Clinical Information

Members of the family Chlamydiaceae are small, nonmotile, gram-negative, obligate intracellular organisms that grow in the cytoplasm of host cells. Two genera of clinical importance are Chlamydia, which includes Chlamydia trachomatis, and Chlamydophila, which includes Chlamydophila pneumoniae and Chlamydophila psittaci. These organisms share many features of bacteria and are susceptible to antibiotic therapy. They are also similar to viruses, requiring living cells for multiplication.

The chlamydial life cycle can be divided into 2 distinct phases: an extracellular, nonreplicating, infectious stage and an obligate intracellular, replicating, noninfectious stage. The infectious form, or elementary body (EB), attaches to the target cell membrane and enters the cell via a phagosome. After cell entry, the EB reorganizes into reticulate particles (forming inclusion bodies) and binary fission begins. After 18 to 24 hours, reticulate particles condense to form EBs. These new EBs are released, beginning another infection cycle.

C psittaci is the causative agent of psittacosis, a disease characterized by pneumonia, headache, altered mentation, and hepatosplenomegaly. Psittacosis is acquired by airborne transmission from infected birds.

C pneumoniae (formerly known as Taiwan acute respiratory agent: TWAR and, more recently, as Chlamydia pneumoniae) causes pneumonia in humans. It is unique because it is a primary pathogen of humans, is spread from human to human, and apparently has no animal or bird host. Chlamydophila pneumoniae is responsible for approximately 10% of pneumonia cases.

C trachomatis has been implicated in a wide variety of infections in humans. It is a common cause of nongonococcal urethritis and cervicitis, and many systemic complications of chlamydial infections have been described. In females, this organism is a cause of pelvic inflammatory disease, salpingitis, and endometritis. In males, epididymitis and Reiter syndrome occur. Lymphogranuloma venereum is a sexually transmitted infection caused by C trachomatis. It presents with a transient primary genital lesion followed by suppurative regional lymphadenopathy. Occasionally, severe proctitis or proctocolitis may develop. C trachomatis also causes ophthalmologic infections, such as trachoma (rare in the United States), adult inclusion conjunctivitis and inclusion conjunctivitis in neonates. These disorders have traditionally been diagnosed by cytologic detection or culture. However, molecular detection methods (CTRNA / Chlamydia trachomatis by Nucleic Acid Amplification [HOLOGIC], Varies) may now represent a more sensitive diagnostic approach.

Fitz-Hugh-Curtis syndrome (perihepatitis) has been associated with chlamydiae.