M2-C3-L17 --> Chlamydia

Front 1

Chlamydia Classification

- order
- family
- genera containing pathogens x2

Back 1

- Chlamydiales

- Chlamydiaceae

- Chlamydia
- Chlamydophila

Hint 1

Chlamydia

O - Alice
F - See A
G - Fella

Front 2

What is the pathogenic species from the genera Chlamydia?

Back 2

Chlamydia Trachomatis

Hint 2

"Chlamy...T...a"

Front 3

What is the pathogenic species from the genera Chlamydiaphila? x2

Back 3

Chlamydophila

- Psittaci

- Pneumoniae

Hint 3

chlamydo....P....hila

Front 4

The term "Chlamys" comes from the histological appearance meaning what?

Back 4

"draped around the shoulder"

Front 5

Chlamydia is what Type of parasite depending on its growth/replication location & O2 requirement?

Back 5

Obligate Intracellular Parasite

Front 6

Chlamydia pathogen

- Size?
- Clinical relevance

Back 6

- Small

- Passes through Filtration method even with a 45 micrometer filter

Front 7

Chlamydia stains how?

Back 7

Gram NEGATIVE

Front 8

Chlamydia has what 2 types of morphological forms?

Back 8

- EB (Elementary body)

- RB (Reticulate body)

Hint 8

Chlamydia's morphological form can be determined at the ER

"Chlamydia is SIMPLE, yet MESHY"

Front 9

Which morphological form is the infectious one, & what is the clinical relevance?

Back 9

EB only

EB is the type of FORM that lives OUTSIDE the cell to infect another cell. Then replicate inside

Front 10

Elementary body (EB)

- size comparison to RB?
- durability to environmental factors?

Back 10

- Small : ~300nm - ~400nm

(RB is ~800nm - 1000nm in size)

- EB is VERY RESISTANT to harsh environmental factors

(much like a spore)

Front 11

Compared to most bacteria, EB's outer membrane is unique because it....

- NOT have what?
- Has what to compensate?

- how does it help it survive?

Back 11

NO Peptidoglycan layer

Extensive
DISULFIDE CROSSLINKING
btw cysteine residues

Disulfide Crosslinks = Protection from osmotic pressure, so don't need PG

Front 12

EB outer membrane has an extensive disulfide crosslink. What is the name of the protein that forms this crosslink?

Back 12

Outer membrane protein 2

Front 13

If EB is the infectious form, then the RB (or Initial Body - IB) is?

Back 13

- Replicative form

Front 14

Differences btw EB vs. RB

- function in lifecycle
- metabolic activity

Back 14

EB
- infectious form
- metabolically INERT (spore-like)

RB
- replicative form (intracellularly)
- metabolically ACTIVE

Front 15

Discuss the outer membrane of the RB in comparison to EB.

This implies what about its status?

Back 15

Reduction of Disulfide bonds

(membrane proteins are NO longer crosslinked)

Osmotically FRAGILE

Front 16

Which Chlamydia form is called the Energy Parasite and why?

Back 16

RB

b/c Requires Host-Derived ATP (energy)

Front 17

Describe the Growth cycle of Chlamydia.

- 8 steps

Back 17

1. EB enters cell via ENDOCYTOSIS

2. After EB internalizes, it PERSISTS inside endosome
(aka-Cytoplasmic PHAGOSOMES)

3. While in the Endosome, EB will INHIBIT Phago-Lysosomal Fusion

4. EB will CHANGE in to RB (after 8 hrs) while still in the endosome/phagosome

5. RB REPLICATES by binary fission

6. Replication causes ASSEMBLY & ACCUMULATION of many INCLUSION BODIES inside the phagosome

7. Once persistent infection established, RB will STOP Replicating & CHANGE Back into EB (18-24 hrs later)

8. Cell EXOCYTOSIS/RUPTURE, thus releasing 100 - 1000 EB units
(48 - 72 hrs)

Hint 17

EPIC

RACE

Front 18

In order to stop the digestion of itself, Chlamydia Trachoma....

- does what?
- where?
- then what?

Back 18

Inhibit Phago-Lysosomal Fusion

Inside the Phagosome/Endosome

Changes to RB for replication

Front 19

While inside the phagosome/endosome, C. trachoma will at what time....

- Change into RB
- Change back in to EB
- Exocytose/rupture out of the cell releasing 100 - 1000 infectious EB units.

Back 19

- 8 hours

- 18 - 24 hours

- 48 - 72 hours

Hint 19

Trachoma has 8 letters

3 events so just multiple previous hr by 3

Front 20

What is a BIOVAR?

Back 20

Prokaryotic strain with different BCHM and/or Physiological characteristic

yet are of the SAME SPECIES

Front 21

What are the 2 HUMAN Biovars for C. Trachomatis?

Back 21

1. Trachoma

2. LGV
(LymphoGranuloma Venereum)

Front 22

C. Trachomatis biovar, Trachoma

- infects what cell types?
- infecting what type of tissues?
- infecting what type of areas? x6

Back 22

- NON-ciliated Epithelial cells
on
- Mucous membranes
of the
- Urethra (not uterus!!!!)
- Fallopian tubes
- Cervix
- AnoRectum
- Respiratory Tract
- Conjunctiva

Hint 22

Infection areas are a NE-Mesis to the UFC ARC

Front 23

C. Trachomatis biovar, LGV

- stands for?
- can also replicate inside what cells
- ... of what body system?

Back 23

- LymphoGranuloma Venereum

- Mononuclear Phagocytes

- Lymphatic system

Front 24

C. trachomatis causes what generalized symptoms?

Back 24

- Ocular / Eye infections
- Genitals / Sex organ infections
- Pneumonia (Lungs infections)
- LGV

Hint 24

ESL

LGV

Front 25

Describe the Pathogenesis options the C. trichomatis has after internalizing inside the host cell.

(also include whether it is in EB or RB form)

Back 25

1. DIRECT destruction of host cell during replication & lyse. (RB)

2. Establishment of persistent/LATENT infection (EB)

Front 26

For C. trachomatis, what would be the cause for the organism going into latent stage?

Back 26

Unfavorable conditions cause development of EB form (non-replicating form)

- Antibody presence
- IFN-gamma
- Deprivation Nutrient

Front 27

For C. trichomatis, describe the duration of infection

Back 27

Can last many months and spontaneously clear

or Direct destruction

Front 28

For C. trichomatis, describe the host's inflammatory immune response with infection, including the consequences.

Back 28

NO long lasting immunity or partial immunological protection
allows for
RE-Infection AND Chronic inflammation

Front 29

For C. trichomatis, Reinfection will induce the host's inflammatory immune system to do what?

What is the end result of this response?

Back 29

VIGOROUS inflammatory response
(potent inducer of IFN-gamma & IL-1)

subsequent TISSUE DAMAGE
(SCARRING)

Front 30

T/F : Chlamydia has a vaccine

Back 30

False

Front 31

Trachoma Biovar

- # of serotypes
- epidemiology x3

Back 31

Leading cause of

- BLINDNESS in developing nations
- Clamydial GENITAL infections
- STD in western world

Hint 31

bcs

Front 32

LGV Biovar

- # of serotypes

Back 32

FIVE

- L1, L2, L2a, L2b, L3

Front 33

Why is it so challenging to ID & Tx infected individuals before irreversible tissue damage occurs?

Back 33

B/c patients are ASYMPTOMATIC

Front 34

Chlamydia Epidemiology

- Highest infection rate in US?
- Louisiana?

Back 34

- Alaska
(Mississippi is #2)

- #7

Front 35

Chlamydia Epidemiology

- Highest incidence rate for gender
- for age group?

Back 35

- women

- 15 - 24

Front 36

List the clinical Dz caused by Trachoma biovar. x5

Back 36

4. Trachoma
5. Adult Inclusion Conjunctivitis
2. Neonatal Conjunctivitis

3. Infant Pneumonia
1. Urogenital infections

Hint 36

TAN UP

Adult I(c)
Neonatal C
Infant P

Front 37

List the clinical Dz caused by LGV biovar.

Back 37

LGV

Front 38

Trachoma Biovar of Serotype A - C

- causes what Dz?
- Dz aka?
- Epidemiology for blindness
- Predominantly occurs in?

Back 38

Trachoma

Chronic Keratoconjunctivitis

Leading cause of PREVENTABLE blindness
#2 Cause of Blindness (behind cataracts)

Children in Endemic areas
(reduced in older kids, but increases again as Dz progresses)

Front 39

Trachoma Dz

- Transmitted how? x6
- what promotes transmission?

Back 39

- hand
- eye to eye droplets
- respiratory droplets
- fecal contamination
- fomites
- flies

Poor sanitation, hygeine, & crowded conditions

Hint 39

her fff

Front 40

Trachoma Dz Progression

- What happens initially x2
- leading to?

- Then what follows?
- leading to?

- Overtime, what leads to blindness? x3

Back 40

1. Chronic Follicular Conjunctivitis
2. Diffuse inflammation involving the ENTIRE conjunctiva

- Scarring of conjunctiva

1. Eyelids turn inward (TRICHIASIS)

- Corneal abrasion

Corneal scarring
Ulceration
Pannus formation

Front 41

Adult inclusion conjunctivitis

- serotypes?
- transmission how?
- transmission vehicles?

- Associated with what symptoms?

Back 41

- A,B, D - K

- STD
- Autoinnoculation w/ genital secretions
OR Direct inoculation by infected partner

- Genital infection that PRECEDE eye involvement

Front 42

Adult inclusion conjunctivitis symptoms? x4

Back 42

- Mucopurulent discharge
- Occasional corneal vascularization
- Corneal infiltrates
- Keratitis

Hint 42

MOCK

Front 43

Adult inclusion conjunctivitis prognosis?

Back 43

Corneal scarring may occur in chronic infections

BUT infections usually resolve without complications

Front 44

Urogenital Infections

- serotypes?
- occurs mostly in?
- symptoms?
- severity of consequences?

Back 44

- Trachoma Biovar D - K

- Women

- Asymptomatic

- Serious consequences

Front 45

What is Trichiasis?

What Dz is it associated with?

Back 45

Eyelids turn inward

Trachoma

Hint 45

Trac-tion of eye turns it inward in Trach-oma

Front 46

Urogenital Infections in women

- Risks x3

Back 46

- sexual intercourse 30% higher than men

- younger age increase risk
(cervix not fully mature?)

- chlamydia infected women are 5x's more likely to be infected with HIV if exposed

Front 47

Urogenital Infections in women

- Infections usually begin where?

- spread to where?

Back 47

Cervix and/or Urethra

ASCENDS to: (if untreated)

- Fallopian tubes
- Uterus

Front 48

Urogenital Infections in women

- Symptomatic infection characterized by? x2

- occurs when?

- resulting Sx? x3

Back 48

- Mucopurulent discharge
- Hypertrophic ectopy

- 1 to 3 wks after infection

- Post-Coital bleed
- Abnormal menstrual bleed
- Dysuria

Hint 48

HE MD

PAD

Front 49

Urogenital Infections in women

- Untreated/Undertreated infections progressing to where?

- resulting Dz

- why bad?

- Sx x3

Back 49

- uterus/fallopian tubes lead to?

- PID

- Irreversible tissue/organ damage

- Infertility
- Chronic pelvic pain
- Ectopic pregnancy

Hint 49

ICE needed for the Pelvis In Disease

Front 50

Urogenital Infections in women

- Ectopic pregnancy occurs b/c of?

- what % of ectopic pregnancies are due to C. trachomatis?

Back 50

Salpingitis
(inflammation of fallopian tubes)

1/3

Front 51

Urogenital Infections in women

- infection during pregnancy can result in? x5

Back 51

- preterm labor
- premature rupture of membranes
- post-partum endometriosis

- Low birth weight
- Neonatal Death

Front 52

Urogenital Infections in women

- C. trachomatis EB's prefer to infect what cells in the cervix?

- problem with this?

Back 52

Columnar epithelial cells of cervix

causes little to no clinical symptoms

Front 53

Neonatal conjunctivitis

- serotype?
- aka
- acquired how?

Back 53

- Trachoma Biovar D - K

- (ophthalmia neonatorum )

- passage thru birth canal thats infected

Front 54

Neonatal conjunctivitis

- what % of exposed newborns develop conjunctivitis?

- Eye infection develops when?

- Prognosis?

- Untreated INFANTS are at increased risk of?

Back 54

25% to 50%

5 to 12 days after birth

Self-Limiting
Spontaneous resolution in 3 - 12 mo.

Pneumonia

Front 55

Infant Pneumonia

- 10 to 20% of exposed newborns will develop what type of pneumonia?

- Onset when usually?

- Characterized by?

Back 55

- Diffuse Interstitial Pneumonia

- 2 to 3 weeks after birth

- Afeb &
- Rhinitis
- Staccato cough

Front 56

Urogenital infections in Men

- What % is Asymptomatic?
- Responsible for what % of nongonococcal urethritis?

- Symptoms?
- Sx develops when?
- Dual infection with what is common?

Back 56

- 25 - 50% asymptomatic
- 35 - 50% of nongonococcal urethritis

- Less purulent (almost clear) Discharge
- Dysuria
- Pyuria

- 1 to 3 wks post infection

- N. gonorrohoeae

Front 57

Urogenital infections in Men

- infected men have what attached to sperm?

- associated with what syndrome?

Back 57

EB

Reiters

Front 58

Reiter's syndrome has what hereditary factor associated?

What % of patients has it?

What % of patients has chlamydial infection?

Back 58

HLA - B27

80%

50 - 60%

Front 59

Urogenital infections in Men

- progression associated Dz? X3

Back 59

- Proctitis (usually symptomatic)
- Urethritis (Non-gonococcal)
- Reiter's
- Epididymitis

Hint 59

MEN get it PURE

Front 60

Urogenital infections in Women

- progression associated Dz? X3

Back 60

- PID

- Infertility

- Ectopic pregnancy

Hint 60

Women's PIE hole progressive worse.

Front 61

LGV

- transmitted how?
- Acute form affects which gender
- why so?

Back 61

STD

Men

Symptomatic infection LESS in Women

Front 62

LGV

- Reservoir in the US?

- emerging dz has led to new dz variant where?

Back 62

- Homo dudes

- Amsterdam (L2b)

Front 63

LGV

- systemic Sx

Back 63

- Fever , HA , Malaise
- Arthralgia , Myalgia,
- Anorexia , Meningismus,

Front 64

T/F : LGV more invasive than Dz caused by urogenital serovars (D-K)

Back 64

True

Front 65

LGV manifests as? x2 syndromes

- include associated symptoms

Back 65

Anogenitorectal syndrome

- Protocolitis
- Intestinal hyperplasia
- Perirectal lymphatic hyperplasia


Inguinal syndrome

- Buboes (inguinal lymphadenopathy)
- Ulcerations of genitals
- Supparation

Hint 65

LGV --> A PIP , IN BUS

Front 66

Which LGV associated Syndrome is common in women?

- spread how? x2

Back 66

Anogenitorectal Syndrome

- anal intercourse
- lymphatic spread from urethra

Front 67

LGV stages x3

Back 67

1. PAINLESS primary lesion of sexual organs/area
(1-4 wks after infection)

2. Inflammation / swelling of Lymph nodes draining site of infection

3. Chronic Ulcerative phase

Front 68

LGV 's 3 stages

- if left UNtreated, what stage occurs?

- in stage 2, lymph nodes become?
- what can happen from this?

- in stage 2, which lymph node most affected?

Back 68

stage 3

PAINFUL Buboes
- can rupture into draining fistulas

Inguinal lymph node

Hint 68

LGV camera at the big stage took good PICs

Pain-LESS
Inflammation --> Pain-FULL Buboes
Chronic ulceration

Front 69

What is a Buboes?

In LGV, seen in what stage usually?

Pain?

Back 69

Inguinal Lymphadenopathy

Stage 2

YES!!!!!!!!!

Front 70

LGV Stage 3 involves development of?

Back 70

Genital
- Fistulas
- Ulcers
- Strictures
- Elephantitis

Hint 70

FUSE

Front 71

LGV can occur where besides the genital area?

- indicated in what Dz
- Sx?

Back 71

Ocular LGV

Perinaud's oculogranuloma conjunctivitis

Conjunctival inflammation
- with nearby swollen lymph nodes

Front 72

LAB DIAGNOSIS

- specimen from? & NOT from?

- specimen cell type should be

- specimen is INADEQUATE if from?

Back 72

- tissue specimen from EndoCervix
- Vagina

- Columnar epithelium cells

- Pus or Exudate

-

Front 73

LAB DIAGNOSIS

- what are the methods? x5

Back 73

Cytology

Serology

Culture

Antigenic detection

Nucleic acid based test

Hint 73

SCAN CYTe (site)

Front 74

LAB DIAGNOSIS : Cytology

- examine what?

- look for what?

- PROBLEM? x2

Back 74

- Giemsa stained cell scrapings

- Look for INCLUSIONS

PROBLEMS:
- Insensitive
- NOT recommended

Front 75

LAB DIAGNOSIS

What is the GOLD standard?

Back 75

Nucleic acid based Test
- molecular probes

Front 76

LAB DIAGNOSIS : Culture

- advantage?

- disadvantage?

- problem is that detection compromised during?

Back 76

- MOST SPECIFIC

- only 70% Sensitive

- specimen manipulation / transport

Front 77

LAB DIAGNOSIS : Culture

- looks for what?

Back 77

Inclusion bodies
- Iodine stained

MOMP or LPS
- Fluorescent

Front 78

LAB DIAGNOSIS : Antigen Detection

- technique? x2
- look for what?

- Problem?

Back 78

- Direct immunofluorescence
- ELISA

- Antibody to detect LPS or MOMP

- Low bacterial load in male urethral samples & asymptomatics
- LPS may be shared with other bacteria

Front 79

LAB DIAGNOSIS : Serology

- value?

- why or why not? x2

Back 79

LIMITED

- Antibody titers do NOT distinguish current or past infections.

- IgM often are NOT produced

Front 80

LAB DIAGNOSIS: Serology

- is there any exception to a good serology test being worthwhile?

- explain

- THUS, Serology is helpful in?
- why?

Back 80

Yes

Most patients do NOT produce IgM antibodies, EXCEPT for ...
- INFANTS with Chlamydial Pneumonia

LGV diagnosis in INFANTS
- Infants produce vigorous Ab response