Instant Cure for Chlamydia

Essential Guide to Cure Chlamydia

Is Chlamydia easily curable? The Answer is a big Yes! Chlamydia is one of the sexually transmitted diseases with proven treatment methods. In fact, there are two main treatment options available both of which have guaranteed results: Conventional medicine and natural medicine. These treatment options And lots of other previously unknown facts about Chlamydia have been explained at great length in this eBook. The Essential guide to Cure Chlamydia unveils the mystery of Chlamydia and methodically presents all the important bits of information that you should know about Chlamydia. The Banish Chlamydia Book tackles the sensitive subject of Chlamydia from the perspective of a professional and presents you with a goldmine of information and facts in a way that has never been done before. Continue reading...

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Chlamydia Trachomatis TRIC Agent Infection

Chlamydia trachomatis (TRIC agent TR trachoma, IC inclusion conjunctivitis) is an obligate intracellular pathogen of columnar epithelial cells 79 . In hot climates it can cause trachoma, primarily affecting the conjunctiva and corneal epithelium, ultimately causing cicatrisation of this tissue. Trachoma commonly affects children and is one of the world's major causes of blindness. Trachoma is spread from eye to eye by transfer of ocular discharges. In temperate climates chlamydial infection is venereal, with only mild con-junctival infection, called inclusion conjunctivitis. A third manifestation of this pathogen is ophthalmia neonatorum 75 .

Chlamydial pneumonia

Patients infected with Chlamydia pneumoniae rarely need admission to the intensive care unit (ICU) and the mortality is low. The incubation period is not known precisely, but may be as long as 3 to 4 weeks. C. pneumoniae are obligate intracellular parasites. The elementary bodies are highly condensed and therefore metabolically inactive. The lifecycle is initiated when an elementary body attaches to a susceptible epithelial cell. The elementary bodies differentiate intracellularly into reticulate bodies, which apparently inhibit phagolysosomal fusion, and multiply using high-energy phosphate compounds and some amino acids from the host cell. As they multiply, chlamydial antigens are released onto the surfaces of infected eukaryotic cells, stimulating the prduction of neutralizing antibodies by the host. They revert to elementary bodies before exocytosis or cell lysis. Infection with C. pneumoniae leads to partial immunity. Reinfections in young adults do not manifest as pneumonia....

Culturenegative endocarditis

Initial empirical treatment of endocarditis is penicillin plus gentamicin or, if there is an acute aggressive onset, flucloxacillin (or similar) plus gentamicin. Patients with prosthetic valves should be treated with a glycopeptide plus an aminoglycoside with or without rifampin. If blood cultures remain negative, it is probable that the patient has received previous antibiotics. The nutritionally deficient streptococci, HACEK organisms, anaerobes, Brucella species, and Listeria species may take a week or more to be recognized in culture. Rarely, failure to respond to penicillin and gentamicin may be the result of infection with Coxiella, Bartonella, or Chlamydia species, and serological tests are required. Fungal endocarditis may appear culture negative. Surgical management will be necessary if there is no response in the presence of clear vegetations on echocardiography. Collagen vascular diseases, sarcoidosis, malignancy, tuberculosis, and viral infections (including HIV) should be...

Differential Diagnosis

Predominantly an infection of sexually active individuals, usually observed in boys. Signs and symptoms include painful or burning urination and discharge from the urethral meatus. Causes may be gonococcal (Neisseria gonorrhea) and nongonococcal urethritis (NGU), which is now more frequent in the United States. NGU may be due to Chlamydia trachomatis, Ureaplasma urealyticum, and, less commonly, Trichomonas vaginalis or herpesvirus infection.

Infectious Conjunctivitis

Infectious conjunctivitis is one of the most common causes of red eye. Infectious conjunctivitis is commonly caused by bacterial or viral infection. The clinical term red eye is applied to a variety of infectious or inflammatory diseases of the eye. Conjunctivitis is most frequently caused by a bacterial or viral infection. Sexually transmitted diseases such as chlamydial infection and gonorrhea are less common causes of conjunctivitis. Ocular allergy is a major cause of chronic conjunctivitis.

Examination of the eye

Visual acuity should be tested before the examination. Regional lymphadenopathy should be sought and the face and eyelids examined. Viral or chlamydial inclusion conjunctivitis typically presents with a tender, preauricular or submandibular lymph node. Palpable adenopathy is rare Chlamydial D. Chlamydial conjunctivitis can be present in newborns, in sexually active teenagers and in adults. Diagnosis is by antibody staining of ocular samples. Treatment includes oral tetracycline, doxycycline (Vibramycin) or erythromycin for two weeks.

Physical Exam Key Points

Gram stain and culture are obtained in neonates to rule out gonococcal and chlamydial disease. g. Chlamydia trachomatis, HSV (or other viruses), chemical, or allergic conjunctivitis. Gram-negative. 3. Giemsa stain. Obtain if chlamydial infection is suspected to check for cytoplasmic inclusion bodies within epithelial cells. Presence of many eosinophils may indicate an allergic cause.

Detection Of Viral Genomes In The Heart By Rtpcr

Regarding the presence of infectious agents in the heart of patients with DCM, there are rather divergent PCR results. Whereas in patients with DCM Pankuweit et al.9 found an incidence of cytomegalovirus DNA of 12 , adenoviral DNA of 15 , and borreliosis of 0.5 , Galama's group did not detect any nucleic acids from enteroviruses, cytomegalovirus, hepatitis B and C viruses, Borrelia burgdorferi, Chlamydia species, mycoplasmata, or Toxoplasma gondii in patients with end-stage DCM.94

Applications of ISH examples

One major field is the detection of infectious agents. DNA ISH has been successfully employed for the demonstration of several bacteria, e.g. Helicobacter pylori, Chlamydia trachomatis, Haemophilus influenzae and Mycoplasma pneumoniae (Horn et al., 1988 Saglie et al., 1988 Terpstra et al., 1987 van den Berg et al., 1989). More recent developments in this field include the use of DNA probes for the detection of ribosomal RNA sequences specific for bacterial or fungal organisms (Boye et al., 2001 Hayden et al., 2002). Furthermore, DNA ISH has been used to study acute viral infections, e.g. in immunocom-promised individuals, and to investigate possible associations of DNA tumour viruses with human malignancies. A major application remains the detection of HPV in anogenital neoplasia. In addition to identifying virus types associated with low or high risk of progression, it has been demonstrated that the pattern produced by HPV DNA ISH using non-radioactive probes may be of relevance....

Adolescent Outpatients

Levofloxacin (Levaquin, 500 mg once daily) with or without metronidazole (Flagyl, 500 mg twice daily) for 14 days. OR -Ceftriaxone (Rocephin, 250 mg IM), cefoxitin (Mefoxin, 2 g IM plus probenecid 1 g orally), or another parenteral third-generation cephalosporin, followed by doxycycline (100 mg orally twice daily) with or without metronidazole for 14 days. Quinolones are not recommended to treat gonorrhea acquired in California or Hawaii. If the patient may have acquired the disease in Asia, Hawaii, or California, cefixime or ceftriaxone should be used OR -Azithromycin (Zithromax, 1 g PO for Chlamydia coverage) and amoxicillin clavulanate (Amoxicillin, 875 mg PO) once by directly observed therapy, followed by amoxicillin clavulanate (Amoxicillin, 875 mg PO BID) for 7 to 10 days.

Cited Publications

Louria, Pneumonia due to viruses, chlamydiaceae, and mycoplasmas. In S. L. Gorbach, J. G. Bartlett, and N. R. Blacklow, eds., Infectious Diseases, 2nd ed., Saunders, Philadelphia, PA, 1998, pp. 387-400. 94 J. Schachter, Chlamydia. In S. L. Gorbach, J. G. Bartlett, and N. R. Blacklow, eds., Infectious Diseases, 2nd ed., Saunders, Philadelphia, PA, 1998, pp. 1980-1990.

Urogenital Tract Pathogens

Neisseria gonorrhoeae and Chlamydia trachomatis were among the first organisms to be targeted for detection in clinical specimens by molecular methods. The molecular methods are so well characterized for these two organisms that detection of the nucleic acid of N. gonor-rhoeae and C. trachomatis is the laboratory method used almost exclusively. Other sexually transmitted bacteria are considered good targets for the development of molecular-based methods because traditional laboratory methods of detection and identification for these organisms either lack sensitivity or are time-consuming. Table Neisseria gonorrhoeae and Chlamydia trachomatis Laboratory diagnosis of C. trachomatis is more problematic. C. trachomatis is an obligate intracellular pathogen thus, when collecting specimens for isolation of C. trachomatis, it is critical that the practitioner scrape the endocervix or urethra to ensure the collection of host columnar epithelial cells that harbor the organisms. C. trachomatis...

Antibacterial Spectrum and Resistance

The sulfonamides are broad-spectrum antimicrobials that are effective against gram-positive and some gramnegative organisms of the Enterobacteriaceae. There is good activity against Escherichia coli, moderate activity against Proteus mirabilis and Enterobacter spp. poor activity against indole-positive Proteus and Klebsiella spp., and no inhibitory activity against Pseudomonas aeruginosa and Serratia spp. They are also effective against Chlamydia spp., but superior drugs are now

Antibacterial Therapy

Certain bacteria are more common than others in ophthalmic practice. Examples of gram-positive organisms important in ocular infections include Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae. Examples of gram-negative bacteria are Neisseria gonorrhea, Haemophilus influenzae, and Pseudomonas aeruginosa. It should be noted here that the treatment of certain other infections involving acanthamoeba (a protozoan) and parasites (eg, Toxoplasmosis gondii and Chlamydia trachomatis) are often treated with antibacterial drugs. These infectious organisms may share common physiologic properties with bacteria thus, antibacterial drugs are sometimes used in the management of nonbacterial infections.

Antibacterial Spectrum

The tetracyclines display broad-spectrum activity and are effective against both gram-positive and gram-negative bacteria, including Rickettsia, Coxiella, Mycoplasma, and Chlamydia spp Tetracycline resistance has increased among pneumococci and gonococci, which limits their use in the treatment of infections caused by these organisms.

Prevention and Treatment

Chlamydias Figure 25.10 Scanning Electron Micrograph of Chlamydia trachomatis Attached to Fallopian Tube Mucosa Chlamydias Figure 25.10 Scanning Electron Micrograph of Chlamydia trachomatis Attached to Fallopian Tube Mucosa women are advised to get tested for Chlamydia each year, or twice yearly if they have multiple partners or if their partner has multiple partners. Several antibiotics offer effective treatment and prevent serious complications if the disease is diagnosed and treated promptly. Azithromycin can be given as a single dose, whereas tetracyclines and erythromycin are less expensive alternatives. The sexual partner is treated at the same time. The main features of chlamydial genital infections are summarized in table 25.9.

Clindamycingentamicin Regimen B

The cefoxitin-doxycycline regimen is superior if Chlamydia is suspected as the primary pathogen. The clindamycin-gentamicin regimen has the advantage when more effective anaerobic coverage is desired, such as with tubo-ovarian or pelvic abscesses. D. Partner referral. Sexual contacts should be treated for GC and Chlamydia, without regard to clinical or laboratory results.

Identification of isolates

Growth of viruses and Chlamydia can be detected in cell cultures by cytopathic effects such as cell rounding, cell clustering, syncytial formation, and intranuclear or intracytoplasmic inclusions. Hemadsorption, direct immunofluorescence, and interference can also indicate viral growth. Final identification of a virus requires specific neutralization of viral activity by homologous antiserum.

Inflammatory Processes

The conjunctiva is prone to inflammations with many different causes, either infectious or as a part of a non-infectious dermatologic or systemic disease. Usually these lesions do not cause diagnostic problems, but a biopsy can be useful in making the correct diagnosis 97 . In this chapter the inflammatory processes of the conjunctiva are divided into acute, chronic and granu-lomatous. The only lesions mentioned separately are ligneous conjunctivitis and lesions caused by Chlamydia infections.

Ligneous Conjunctivitis

Chronic conjunctivitis can be caused by many infectious, immunological and toxic agents. Also, anatomic aberrations (like ectropion or proptosis) can cause inflammation. In chronic conjunctivitis the epithelium becomes hyperplastic and the goblet cells increase in number. Crypt-like epithelial infoldings can occur, forming sub-epithelial retention cysts. These cysts contain mucus in which calcification can be seen over time. The presence of perivascular infiltrate in the stroma can induce fibrous bands between the epithelium and the tarsus, which can cause surface irregularities, the so-called papillary conjunctivitis. In fact, the epithelial and stromal responses of a papillary conjunctivitis are non-specific and can also be seen in atopic conjunctivitis and, in a more extreme form in individuals wearing contact lenses (giant papillary conjunctivitis) 108, 114 . When lymph follicles are found in the superficial stroma, it is called follicular conjunctivitis. The presence of these...

Inclusion Conjunctivitis

The conjunctival involvement of the sexually transmitted chlamydial infection is mild and can even be asymptomatic. In adults, it presents as a subacute follicular conjunctivitis. It is accompanied by a chronic urethritis in the male and a symptomless cervicitis in the female. In newborns, it occurs with an acute mucopurulent discharge, 5 to 10 days after birth. It is accompanied by infection of the maternal vagina by the same agent. Because the extranodal lymphoid tissues are not fully developed, the conjunctivitis is more papillary than follicular. Like trachoma it can be diagnosed by Giemsa staining on conjunctival scrapings.

Vaccination or Immunoglobulin Administration in Atherosclerosis

Microbial antigens may also play a role in the pathogenesis of atherosclerosis. For instance, certain microbial infections such as Chlamydia pneumoniae have been frequently reported in patients with atherosclerosis and it has been suggested that molecular mimicry may exist between these bacteria and modified LDLs (Hansson, 2001 Binder et al., 2003). As described above, strong similarities exist between anti-oxLDL antibodies isolated from apoE-deficient mice and naturally occurring T15 antibodies that are protective against common pathogens such as pneumococci (Shaw et al., 2000). Immunization of LDLR- - mice with Streptococcus pneumoniae resulted in the production of elevated levels of anti-oxLDL, decreased atherosclerotic lesions, and plasma antibodies from these mice prevented the binding of oxLDL to macrophages (Binder et al., 2003).

Evaluating Performance

The evaluation of any new diagnostic test involves comparison to an appropriate gold standard test and determination of the percentage sensitivity, specificity, and positive and negative predictive values. Prior to determining the performance characteristics on clinical specimens, the analytical sensitivity of a test, that is, the smallest amount of analyte that can be detected by the test, should be determined. For PCR, this is usually expressed as pg or fg purified DNA and is easily determined by testing serial 10-fold dilutions of target DNA. The most sensitive PCRs can detect 0.1 fg target or the equivalent of 1-5 target copies (Erlich et al., 1991 Mahony et al., 1993a). The sensitivity of M-PCR for each target can be determined by preparing a five-member sensitivity panel consisting of serial 10-fold dilutions of each target DNA pooled together, ranging from 1 pg to 0.1 fg (Fig. 1). Once the analytical sensitivity has been determined, the sensitivity and specificity can be...

Conjunctiva Inclusion Conjunctivitis

Etiology Oculogenital infection (Chlamydia trachomatis serotype D-K) is also caused by direct contact. In the newborn (see neonatal conjunctivitis), this occurs at birth through the cervical secretion. In adults, it is primarily transmitted during sexual intercourse, and rarely from infection in poorly chlorinated swimming pools. Diagnostic considerations Tarsal follicles are observed typically on the upper and lower eyelids, and pannus will be seen to spread across the limbus of the cornea. As this is an oculogenital infection, it is essential to determine whether the mother has any history of vaginitis, cervicitis, or urethritis if there is clinical suspicion of neonatal infection. Gynecologic or urologic examination is indicated in appropriate cases. Chlamydia may be detected in conjunctival smears, by immunofluorescence, or in tissue cultures. Typical cytologic signs include basophilic cytoplasmic inclusion bodies (Fig. 4.13). Chlamydial conjunctivitis. Chlamydial conjunctivitis.

Neonatal Conjunctivitis

Gonococcal Conjunctivitis Newborn

Etiology (Table 4.3) The most frequent pathogens are Chlamydia, followed by gonococci. Neonatal conjunctivitis is less frequently attributable to other bacteria such as Pseudomonas aeruginosa, Haemophilus, Staphylococcus aureus and Streptococcus pneumoniae, or to herpes simplex. The infection occurs at birth. Chlamydia infections are particularly important because they are among the most common undetected maternal genital diseases in Europe, affecting 5 of all pregnant women. Neonatal conjunctivitis sometimes occurs as a result of Crede's method of prophylaxis with silver nitrate, required by law in Europe to prevent bacterial infection. Chlamydia (inclusion Chlamydial conjunctivitis Systemic erythromycin and topical erythromycin eyedrops five times daily. There is a risk of recurrence where the dosage or duration of treatment is insufficient. It is essential to examine the parents and include them in therapy. Prophylaxis Cred 's method of prophylaxis (application of 1 silver nitrate...

Anatomy and Physiology

Head Capillaries

In 1988, researchers in Helsinki, Finland, reported that patients with coronary artery disease, meaning arteriosclerosis of the arteries that supply the heart muscle, commonly had antibodies against Chlamydia pneumoniae.This organism is a tiny obligate intracellular bacterium that is responsible for a variety of upper and lower respiratory infections including sinusitis and pneumonia.The infections are common, and most

Obligate Intracellular Parasites

Obligate intracellular parasites are unable to reproduce outside a host cell. In general, the term only refers to those that infect eukaryotic cells. By living within eukaryotic cells, these bacteria are supplied with a readily available source of compounds they would otherwise need to synthesize for themselves. As a result, most species of these genera have lost the ability to synthesize substances needed for extracellular growth. Bacterial examples include members of the genera Rickettsia, Orientia, Ehrlichia, Coxiella, and Chlamydia, which are all tiny Gramnegative rods or coccobacilli. The Genus Chlamydia Chlamydia species are quite different from the other obligate intracellular parasites. They are transmitted directly from person to person rather than through the bite of a blood-sucking arthropod, and they have a unique growth cycle (figure 11.30). Inside the host cell, they initially exist as a fragile non-infectious form called a reticulate body that reproduces by binary...

Chemiluminescence Detection Systems

Selected Studies That Have Used Chemiiuminescence to Detect Viruses, Chlamydia trachomatis, and Other Microorganisms Chlamydia trachomatis agents. Membrane-based hybridization assays have been used for the detection of HBV (Bronstein et al., 1989c Yang et al., 1991 Escarceller et al., 1992), herpes simplex virus (HSV-1) (Bronstein and Voyta, 1989), CMV (Musiani et al., 1991a,1992 Yang et al., 1991), HIV-1 (Zachar et al., 1991), and other viral agents (Fouly et al., 1992 Tham and Stanislawek, 1992a,b Fuchs et al., 1993). Solution hybridization assays include those for HBV (Urdea et al., 1990), HIV-1 (Suzuki et al., 1992), and Chlamydia (Clyne et al., 1989 Urdea et al., 1989). In situ hybridization assays have been performed with both HSV-1 infected cells (Bronstein and Voyta, 1989) and HIV-infected cells (Bronstein et al., 1989b). Finally, assays for retroviruses based on the detection of reverse transcriptase activity can be coupled with chemiluminescence detection by measuring the...

Immediate Questions

Are there associated complaints (eg, fever, drainage or discharge between urinations, abnormal urine odor or color, or changes in volume or frequency of urination) Fever, dark and foul-smelling urine, frequency, and urgency are all symptoms associated with UTIs. If patient is sexually active and experiencing discharge or dyspareunia, consider STDs (eg, gonorrhea, chlamydia).

Adolescent Biological Vulnerability

Factors that influence or induce squamous metaplasia are not well defined. Because of the active immature squamous metaplasia during adolescence compared with childhood, the influence of estrogen is believed to be important. However, other factors including local trauma and infection have also been shown to induce metaplasia. Several decades ago, Singer et al. (24) showed that adolescents who had initiated intercourse, and reported several sexual partners were more likely to have mature cervixes covered predominantly by squamous epithelium in comparison with virginal adolescents whose cervixes were predominantly covered by columnar epithelium. In a recent study of high-risk adolescents using colpophotographical descriptions, the more the number of sexual partners the more likely these women had a mature cervix (25). These studies suggest that factors associated with sexual intercourse (i.e., sperm, STIs) may be capable of inducing metaplasia and increase the risk of HPV and LSIL....

Credes prophylaxis today

Despite cases of ophthalmia neonatorum due to Neisseria gonorrhoeae infections, chlamydial eye infections in the newborn became more the primary focus compared to gonorrheal eye infections 40-45 . Silver nitrate and acetate show no sufficient activity in prophylaxis of chlamydial eye infections and exhibit irritative adverse effects of chemical conjunctivitis including consecutive psychological adverse effects (impairment in eye-to-eye contact in early maternal-infant attachment), which are currently under discussion 46-50 . Many antibiotic and other aseptic kinds of eye prophylaxis have therefore been considered and evaluated for prophylaxis of ophthalmia neonatorum 51-55 . At present, aseptic eye prophylaxis with povidone-iodine at different concentrations (preferably 1-2.5 ) is often recommended 56-63 .

Viral Clearance Vs Oncogenic Progression

With patients with high viral loads (40). Epidemiological evidence exists for several risk factors, which may promote the progression from infection and CIN to invasive cancer, including human leukocyte antigen (HLA) haplotype (34,40), HPV-16 positive HSILs (40), tobacco (41), oral contraceptives (42,43), age, parity (44,45), and infection with Chlamydia trachomatis (for a more complete review, see ref. 34). The identification of potential risk factors for the progression of HPV infection to cancer remains especially important to consider in the context of the developing world, where cervical cancer is common, but few women have access to proper cytological screening resources.

Chanchroid Causative Agent

Chlamydial Genital System Infections (Table 25.9, Figure 25.10) 1. Chlamydial genital infections, caused by Chlamydia trachomatis, are reported more often than any other bacterial disease. 2. Symptoms and complications of chlamydial infections are very similar to those of gonorrhea, but milder asymptomatic infections are common, and readily transmitted.

Inflammation on Pap smear

Moderate or severe inflammation should be evaluated with a saline preparation, KOH preparation, and gonorrhea and Chlamydia tests. If the source of infection is found, treatment should be provided, and a repeat Pap smear should be done every 6 to 12 months. If no etiology is found, the Pap smear should be repeated in 6 months.

Serious Gram Negative Bacillary Infections

Acute salpingitis (pelvic inflammatory disease) due to Neisseria gonorrhoeae, Chlamydia trachomatis, or both is often complicated by superinfection with gramnegative bacilli and anaerobes. A combination of gen-tamicin, clindamycin, and doxycycline has been shown to be an effective treatment for this polymicrobial infection.

Etiology

Because of the limitations of diagnostic methods, the presence of a reliable etiological agent can be proved in only half of the community-acquired pneumonias affecting the general adult population. As shown in Tabje,2, the organisms identified most frequently are Strep. pneumoniae, M. pneumoniae, respiratory viruses, and Chlamydia pneumoniae. Coxiella burnetii has been reported to be prevalent in some rural areas. Other organisms, such as L. pneumophila, H. influenzae, Gram-negative aerobic bacilli, and Staph. aureus, are rare. In the case of severe community-acquired pneumonia, this etiological pattern shows some modifications (Table,, 2), as has been demonstrated in different studies using sophisticated or invasive methods. Strep. pneumoniae remains the most common pathogen, but the relative frequencies of L. pneumophila, H. influenzae, enteric Gram-negative bacilli, and Staph. aureus are substantially increased. In contrast, other etiologies such as M. pneumoniae, C. pneumoniae,...

Pathophysiology

Pathogens in community-acquired pneumonia include Streptococcus pneumoniae (33 ), Haemophilus influenzae (10 ), Legionella species (7 ), and Chlamydia pneumoniae (5 ) Other organisms include Mycoplasma pneumoniae, other gram-positive organisms, gram-negative organisms, anaerobes, mycobacteria, fungi, and viruses. S pneumoniae is the leading cause of community-acquired pneumonia in both inpatients and outpatients.

Conjunctivitis

Most commonly caused by Chlamydia trachomatis, Strep, viridans, Staph, aureus, Haemophilus influenzae, group B Streptococcus,Moraxella catarrhalis, or Neisseria gonorrhea. Treatment is guided by Gram stain (which should be performed immediately to identify N.gonorrhea) and culture results. N. gonorrhea and C. trachomatis have specific regimens as described. If not gonococcal or chlamydial, may use erythromycin or bacitracin ointment Q4-6 hr. as the only initial treatment. In the United States, neonatal conjunctivits is most commonly chlamydial.

Testing for STDs

Pubertal and postpubertal adolescents. Adolescents who describe sexual contact that could transmit an STD should be tested routinely, with culturing for Neisseria gonorrhea and Chlamydia, wet mount of secretions for trichomonas (in girls), and rapid plasmin reagin (RPR). Consider hepatitis B virus and HIV testing.

Trachoma

Trachoma (Chlamydia trachomatis serotype A-C) is rare in temperate countries. In endemic regions (warm climates, poor standard of living, and poor hygiene), it is among the most frequent causes of blindness (see Table 4.2 for symptoms, findings, and therapy). Left untreated, the disorder progresses through four stages (Fig. 4.14)

Oral Therapy

susp 200 mg 5 mL, 400 mg 5 mL tab 875 mg tabs, chew 200, 400 mg Community-Acquired Pneumonia 5-18 years old (viral, Mycoplasma pneumoniae, chlamydia pneumoniae, pneumococcus, legionella) Immunosuppressed, Neutropenic Pneumonia (S. pneumoniae, group A strep, H flu, gram neg enterics, Klebsiella, Mycoplasma Pneumonia, Legionella, Chlamydia pneumoniae, S aureus) 12. Labs CBC, ABG, blood culture and sensitivity x 2. Sputum gram stain, culture and sensitivity, AFB. Antibiotic levels. Nasopharyngeal washings for direct fluorescent antibody (RSV, adenovirus, parainfluenza, influenza virus, chlamydia) and cultures for respiratory viruses. UA.

Pharyngitis

The most common viral cause of pharyngitis is rhinovirus (approximately 20 ). Coronavirus, influenza, parainfluenza, and cytomegalovirus are other viral causes. Patients with HIV acute retroviral syndrome often present with sore throat, fever, lymphadenopathy, lethargy, and nonexuda-tive tonsillitis. Other bacterial causes include mycoplasma, Neisseria gonorrhea, and Chlamydia pneumoniae.

Stained smears

The only commonly available techniques for detecting microbial products directly in specimens are various immunological methods used to identify microbial antigens and direct gene probes to detect various viruses, Neisseria gonorrhoeae, and Chlamydia trachomatis. Enzyme-linked immunosorbent assays (ELISAs), using enzyme-labeled antibodies, have been developed for the detection of bacterial antigens.

Alveolar Macrophages

Reduced expression levels, with a 10-fold increase in the AM population and a 1000-fold increase in the polymorphonuclear neutrophil population 167 . However, macrophages may also serve as potential targets of gene therapy. Cytokine gene therapy in the lung with interferon-g (IFN-g) increased AM phagocytic and destructive capacity against bacteria, parasites, and fungi 166 . Murine studies have demonstrated that IFN-g plays a key role in normal host defense from a number of pulmonary pathogens, including Pseudomonas, Histoplasma, Candida, Mycoplasma, Hemophilus, Legionella, Chlamydia, and Pneumocytis 166 .

S23SrDNA Arrays

Microarrays offer tremendous potential for microbial community analysis, pathogen detection, and process monitoring in both basic and applied environmental science. In the hybridization fingerprinting approaches, the sensitivity of PCR and the specificity of oligonucleotide microarray hybridization are combined to enable microbial identification through analysis of the 5' region of prokaryotic 16S-rRNA genes of different bacterial strains. Special attention is paid to the impact of molecular tools and applications on the diagnostics of tuberculosis. Responsible for more than 2 million deaths and 8 million new cases annually, tuberculosis is one of the leading infectious diseases in the world. Because of the slow growth rate of the causative agent Mycobacterium tuberculosis, isolation, identification, and drug susceptibility testing of this organism and other clinically important mycobacteria can take several weeks or longer. High-density oligonucleotide arrays have been developed...

Macrolides

Erythromycin acts on protein synthesis at the ribosome and is active against streptococci, Corynebacterium diphtheriae, and most Staph. aureus. Most Gram-negative species are resistant. Mycoplasma species, Chlamydia species, and Legionella species are susceptible. Erythromycin is excreted by the liver and should be avoided in severe liver disease. It is used in the treatment of mycoplasmal and chlamydial pneumonia, legionnaires' disease, whooping cough, diphtheria, and Campylobacter infections. Nausea and vomiting are common adverse effects. Cholestatic jaudice (with estolate) and reversible ototoxicity are reported. Clarithromycin is more active against Hemophilus species. It is given twice daily and has good tissue penetration. It is used in respiratory tract infections and gastrointestinal symptoms are less common than with erythromycin.

Applications

The first infectious disease application of M-PCR was for the detection of HPV using either degenerate primers or consensus primers. Gregoire et al. (1989) used degenerate primers containing deoxyinosine at the variable base locations and showed that these consensus primers could detect all the HPV genotypes tested. Manos et al. (1989) also used degenerate primers, targeted to the LI gene instead of the El gene used by Gregoire et al., to detect several HPV genotypes recovered from the cervix. More recently, Vandervelde et al. (1992) used six pairs of HPV primers targeted to the E7 region to detect dysplastic changes in cervix tissue samples from Belgian women. Jullian et al. (1993) used HPV 16- and HPV 18-specific primers in an M-PCR assay to detect HPV in cervix tissue samples of women with normal cytology. Human T-lymphotropic virus (HTLV) types I and II have been detected in peripheral blood using type I- and type II-specific primers for three different genes (env, pol, and tax)...

Anal Cancer

Anus Levator Muscle

Cancers of the anal canal are rare, accounting for approximately 1.5 of gastrointestinal tract malignancies. In the United States, there were an estimated 3400 new cases in 2000. In England, there were 245 new cases in men (1.0 100000) and 377 in women (1.5 100000) in 1997. It was originally thought that anal cancer was associated with chronic irritation from haemorrhoids, fissures, fistulae and inflammatory bowel disease. However, this is now known not to be so. The majority of anal cancers in both sexes are due to infection with human papilloma virus, particularly HPV1 6. There is an increased risk of anal cancer in men and women who practice anal receptive intercourse, who have had more than 10 sexual partners, or who have sexually transmitted diseases such as genital warts, gonorrhoea, or Chlamydia trachomatis. Other aetiological risk factors are immunosuppression, human immunodeficiency virus (HIV) infection, and smoking. Women with anal cancer have a higher incidence of vulval,...

Urethritis

Suspect when dysuria, pyuria, but no bacteriuria, is present. Treatment with azithromycin, 1 g in a single dose, or doxycycline, 100 mg twice daily for 7 days, is effective. Alternative treatments erythromycin, 500 mg 4 times daily for 7 days, or ofloxacin, 300 mg twice daily for 7 days. Patient's sexual partner should also be evaluated and treated. Doxycycline should not be used in children younger than 9 years of age. Ofloxacin should be used with caution in those younger than 18. 2. Gonococcal urethritis. With the emergence of penicillin resistance, cefixime, 400 mg in a single dose, or ceftriaxone, 125 mg IM in a single dose, should be given. Alternative treatments ciprofloxacin, 500 mg, or ofloxacin, 400 mg, in single doses. Because of frequent coexistence of chlamydial urethritis, appropriate antichlamydial treatment should also be given (see preceding paragraph). Patient's sexual partner should also be evaluated and treated. Use ciprofloxacin and...

Laboratory Data

Obtain Gram stain and culture on Thayer-Martin medium. Presence of intracellular, gram-negative diplo-cocci on Gram stain requires empiric treatment for gonorrhea. Always evaluate for the possibility of coinfection with Chlamydia. Giemsa stain will show cytoplasmic inclusion within epithelial cells if infection is present. Alternatively, discharges can be sent for DNA probe for C trachomatis and Gonococcus. 4. Urine test for N gonorrhea and Chlamydia. Less-invasive method of diagnosing these organisms. Involves a ligase chain reaction. Test looks for the presence of both organisms and amplifies their DNA if present.

Amplicon Analysis

Figure 1 Assessment of the sensitivity of an M-PCR assay for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae DNA. Serial 10-fold dilutions of C. trachomatis and N. gonorrhoeae DNA were tested by PCR using KL1 KL2 and H01 H03 primers, as described in the text. Amplification products were assessed by agarose gel electrophoresis. Outer lanes contain 1-kb marker DNA. Lane 1 1 pg Lane 2 100 fg Lane 3 10 fg Lane 4 1 fg Lane 5 0.1 fg. Locations of 390-bp and 241-bp amplicons of N. gonorrhoeae and C. trachomatis are indicated by arrows. Figure 1 Assessment of the sensitivity of an M-PCR assay for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae DNA. Serial 10-fold dilutions of C. trachomatis and N. gonorrhoeae DNA were tested by PCR using KL1 KL2 and H01 H03 primers, as described in the text. Amplification products were assessed by agarose gel electrophoresis. Outer lanes contain 1-kb marker DNA. Lane 1 1 pg Lane 2 100 fg Lane 3 10 fg Lane 4 1 fg Lane 5 0.1...

Metal Compounds

Metal compounds kill microorganisms by combining with sulfhydryl groups of enzymes and other proteins, thereby interfering with their function. Unfortunately, most metals at high concentrations are too toxic to human tissue to be used medically. Silver is one of the few metals still used as a disinfectant. Dressings containing silver sulfadiazine are used to prevent infection of burns. For many years, doctors were required by law to instill drops of another silver compound, 1 silver nitrate, into the eyes of newborns to prevent opthalmia neonatorum, an eye infection caused by Neisseria gonorrhoeae, which is acquired from infected mothers during the birth process. Drops of antibiotics have now largely replaced use of silver nitrate because they are less irritating to the eye and more effective against another genitally acquired pathogen, Chlamydia trachomatis. Neisseria gonorrhoeae, p. 644 Chlamydia trachomatis, p. 646

Sexual Abuse

Although uncommon, sexual abuse may present as sexually transmitted ocular disease. Gonorrhea or chlamydial conjunctivitis, human papilloma virus of the conjunctiva, pubic lice of the eyelashes, periocular infection with mollus-cum or herpes simplex, or ocular involvement with HIV or syphilis may all occur in sexually abused children. However, there is evidence that some infections, such as gonorrhea 18 , may be transmitted to the eye nonsexually. This is contrary to the well-documented exclusivity of sexual transmission for gonorrhea to the oropharynx, vagina, rectum and male urethra. There may be unique factors about the externalized conjunctival mucosa that allow for this nonsexual transmission to occur. Infections such as molluscum and herpes simplex are so frequently transmitted nonsexually that consideration of sexual abuse seems almost misdirected in the absence of other concerning findings. Nonsexual transmission of syphilis to children does not occur. But like virtually all...

Pharmacokinetics

Partitioning of some drugs into cells occurs. Red blood cells parasitized by malaria selectively take up chloroquine, which accounts in part for the efficacy of this antimalarial against intracellular malarial forms. The intrahepatocellular concentration of chloroquine is 500 times that of the blood plasma concentration. Macrolides and fluoroquinolones are also selectively partitioned into cells, which accounts in part for their efficacy against mycoplasma and chlamydia, both intra-cellular pathogens.

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