Chlamydia trachomatis, Mycoplasma, Ureaplasma, and other Non-Gonococcal urethritis:

Chlamydia trachomatis: Microscopy and culture:

- Small unicellular round-to-ovoid bacteria that cannot

stained by Gram’s stain.- Some inclusion bodies retain Iodine or the counter

stain safranin. - Rigid Cell wall .

- The cell envelope has two lipid bilayers with cell wall

material resembles a gram-negative (but not

peptidoglycan nor muramic acid).

n

- Obligatory intracellular parasite.- It depends on the host cellular energy compounds ATP,

and NAD.- Cultivated in yolk sac of embryonated egg or tissue

culture.

Chlamydia inclusion :R. bodies. Chlamydia inclusion .

Pathogenesis and life cycle:-Transmission: Sexual route.-Infectious part: The elementary body.-The elementary bodies taken by phagocytosis into susceptible host cell.-Once inside the cell, the elementary body prevents fusion of the phagosome and lysosomes.

-It will converted into metabolically active dividing Reticulate body. (non-infectious body).-Inclusion bodies. -After 48 hours, rupture of infected cell to release many elementary bodies.-Host cell death.

Chlamydia life cycle:N

Clinical picture of Chlamydia trachomatis:Annually, more than four million urogenital Chlamydia trachomatis infections occur in the USA in young individuals.1-Nongonococcal urethritis: -Caused by Serovars: D,E, F,.., to K. - In male : Urethritis, infection could extend to epididymitis. and orchitis. - In Female: Pelvic inflammatory disease. Urethritis, Cervicitis, Endometritis, Salpingitis.2-Lymphogranuloma venereum:(LGV): more invasive infection -Caused by Serovars: L1, L2, and L3. -Papules in the external genitalia.(for one to two months). -Painful swelling of inguinal and perirectal lymph nodes.

Clinical picture of Chlamydia trachomatis: N

Clinical picture of Chlamydia trachomatis:

Urethral discharge : (more mucoid with fewer pus cell). Chlamydial Cervicitis.

Laboratory diagnosis: Clinical specimens:Urethral discharge, urine, and Scraping of infected epithelial cells.1- Direct microscopy: A-Immunofluorescent microscopy. B-Electron microscopy.

2-Detection of Chlamydia genetic material by PCR.

3-Serology: Serologic testing for specific antibodies is not helpful except in suspected Lymphogranuloma venereum.

Laboratory diagnosis:

Immunofluorescent staining of inclusion body. Electron microscopy and immuno-electrone microscopy for inclusions.

Mycoplasma hominis and Ureaplasma urealyticum:- The smallest prokaryotic microbe with no peptidoglycan cell

wall.

- Because of their extremely small size(0.1-0.3 micrometer),

Mycoplasma species pass through sterilization filters.

- Lacking cell walls, all species are enclosed instead by lipid

bilayer membrane containing sterols. - Due to the absence of Cell walls:

1-The bacteria are plastic, pleomorphic in nature, and

cannot be classified as either cocci or rods.

2-The bacteria are resistance to penicillin and cephalosporins.

n

- Double-stranded DNA genomes measure less than one million Kilodaltons.

Cultural characteristics and colony morphology: - Facultative anaerobes, and some species are strict anaerobes.- Fastidious for external source of cholesterol (serum).- Given appropriate supplementation, they can be grown in cell-

free media.- Colonies are visualized microscopically by 30 to 100 x

magnification.- Colonies show a characteristics (fried egg) appearance.

Biochemical activities and clinical picture:

-Mycoplasma hominis and Ureaplasma urealyticum grow more rapidly than Mycoplasma pneumoniae.

-They can be distinguished by their carbon utilization patterns; M. hominis degrades arginine. U. urealyticum hydrolyses urea.In female:-The major clinical condition associated with M. hominis is postabortal fever.-M. hominis is recovered locally in cases of Pelvic inflammatory disease.-All M. hominis species are Erythromycin resistance.

n

- The drug of choice for treatment is tetracycline (for M. hominis). - Ureaplasma urealyticum is associated with cases of

Endometritis and vaginitis.

In male:- Ureaplasma urealyticum is associated with cases of Urethritis. - The infection could be disseminated to other tissue in immunocompromised patients.

Candidiasis:

- Most commonly encountered opportunistic mycoses worldwide.

- Cellular immunity protects against mucocutaneous candidiasis,

neutrophils protect against invasive candidiasis

- They are members of the normal flora.

- More than 150 species of Candida known.- Only ten species cause disease in humans.

- The most common species of medical significance are:

1-Candida albicans.

2-Candida tropicalis.

Morphology and cultural characteristics: Candida is thin-walled, small yeasts (4 to 6 microns) that reproduce by budding.Microscopically: Candida albicans is dimorphic, in addition to budding yeast cells, pseudohyphae, it also can produce true hyphae.Asexual Germination of Candida occurs by production of Blastospores or Chlamydiospores.

n

-Macroscopically: on agar media they produce creamy colonies within 24 hours at 37 C or room temperature.

-Candida species produce a small ,white, rounded colonies with feet projection and regular margin.

Germ tube test: -Candida species must be incubated with serum for 90 minutes at 37 C;

-yeast cells of C. albicans will produce true hyphae or germ tube.

Clinical picture of Candida albicans:

- Candida albicans causes almost 100% of cases of

oropharyngeal candidiasis and at least 90% of cases of

Candida vulvovaginitis.

- Vaginal candidiasis presents as itching and burning pain of

the vulva and vagina.

- Thick or thin white discharge.

- Vaginal swab and discharge should be examined for

differential diagnosis.

- Candida albicans can cause urethritis in male.

Trichomoniasis: Trichomonas vaginalis: Classification: urogenital Mastigophora. Morphology:20-30 um ,oval or pyriform in shape ,with short undulating membrane , axostyle and four free flagellae.Transmission: sexual intercourse,and contaminated clothes.

Pathology and Clinical picture: Vaginitis - itching, copious- yellowish offensive discharge. Urethritis in male and female. Prostatitis and seminal vesiculitis in male.

Diagnosis: by finding the trophozoites in smears from vaginal or urethral discharge.

Trichomoniasis:n