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Chlamydia: the three germs that determine the different forms of the infection

By Cristiano Antonino On May 19, 2023

Chlamydia infections can be caused by three different germs that cause various symptoms including conjunctivitis and pneumonia

Chlamydiae belong to the Chlamidyaceae family

They are bacteria that are acquired by cells by phagocytosis and can affect the oral, nasopharyngeal, genital, urinary, and rectal mucosa.

They can remain silent or cause a variety of clinical manifestations grouped into three prevalent groups:

Chlamydia pneumoniae: human-to-human transmission. Children become infected mostly indoors, develop upper respiratory tract infections and pneumonia;
Chlamydia psittaci: transmission from birds to humans (ornitosis), can be asymptomatic or cause upper respiratory tract infection (flu-like symptoms);
Chlamydia Trachomatis: transmission mainly by sexual route.

Chlamydia pneumoniae infection

The first symptoms appear 3-4 weeks after exposure to the bacterium.

It can present with colds, sore throat, deepening of the voice, hoarseness and pneumonia.

In this circumstance the signs of respiratory distress can last for 2-6 weeks;

Chlamydia psittaci infection

It presents with fever, dry cough, difficulty breathing, more rarely pneumonia.

The prevalent symptoms are: chills, body aches and headaches.

The infection can cause inflammation of the brain, heart (endocarditis) and liver.

The disease can last more than a month, with frequent relapses and re-infections.

In most cases the convalescence can last 4-6 months;

Chlamydia trachomatis infection

In pregnancy the probability of transmission to the child during spontaneous delivery is about 50%.

After 5-12 days from birth, conjunctivitis mainly appears (in 25-50% of cases), redness and swelling of the eyes.

Symptoms can last 1-2 weeks, often longer.

Pneumonia presents at the age of 1-3 months (in 5-30% of cases), with respiratory distress associated with isolated and close coughing, separated by a short inspiration but without the typical scream of pertussis.

No fever appears; respiratory acts reach 50-60 a minute.

After puberty, the infection affects the genital and urinary tracts; it can cause chronic inflammation and wounds.

Trachoma is a chronic keratoconjunctivitis with extensive scarring and loss of vision in 1-15% of cases.

The suspicion is mainly based on the anamnesis, as well as on clinical symptoms, instrumental and laboratory tests.

Chlamydia pneumoniae infection is suspected by evaluating the results of a chest X-ray

Very characteristic of this infection is the presence, together with pneumonia, of laryngeal symptoms (hoarseness, lowering of voice.

The most suitable laboratory test to demonstrate the presence of the germ is gene amplification (PCR) in addition to the dosage of specific antibodies.

Chlamydia psittaci infection manifests itself with more attenuated respiratory symptoms.

There are relatively few laboratories equipped to carry out germ research on biological material, mainly gene amplification (PCR).

Chlamydia trachomatis infection in the newborn requires isolation of the bacterium by conjunctival swab (conjunctivitis due to N. gonorrhea must be excluded).

For the confirmation of Chlamydia Trachomatis pneumonia, the material must be taken from the nasopharynx or, in the most serious cases, from the trachea or lung biopsy.

Confirmation also in this case makes use of microbiological isolation tests or gene amplification (PCR).

All Chlamydia infections (Psittaci, Pneumoniae and Trachomatis) are treated with erythromycin ethylsuccinate for 14 days or azithromycin for 3 days.

At birth, antibiotic eye drops are used to prevent the development of conjunctivitis.

Follow-up 3 months after completion of antibiotic therapy is required to rule out possible recurrence.

Pneumonia, if severe, may require hospitalization in intensive care and intubation with assisted ventilation

Chlamydia Pneumoniae: to reduce the chances of contagion through coughing, sneezing and unavoidable physical contacts, it is advisable to wash your hands thoroughly;

Chlamydia psittaci: since in 50% of cases transmission to the newborn occurs during spontaneous delivery, infections in pregnancy must be diagnosed as soon as possible. The genetic material of the germ is identified with PCR on urine (first flush) or on vaginal and rectal swab in order to define the most appropriate antibiotic therapy;

Chlamidia Trachomatis: birds raised at home must be cared for and the cage cleaned, remembering to wash your hands carefully with running water and soap after each contact, even with their droppings.

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