 (18%) of the infants. Chlamydial pneumonia was diagnosed in 21 (16%) of the infants at risk. Chlamydia trachomatis was recovered from 47 of the infants (36%), while 79 (60%) showed serologic evidence of infection. Subclinical rectal and vaginal infections were detected in 14% of infants at risk. In our population, 2.8% of newborn infants show serologic evidence of perinatal chlamydial infection and 1.4% develop either chlamydial pneumonia or conjunctivitis. Incidence rates of this magnitude indicate the need for programs aimed at preventing perinatal transmission of C trachomatis.

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.

Intrauterine lung infection with Chlamydia trachomatis in a premature infant

The present study shows the probable intrauterine infection with Chlamydia trachomatis in a premature infant born in the 29th week of gestation. Chlamydiae were isolated from lung tissue collected at sterile autopsy and also demonstrated in sections of such tissue by immunofluorescence tests using monoclonal antibodies.

Maternal and infant sexually transmitted diseases

Sexually transmitted infection may result in serious damage to the reproductive tract of the mother, damage to the fetus, wastage of pregnancy, or illness or death of the infant. The effects of gonorrhea, Chlamydia trachomatis infection, mycoplasmal infections, group B streptococcus infections, syphilis, and viral infections are discussed separately for both mother and infant.

Chlamydia trachomatis and clinical genital infections: a general review

Genital infections caused by Chlamydia trachomatis (immunotypes D to K) are briefly reviewed. Urethritis is not only the most important chlamydial infection in men, but is also the most common sexually transmitted disease. The complication of this form of nongonococcal or postgonococcal urethritis include prostatitis, epididymitis and arthritis. Urethritis and cervicitis are the primary infections in women, and may lead to salpingitis, peritonitis or perihepatitis. Chlamydial infection is transmitted to the infant at birth, causing conjunctivitis or pneumonia. The diagnosis and treatment of genital chlamydial infections are briefly reviewed. Finally, some general recommendations on genital chlamydial infections are presented.