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level: Level 1

Questions and Answers List

CHLAMYDIA LVG

level questions: Level 1

Question	Answer
CHLMYDIA IS classified according to MOMP of which there are 18 serovariants..?	1)A,B, Ba, C: TRACHOMA 2) D-K(B,C): GENITAL INFECTION 3)L(L1-L3) LYMPHOGRANULOMA VENEREUM LVG. women with infection with serotype G are increases risk of developing cervical cancer.
LVG biovar are characterised in the lab by some abilities: what are they?	1) grow fast and vigorously in cell cultures 2) grow unassisted without centrifuge infection and pre treatment with polycations.
LVG BIOVAR is remarkable for its tropism (ability to infet diff cells) which include?	lymphoid cells and cause systemic disease. it primarily occurs in homosexuals as genital infections and Must be considered in differential diagnosis of genital ulcers.
seen in the primary stage, after the Incubation Phase which may be as wide as 3-30/7 lesions which are usually transient and painless appear in men and women on which part of the body?	Men:gland penis Women: vaginal wall, labia or cervix. occasionally on extra genital sites: anus, fingers or tongue.
in the secondary stage, where most patient appear in the clinic, the characteristic features include	marked Lymphadenopathy (unilateral). Retroperitoneal in women and inguinal in men. in the bubonic form, both the inguinal and femoral lymph nodes are involved giving rise to the 'characteristic 'grooves sign'.
in the bubonic form of LVG, there is the 'characteristic 'grooves sign' which is seen in small proportions of patients. this is due to?	involvement of both inguinal and femoral lymph nodes and separation of pupart's ligament.
in secondary LVG, infected lymph nodes may become abscesses which eventually suppurate and give rise to fistulae, to avoid rupture swollen buboes must be?	aspirated. in some patients, chronic lymphadenopathy may persist for years.
tissue destruction is common in tertiary LVG where epithelial tissue is replaced by granulation and infiltration of plasma cells. the order of tissue destruction are?	1st) proctitis. 2nd) followed by recto-vaginal fistulae(women) 3rd) urethral destruction
rectal infection with LVG biovar of C. trachomatis is relatively common in homosexual men. when compared to other chlamydial proctitis, LVG biovar of C. trachomatis is accompanied by?	signs of systemic Cachexic(loss of body weight and muscle mass and weakness) illness: fever, chills, weight loss and constipation.
LVG biovar of C. Trachomatis involves primary, secondary and tertiary complications which include?	primary: PROCTOCOLITIS secondary: RECTAL STRICTURE, ACUTE MENINGEOENCEPHALITIS, FOLLICULAR CONJUNCTIVITIS tertiary: GENITAL ELEPHANTIASIS, FISTULAE, RECTAL STRICTURE
COMPLIcations of primary LVG	PROCTOCOLITIS
complications of secondary LVG	RECTAL STRICTURE, ACUTE MENINGEOENCEPHALITIS, FOLLICULAR CONJUNCTIVITIS
complication of tertiary LVG	GENITAL ELEPHANTIASIS, FISTULAE, RECTAL STRICTURE
in lab diagnosis, the gold standard in chlamydial diagnosis is via	Culturing(incubation 40-72 hrs). Geimsa stain is used for staining smear/ scrapping from urethra, cervix vagina, lymph nodes and ulcer.
cell line in Chlamydia culturing include	Mc Coy, Hela-229, BHK-21
in cases with legal implications, because of its specificity(100%) and sensitivity, the only test to be used to establish the presence of infection of chlamydia is?	cell culture. (what are the cell lines?)
serological diagnosis(not recommended in diagnosis of genital tract disease) of chlamydia is inadequate in chronic infection, however in acute infection they may be useful. what immuoglobulins are measured.	four fold rise in IgA/IgG titres measure over several weeks apart. Pos IgM is marker for current infection. diagnosis is made via Micro-immunoflorescence(MIF) which uses EBs as antigen.
sensitivity, specificity and predictive values of serologic studies for chlamydia are not high enough to make any of them clinically useful in the diagnosis of active disease, the antibodies measured include?	IgA,IgG and IgM antibodies that can distinguish recent infection (IgM) from past infections(IgG) as well as primary infections. ELISA can also measure the three antibodies.
Complimet fixation test can also be used in detection of antibodies in chlamydial infections although it lacks specificity, it is beneficial because?	1) much less demanding the MIF 2)LP antibodies are produced very early in primary infection. (60% sensiitivity)
other lab techiniques for chlamydia infections	1)DFA method of choice for confirming other assays: sensitivity 50-80, specificity: 99% 2)ELISA used in A&E: sensitvity:40-60, specificity 99%.
newer probes used in nucleic acid detection of chlamydia trachomatis and N. gonorrhoeae use MSU may obviate the need of direct sampling in uncomplicated cases and in evaluation of sexual abuse. some methods of NAD include	1) pcr (can deteect 10-100 EBs) 99/99. rapid and relaible diagnosis. 2)lcr 3) strand displacemnt amplification (SDA) 4) HYbrid capture system(HCS) 5) transcription mediated amplification (TMA) or RNA 6) specific probes for DNA
other tests and biopsy for chlamydia	biopy: genital tract or material aspirated for lymph nodes CT: identify Fitz-hugh- curtis syndrome (perihepatitis) and free perotoneal fluid Ultrasound: tubo-ovarian abscess radiography: infants suspected of pneumonia.
treatment of chlamydia infections	1)doxycycline is the drug of choice. 2)tet/ macrolides: erythromycin and azithromycin. flouroquinolones can also be used.
benefit of azithromycin in chlamydia infection	it is long actin and concentrated within cells, allowing for single dose in genital infections and is a short course therapy (3 dasy) for pneumonia.
obtaining a pregnancy test is helpful in early diagnosis and treatement guidance. why is pregancy test critical befroe beginning treatement.?	it is contraindicated in the use of Doxycycline and ofloxacin
reommended regimens for LVG	1a)AZITHROMYCIN: 1G orally in a single dose/ or 1b)DOXYCYCLINE 100mg p/o 2x/7days alternative regimens) 2a) ERYTHROMYCIN ETHYLSUCCINATE 800mg P/O 4x /7d or 2b)ERTHROMYCIN base 500mg p/o 4x/7days OR 2c)LEVOFLOXACIN 500mg p/o1x/7days or 2d)OFLOXACIN 300mg p/o 2x/7 days.