ABSTRACT
Chlamydia trachomatis (CT) es uno de los agentes etiológicos más importantes en las infecciones de transmisión sexual. En la mujer CT causa patologías tales como cervicitis, uretritis y enfermedad pélvica inflamatoria, entre otras. Los objetivos de este trabajo fueron determinar la prevalencia de la infección y la concordancia de las pruebas diagnósticas para CT en pacientes sintomáticas de vaginitis o leucorrea inespecífica, que asistieron al hospital Pablo VI de Bosa y al Hospital del Sur de Bogotá, durante los meses de junio y julio de 2004. Se obtuvieron 180 muestras simultáneas de suero y de orina para la determinación de IgG, IgM e IgA anticlamidia y para PCR, respectivamente. La detección de los anticuerpos para CT en suero se realizó mediante el método ELISA (VIRCEL) y la detección del DNA en orina se hizo con la prueba AMPLICOR CT PCR (ROCHE). La prevalencia de la infección fue del 31 porciento (56 casos). La mediana de edad en mujeres con evidencia de infección reciente o activa fue de 23 años; 37 pacientes (66)porciento positivas para algún marcador tenían infección activa. En 24 participantes (42.8)porciento con infección activa, de acuerdo con los resultados serológicos, no se detectó el DNA en orina; en 14 pacientes (25 porciento de las pacientes positivas en las pruebas serológicas) se encontró el PCR positivo en las muestras de orina. Una prevalencia del 31 porciento en mujeres sintomáticas indica que la infección por Chlamydia es un problema para la salud pública. Implantar un programa de tamizaje para la búsqueda activa de casos, así como la búsqueda activa de contactos sexuales, reducirá el peso socioeconómico de la infección. La prueba ideal para diagnóstico tanto de cervicitis como de uretritis en el mismo procedimiento deberá utilizar muestra de orina y de cepillado cervical.
Subject(s)
Humans , Adult , Female , Chlamydia trachomatis/classification , Chlamydia trachomatis/metabolism , Urethritis/diagnosis , Prevalence , Enzyme-Linked Immunosorbent Assay/classification , Enzyme-Linked Immunosorbent AssayABSTRACT
BACKGROUND & OBJECTIVES: With increasing burden of human immunodeficiency virus (HIV) infection acquired immunodeficiency syndrome (AIDS) in India, documentation on the epidemiology of genital chlamydial infections in high-risk patients with sexually transmitted diseases (STD) is of significant public health value. Specific diagnosis is essential to prevent the morbidity due to the chlamydial infection and to reduce the risk of acquiring HIV infection. The present study was undertaken to analyse the usefulness of culture and antigen detection by direct fluorescent antibody (DFA) test for assessing the rate of Chlamydia trachomatis infection in symptomatic patients and feasibility of these tests for routine adoption in Indian setting. METHODS: Clinically diagnosed patients of both sex (n=143) attending the Institute of Sexually Transmitted Diseases, Government General Hospital, Chennai who consented for the study, were enrolled. Clinical and demographic details were recorded on a stratified proforma. Genital swab specimens collected from them were subjected for culture using McCoy cell line and for antigen detection by DFA testing. RESULTS: C. trachomatis was isolated in 27 of the total 143 patients (18.9%). Culture positivity was seen in 11 of the 63 (17.5%) males and in 16 of 80 (20%) females. DFA detected C. trachomatis specific antigen in 35 patients (24.5%); 15 (23.8%) males and 20 (25%) females. The rate of C. trachomatis diagnosis increased to 25.2 per cent by adopting both the methods as against 18.9 per cent by culture only and 24.5 per cent by DFA only. No association of C. trachomatis infection with any predictable genitourinary symptom (s), was seen. INTERPRETATION & CONCLUSION: The findings show a high infection rate for C. trachomatis in symptomatic patients with STD. Clinical symptoms alone can be unreliable in specifically predicting infections with C. trachomatis. Specific diagnostic tests need to be recommended for routine inclusion in the STD diagnosis to facilitate risk reduction of HIV infection in STD patients.
Subject(s)
Adult , Chlamydia Infections/diagnosis , Chlamydia trachomatis/metabolism , Female , Fluorescent Antibody Technique, Direct , Humans , India , Male , Middle Aged , Risk , Sexually Transmitted Diseases/diagnosisABSTRACT
BACKGROUND & OBJECTIVES: Very few studies have been done in India to determine the prevalence of Chlamydia trachomatis causing conjunctivitis using polymerase chain reaction (PCR) methods. Hence the prevalence of primary conjunctivitis due to C. trachomatis among individuals attending ophthalmic hospitals in Chennai was determined and compared with our earlier results. METHODS: A total of 328 conjunctival swabs from 255 (both eyes 73 and one eye 182) patients were investigated by fluorescent antibody test (FAT) on direct smears, culture and PCRs for cryptic plasmid and major outer membrane protein (MOMPI) gene of C. trachomatis. An infant with ophthalmia neonatorum was also included. RESULTS: Among these 328 specimens processed, 16 (4.9%) from 12 (4.7%) patients were positive by cryptic plasmid PCR. Among these, 3 from 2 patients were positive by FAT (direct smear), culture and PCR for MOMP 1 gene. Both eyes of the infant with ophthalmia neonatorum were positive by all the methods. The sensitivity of FAT and culture (18.8%) was lower compared to PCR. INTERPRETATION & CONCLUSION: A significant decrease in the prevalence of adult chlamydial conjunctivitis has occurred in the 10-year period among patients reporting to the ophthalmic hospitals in Chennai. PCR using cryptic plasmid primers was found to be the most sensitive method to detect C. trachomatis in patients with conjunctivitis.