Læknablaðið - 15.07.1995, Blaðsíða 48

558
LÆKNABLAÐIÐ 1995; 81
Some studies suggest that the follicular cervic-
itis is characteristic of C. trachomatis infection.
Mucous or mucopurulent discharge, oedema,
erythema and friability are features of Chlamy-
dial cervicitis.
The majority of female Chlamydia carriers
are symptom free. Because symptoms of ure-
thritis are relatively common in women with
genital Chlamydial infections, a Chlamydial
urethritis must be considered in women con-
sulting for urinary tract symptoms, including
the acute urethral (dysuria, pyuria) syndrome.
Cultures from the urethra may be positive for
C. trachomatis in women whose cervical cul-
ture is negative.
If left untreated, Chlamydial infections of
the cervix (as in the urethra in men) can persist
for years.
Most cases of acute salpingitis in women of
childbearing age are caused by an ascending
sexually transmitted infection from the cervix.
A significant portion of acute salpingitis cases
in Iceland are infected by C. trachomatis
whereas gonorrhoea has disappeared as a
cause of this disease. Chlamydial endometritis
can occur as one manifestation of an ascending
genital infection in women with or without
signs of salpingitis.
In the high risk group, i.e. women 15 to 24
years of age, the annual incidence of acute
salpingitis has been found to be one in 70; of
those affected, about one in five will become
infertile due to occlusion of the Fallopian
tubes. Measures that should be undertaken to
prevent infertility secondary to salpingitis in-
clude early diagnosis and the treatment of gen-
ital infections that can lead to salpingitis.
Genital Chlamydial infection can precede
arthritic symptoms in both men and women.
Reiter’s syndrome sometimes follows a Chla-
mydial infection.
Eye infections in adults: C. trachomatis, sero-
types A-C, are the cause of trachoma, a condi-
tion outside the scope of the present recom-
mendations.
C. trachomatis, serotypes D-K, can cause
follicular conjunctivitis and punctate keratitis,
usually as one manifestation of an oculo-gen-
ital infection. The eye infection is frequently
unilateral, and the eyelid often badly swollen.
The infection frequently persists for months.
Erroneous diagnosis and inappropriate treat-
ment are common in the history of such cases.
Chlamydial eye infections in adults usually are
acquired by auto inoculation from a concom-
itant genital infection.
Infections of infants: Up to one half of all
infants born to mothers infected by C. tracho-
matis has been reported to become colonized
by the organism, primarily in the conjunctiva
and nasopharynx. The infection can be sub-
clinical, but may also result in conjunctivitis
and pneumonia. Rhinitis, otitis media, enter-
itis, proctitis, and vulvitis have been reported
to occur more often in infants infected by C.
trachomatis than in those not infected by this
agent.
Inclusion conjunctivitis usually appears after
the infant comes home from the maternity
ward (at an age of two to 12 weeks). The clin-
ical picture may vary between a mild conjunc-
tivitis and fulminant infection with swollen
eyelids. The infection is often unilateral. If left
untreated, or if treated incorrectly, there may
be recurrent problems, but sequelae occur
comparatively seldom. Chlamydia can spread
from the eyes and the nasopharynx to the lungs
and cause pneumonia with symptoms that start
insidiously (at a age six to 12 weeks). Charac-
teristically, there is cough and tachypnea,
though the infant usually is afebrile.
Diagnosis
Introduction: The diagnosis of infection
caused by C. trachomatis rests on isolation of
the organism in cell culture, antigen detection
or recently by methods of molecular biology.
Amplicor®-PCR is now the main diagnostic
method used at the Department of Microbiol-
ogy at the National University Hospital. Urine
is the sample of choice for both men and wom-
en. Cell culture is still available on consultation
but antigen detection is no longer available.
Antigen detection is the method used at the
Regional Hospital in Akureyri.
Indication for diagnostic tests: Specimen for
the isolation of C. trachomatis should be col-
lected front patients with signs of genital in-
fection in whom sexual transfer cannot be
ruled out. Teenagers and young adults (15-28
years of age) constitute special risk groups.
Thus samples for Chlamydia testing should
be collected from the following patient groups:
Males, 15-40 years of age with the following
symptoms: