Snapshot A 5-year-old girl presents to the community clinic with a complaint of an intensely irritating foreign-body sensation in her left eye. On physical exam, she exhibits erratic twitching of her eyelid, inflammatory thickening of the upper tarsal conjunctiva, and evidence of conjunctival scarring. The girl and her family recently arrived in the United States from a refugee camp in Ethiopia, where they lived in crowded sleeping arrangements and had inadequate water access for personal hygiene. Overview Introduction Classification Chlamydia trachomatis obligate intracellular bacteria Pathogenesis transmission sexual intercourse passage through birth canal trachoma transmitted by hand-to-eye contact and flies location of infection genital tract eyes molecular biology obligate intracellular organism cannot make their own ATP requires live cells for growth in laboratory 2 forms reticulate body intracellular, metabolically active, replicating form "Reticulate Replicates" collections of reticulate bodies can be seen in the cytoplasm under light microscopy and are called "inclusion bodies" elementary body infectious, inactive, extracellular form small, dense "Elementary is Enfectious and Enters cell via Endocytosis" infection of mucosal surfaces leads to granulomatous response and damage cell wall lacks peptidoglycan beta-lactam antibiotics are thus ineffective Diseases trachoma most common cause of preventable blindness serotypes A, B, C chlamydia the most common bacterial STD in the United States serotypes D-K lymphogranuloma venereum serotypes L1-3 ("L for lymphogranuloma") Associated conditions co-infection with Neisseria gonorrhoeae pelvic inflammatory disease (PID) Presentation Trachoma itching and irritation of the eyes and eyelids discharge from the eyes containing mucus or pus eyelid inflammation blepharospasm conjunctival scarring trichiasis (inward-growing eyelashes) Chlamydia in females dysuria yellow mucopurulent discharge from the urethra vaginal discharge abnormal vaginal bleeding dyspareunia fever (in pelvic inflammatory disesease) asymptomatic in 80% of patients in males dysuria yellow mucopurulent discharge from the urethra unilateral pain and swelling of the scrotum fever asymptomatic in 50% of patients in newborns symptoms of conjunctivitis beginning at 1-2 weeks eye discharge eyelid swelling symptoms of pneumonia beginning at 1-3 months cough fever Lymphogranuloma venereum painful, localized inguinal adenopathy (buboes) genital ulceration Studies Laboratory diagnosis polymerase chain reaction (PCR) nucleic acid amplification test (NAAT) cytology for diagnosing infant conjunctivitis and trachoma visualization of intracytoplasmic inclusions Histology cytoplasmic inclusions (reticulate bodies) seen on Giemsa or fluorescent antibody-stained smear Additional studies pregnancy test for females with suspected chlamydial infection doxycycline contraindicated in pregnancy strongly consider testing sexual partners for Chlamydia Differential Bacterial vaginosis distinguishing factor gray vaginal discharge with a fishy smell Trichomonas vaginitis distinguishing factor frothy, yellow-green discharge motile trichomonads on wet mount Urinary tract infection distinguishing factor lack of cytoplasmic inclusions seen on Giemsa or fluorescent antibody-stained smear Treatment Medical azithromycin (one-time treatment) doxycycline add ceftriaxone for possible concomitant N. gonorrhoeae infection topical and oral erythromycin for neonatal chlamydial conjunctivitis Complications Pelvic inflammatory disease (PID) may include salpingitis endometritis hydrosalpinx tubo-ovarian abscess risk factor for ectopic pregnancy, infertility, chronic pelvic pain, and adhesions
QUESTIONS 1 of 4 1 2 3 4 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MC.17) A sample is taken of an ulcer in the inguinal region of a 29-year-old Malaysian male who has had unprotected sex in the past few months. Intracytoplasmic inclusions are seen in the Giemsa staining in Image A. On which of the following can the organism in the staining be grown? Review Topic QID: 101476 FIGURES: A 1 Bordet-Gengou agar 8% (20/238) 2 Löwenstein-Jensen agar 12% (28/238) 3 Charcoal yeast extract agar with cysteine and iron 13% (32/238) 4 Eaton's agar 14% (33/238) 5 Yolk sac of a chick embryo 51% (122/238) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK