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Evaluar la presencia de IgG contra C. trachomatis en mujeres entre 18 a 30 años con diagnóstico de artritis de la ciudad de Bogotá D.C. Métodos. Los grupos de estudio están compuestos por un grupo de casos AR (mujeres con diagnóstico de artritis reumatoide y reactiva) y un grupo control. Se obtuvieron muestras de suero y se realizó la determinación cuantitativa de IgG contra C. trachomatis, la determinación PCR (proteína C reactiva) y FR (factor reumatoide). Resultados. Las variables de talla y peso descritas en la población de estudio, muestran un comportamiento homogéneo, por lo cual no interfieren en los resultados obtenidos. Las medias se compararon por los test Mann Whitney y t test no pareado. El porcentaje de resultados positivos en la determinación cualitativa de PCR fueron de: 36,6% para el grupo de casos y 14,5% para el grupo control. En la determinación cualitativa de FR el porcentaje de resultados positivos fueron: 48,8% para el grupo de casos y 5,3% para el grupo control. Finalmente, el porcentaje de resultados positivos en la determinación de anticuerpos IgG específicos contra C trachomatis fue de 2,4% para el grupo de casos y 22,4% para el grupo de controles. Las variables de PCR y FR mostraron mayor frecuencia de resultados positivos en el grupo de casos, en comparación con el grupo control, lo cual se correlaciona con la existencia de procesos inflamatorios propios del desarrollo de artritis. Sin embargo el grupo control presentó mayor frecuencia de anticuerpos IgG específicos contra C. trachomatis en comparación con el grupo de casos. Estos resultados hacen necesario evaluar a futuro, el comportamiento de las pacientes del grupo control con resultados positivos de IgG contra C. trichomatis que permitirían observar una posible aparición de síntomas relacionados con artritis.

Chlamydia trachomatis, the leading cause of bacterial sexually transmitted diseases in developed countries, with around 127 million new cases per year, is mainly responsible for urethritis and cervicitis in women, and urethritis and epididymitis in men. Most C. trachomatis infections remain asymptomatic (>50%) and, hence, untreated, leading to severe reproductive complications in both women and men, like infertility. Therefore, the detection of C. trachomatis as well as the antimicrobial susceptibility testing becomes a priority, and, along the years, several methods have been recommended, like cell culture and direct immunofluorescence (DFA) on cell cultures. Herein, we described the application of In-Cell Western assay (ICW) via Odyssey CLx as a fast, more accessible, and high-throughput platform for the quantification of C. trachomatis and the screening of anti-chlamydial drugs. As a first step, we set up a standard curve by infecting cell monolayers with 2-fold serial dilutions of C. trachomatis Elementary Body (EB) suspension. Then, different unknown C. trachomatis EB suspensions were quantified and the chlamydial susceptibility testing to erythromycin was performed, using the DFA as comparison. Our results showed a very high concordance between these two assays, as evidenced by the enumeration of chlamydial IFUs as well as the determination of erythromycin Minimum Inhibitory Concentration (MIC). In conclusion, the ICW assay may be a promising candidate as an accurate and accessible methodology for C. trachomatis antimicrobial susceptibility testing.

Uvod: Infekcija s C.trachomatis ubraja se u najčešće bakterijske spolno prenosive infekcije. Serovari D-K su najčešći uzročnici infekcija koje su većinom asimptomatske ili se mogu očitovati širokim spektrom urogenitalnih bolesti. Serovari L1-L3 uzrokuju limfogranuloma venereum (LGV) koja se sve češće otkriva kod HIV pozitivnih bolesnika u razvijenom svijetu. Bolest se prezentira u 3 stadija: primarna lezija u obliku ulceracije ili erozije, sekundarni stadij kao najčešće ingvinalna limfadenopatija te tercijarni stadij kao fibroza, limfedem i anorektalne strikture. Ovdje ćemo prikazati HIV bolesnika s proktitisom i cervikalnim limfadenitisom iz kojeg je izolirana C.trachomatis. Prikaz bolesnika: Bolesnik u dobi od 48 godina sa otprije poznatom HIV infekcijom se javio u ambulantu zbog perianalne boli i rektalnog sluzavo-krvavog iscjetka koji traju unatrag 10-ak dana bez promjene u konzistenciji stolice. Također je primijetio povećanje limfnog čvora na vratu. Dva tjedna prije početka simptoma je boravio u Berlinu. Prvoga dana bolesti bio je febrilan do 38.5C, kasnije cijelo vrijeme afebrilan. Bez ostalih simptoma. Bolesnik je bio dobrog općeg stanja, u statusu je zamijećen solitaran bolan limfni čvor na vratu promjera 5x2 cm te te perianalna bolnost i žućkasti eksudat. Bolesnik je više godina nemjerljive viremije PCR HIV1 RNA, CD4 2082 na dan pregleda. Empirijski je započeta terapija ceftriaksonom i doksiciklinom uz nastavak ART terapije. Citološkom punkcijom limfnog čvora se dobije supurativna, granulomatozna upala. Uzorak je analiziran i bakteriološki, na BK i C.trachomatis Uzet je analni obrisak na N.gonorrhoeae, HSV te serologija na T.pallidum, Bartonella spp, Tularemiju i Toxoplasmu. Na primjenjenu antimikrobnu terapiju dolazi do regresije simptoma i smanjenja limfnog čvora na vratu. Molekularnom dijagnostikom (NAAT - nucleid acid amplification test) je detektirana C.trachomatis iz limfnog čvora i rektalnog iscjetka, ostali nalazi izolata su bili negativni. Terapija je nastavljena doksiciklinom ukupno 21 dan zbog sumnje na LGV nakon čega dolazi do potpune regresije simptoma. Diskusija: Prikazani bolesnik se prezentirao cervikalnom limfadenopatijom i proktitisom što je, koliko je poznato iz dostupne literature, jedni takav slučaj opisan u našim krajevima. Dijagnostika klamidijskih infekcija se potvrđuje molekularnim testom nukleinske amplifikacije (NAAT), a određivanje serovara se vrši daljnjom molekularnom dijagnostikom u specijaliziranim ustanovama. Klinički možemo pretpostaviti da se kod prikazanog bolesnika radi o LVG, no nažalost nismo uspjeli odrediti serovar. Možemo zaključiti da LGV nije toliko rijetka bolest kako se misli te da na nju treba sumnjati kod svakog bolesnika s proktitisom i limfadenitisom pogotovo ako se radi o HIV pozitivnim bolesnicima.

Chlamydia trachomatis (C.trachomatis) danas je najčešći bakterijski uzročnik spolnoprenosivih bolesti. Uspjeh liječenja ovisi o izboru antimikrobnog lijeka, te je veoma važno poznavati antimikrobnu osjetljivost ovog patogena. Kultivacija u staničnoj kulturi metoda je izbora dijagnostike C.trachomatis, kada se radi o sudsko-medicinskim vještačenjima, kontroli nakon provedene terapije, a služi u svrhu odrđeivanja antimikrobne osjetljivosti C.trachomatis. Tetraciklini, makrolidi i kinoloni uobičajeno se primjenjuju za liječenje infekcije C.trachomatis. Na ove antibiotike opisana je rezistencija kod sojeva izoliranih u neuspješno liječenih bolesnika. Svi do sada opisani izolirani rezistentni klinički sojevi pokazuju tzv. "heterotipnu rezistenciju". Do danas nije opisana "homotipna rezistencija" u izolata izoliranih u ljudi. Procjena antimikrobne rezistencije i ishoda liječenja infekcije C.trachomatis otežana je nedostatkom standardizacije testova kao i činjenicom da in vitro rezistencija ne korelira s kliničkim ishodom. S ciljem stjecanja što više podataka o rezistenciji C.trachomatis preporuča se svaku sumnju u neuspješno liječenje infekcije spolnomokraćnog sustava uzrokovane C.trachomatis potvrditi ili isključiti dijagnostičkom metodom izolacije na staničnoj kulturi te izolirane sojeve proslijediti u specijalizirani laboratorij.

Objective: To determine prevalence of Chlamydia trachomatis (C. trachomatis) in aymptomatic and symptomatic men with genitourinary infection. Sample included 300 male participants (age ranged from 20-69) who approached CNIPH Laboratory for testing on C. trachomatis infection in period from October 2003 to March 2004. Based on clinical data patients were divided in 4 categories: I. Symptomatic patients (nonspecific urethritis), N=109 II. Asymptomatic participants (test was a part of extended periodical general medical examination), N=90 III. Asymptomatic participants (came because their partner has some symptoms in genital or urethral area), N=83 IV. Asymptomatic participants (came due to infertility problems), N=18. Urethral swabs were tested by enzyme immunoassay - EIA for detection of chlamydial antigen (MicroTrak II Chlamydia EIA-Trinity Biotech). Positive results were confirmed by direct fluorescent-antibody test - DFA (MicroTrak II Chlamydia trachomatis Direct Specimen Test). Overall prevalence of C. trachomatis was 8%. Average age of positive patients was 30.2 years. The prevalence of symptomatic C. trachomatis infections was 18.3%, while the prevalence of asymptomatic C. trachomatis infections was 2.1% (in the group II the prevalence was 1/90, in the group III - 2/83, and in the group IV - 1/18). Since reporting of C. trachomatis positive cases is known to be underestimated, it is valuable to continue the study in order to obtain more objective data about prevalence of symptomatic and asymptomatic C. trachomatis infections in men in Croatia.

Most epidemiologic studies of sexually transmitted diseases (STD) are based on patients seeking help or advice at various health care settings. Because many STD:s are subclinical, epidemiologic surveys can be strengthened by a population-based approach. The aims of the present study were to investigate the prevalence and incidence of STDs in a population of young women, and to assess associations between STDs and social background, education, previous genital infections, sexual behaviour, contraceptive use and reproductive experience. All women belonging to the 19-, 21-, 23- and 25-year age cohorts and living in the catchment area of a community health center, were invited by mail to participate in the study. In the presence of the investigator, participants answered a structured questionaire regarding their social background, education, previous genital infections, sexual behaviour, contraceptive use and reproductive experience. A gynecologic examination was performed. Cervical scrapes for human papillomavirus (HPV) DNA, as well as samples for wet smear, cervical pap smear, and Chlamydia trachomatis (CT) culture were taken. The presence of genital warts was noted, and a colposcopy was performed 2-5 minutes after application of 5% acetic acid on the cervix and vulva. Acetowhite changes were then assessed. A serologic test for CT and herpes simplex virus type 2 (HSV-2) antibodies were performed. Of the 816 women available, 611 (75%) participated in the study. One out of four women reported symptoms from the lower genital tract. The most common were itching, followed by discharge and soreness. There was a significant correlation between the womens" complaint of vaginal discharge, and previous CT infection, lack of lactobacilli and the presence of leucocytosis in wet smear. Twenty-two percent of the women were HPV DNA positive and acetowhitening at the cervix was observed in 16% of the women. The sensitivity of detection of HPV infection by acetowhitening of the cervix was 22% (95%CI 18%, 26%), and the specificity was 90% (95% Cl 87%, 93%). C.trachomatis culture positivity was found in 2.7% of the women and the seroprevalence of CT was 24.7 %. Atypical cytology was found in 3.4% of the women and 6.6% was HSV-2 seropositiv. Of the women studied 23.6% reported having had at least one STD previously and the laboratory analysis showed 45.4% to have had at least one STD. Multivariate logistic regression analysis showed that the number of sexual partners, age at first coitus, history of therapeutic abortion, and previous pelvic inflammatory disease (PID) was independently correlated with CT seropositivity. Lifetime number of sexual partners was the only independent risk factor for HPV. Multivariate analysis showed that increasing age, early sexual debut, and a history of spontaneous abortion were independently related to the presence of HSV-2 antibodies. The lifetime number of sexual partners and coitus on first date were independently associated with a previous STD. Conclusion, We found that one out of four women had some kind of lower genital tract complaint, almost every other women had at sometime in their life an STD, and STDs were often asymptomatic. Acetowhitening of the cervix and vulva has low sensitivity, to low to warrant its use as a predictor of subclinical HPV infection. The pattern of risk factors differed between STDs. Härtill 6 uppsatser digitalisering@umu

In the present report, we have analysed C.trachomatis infection and HIV positivity among patients (n-143) who attended the STD clinic at the Institute of STDs, Government General Hospital, Chennai. HIV positivity rate was significantly high among those with chlamydial infection than in those without chlamydial infection (29.5% (13/44) vs. 11.1% (11/99); p<0.05). The results of the present study suggest the association between C.trachomatis and HIV infections and reinforce the need for routine screening for C.trachomatis as a necessary intervention to reduce the burden of chlamydial diseases and to reduce the risk of HIV and its spread in India.