Chlamydia in the medical and popular literature usually relate to
diseases transmitted through sexual contact. At the same time almost all
reputable studies clearly show - chlamydia is currently the most common disease
of the diseases transmitted primarily through sexual contact. A detect
chlamydia every second of the surveyed women with inflammatory diseases of the
urogenital area, with two thirds of women suffering from infertility, in 9 out
of 10 women with recurrent miscarriages. In men, every second is caused by
chlamydia urethritis. Not so long ago associated with the infection cause
chronic diseases of the respiratory and digestive systems, the development of
atherosclerosis and its complications, cancer and many other serious disorders.
Is it all so seriously? And only a sexually transmitted infection chlamydia can
be? How dangerous are its complications? And is it possible to cure this
disease?
Numerous studies on the basis of which revealed the
prevalence of chlamydia, held at the end of the last century. A first
classification of microorganisms, which allowed to justify the treatment, set
up in 80-th years (Table 1).
Table 1.
Classification of chlamydia,
adopted by the International Association of Microbiological Societies (IAMS) in
1980
At present, it is safe to say that many of
populyarizuemyh at the time of the facts and opinions (many of which are
repeated unnecessarily and recklessly in the popular press of the present time)
have undergone major changes. This was the result of studies and acquisition of
new knowledge about chlamydia. Referred to changing attitudes affected the
revision of the virulence of the infection, clinical course and prognosis of
diseases caused by them, their epidemiology, etc. [1, 2]. And that is likely to
be elaborate.
Modern classification of chlamydia adopted
relatively recently - in 2000 - and includes four families and five genera of
microorganisms. In each genus is represented by one to six species, differing
in the structure of genes, which allowed to systematize the available clinical
information to a qualitatively new level. In particular, as previously
tipiruemyh isolated pathogens Chlamydia genus Chlamydophila, includes
nizkovirulentnye types of microorganisms. Previously, a number of reasons
(morphological complexity and technical nature), they are not separated. And if
they were isolated, it is not on the grounds of virulence. For example, Ch.
psittaci featured on Ch. trachomatis on the basis of resistance to
sulfadiazine. Although not all of C. psittaci are resistant to it. A Ch.
pneumoniae were classified according to its appearance under the electron
microscope, although it was found that they differed in the different research
groups [3, 4].
Table 2.
Classification of chlamydia,
adopted at the IV European Congress of "Chlamydia-2000" in Helsinki
The essence of this separation is that only the
original family of Chlamydia (in the overwhelming number of cases of Chlamydia
trachomatis) can cause specific diseases in humans. A classified in the genus
Chlamydophila only mimic the presence of chlamydia by their presence (or rather
"hlamidiopodobnoy") infection.
Etiopathogenesis. Despite
the fact that in this matter is not clear, from a practical point of view (the
prevention and treatment), chlamydia is now the former problem can be
considered solved. Some problems exist in the use of conventional methods for
diagnosis of infection, as discussed more below. Similarly, because of the complexities
of former and current topical diagnosis of chlamydia is unacceptable, some
previously accumulated arrays melon.
All species of Chlamydia are obligate intracellular
bacteria. Have two forms of life (elementary and reticular cells), and biphasic
cycle of development, have a penchant for persistence. Elementary body is
metabolically inactive, the extracellular form. Have a diameter of 250 - 500 nm
and a rounded shape. In the body get chlamydia in the form of elementary bodies
and, therefore, has called this form of infection. Reticular body is
intracellular, metabolically active form. It has a larger diameter - from 300
to 1000 nm - and may have a different shape. These unique of its kind microbes
occupy an intermediate position between viruses and bacteria, possessing some
properties of both. The presence of the cell wall at the stage of the reticular
cells does chlamydia like bacteria accessible to antibiotics. A difference in
the morphology of various phases of development determines the difficulty of
diagnosis. For example, some types of microorganisms of this group have a third
form.
At present, the ability to cause specific diseases
in humans has been proved only for the three types of chlamydia.
1. Chlamydia trachomatis - found only
in humans and causes a wide spectrum of disease (urogenital disease,
conjunctivitis, some forms of arthritis, myocarditis, etc.). Although the
frequency and nature of their different in nature. 18 known serotypes of this
organism and that from this point of view it is convenient to consider the
characteristics of the course of infection. For example, serotypes A, B, Ba,
and C are the causative agents of trachoma (an infectious disease that can lead
to blindness). Vectors are insects, and the main route of infection - rubbing
eyes with dirty hands. At the same time, from an epidemiological point of view,
some sort of danger is only serotype Ba (North America) and, to a much lesser
extent, serotype A (Middle East and North Africa). Serotypes L1, L2 and L3 can
cause a relatively rare Lymphogranuloma venerum (venereal limfogranulemu) and,
as casuistry, haemorrhagic proctosigmoiditis.
And that serotypes D, E, F, G, H, I, J and K cause
urogenital chlamydiosis, which is the main route of transmission is sexual. In
addition, they are able to conjunctivitis (serotype D) and neonatal pneumonia
(serotype E). Very rarely are the cause of paratrahomy adults. And from a
medical point of view it is a disease of epidemic interest [2, 5, 6].
The other two representatives of the genus Chlamydia
- Ch. suis and Ch. muridarum - do not cause infectious processes in humans,
being highly specific for the disease, respectively, pigs and rodents of the
family Muridae (mice and hamsters).
2. Chlamydophila pneumoniae - in
spite of their belonging to the "hlamidiopodobnym" microorganisms
capable of causing endemic (sporadic) cases of pneumonia-specific. Locally, the
incidence may be 60-84 cases per 1000 population. Infection occurs mainly
bronchitis and mild forms of pneumonia (with a tendency to chronicity of the
process). Infection is airborne and air-dust paths in the presence of mandatory
environmental conditions (warm, and dry air). The most vulnerable are those
aged 20 to 49 years. At the same time found that 70-90% of infected process is
latent, without severe symptoms. It is assumed that in rare cases can cause
specific meningoencephalitis, arthritis, myocarditis, and Guillain-Barre
syndrome. Currently, however, these data are reviewed [1, 7].
3. Chlamydophila psittaci - an
absolute zoonotic disease - an infection transmitted to humans from animals.
The potential to cause disease in birds and can then be transmitted to humans,
causing quite formerly known disease - psittacosis. Modes of transmission is
airborne and air-dust. In the United States each year not more than 200 cases,
although experts believe the actual number is greater. Endemic among the
parrots and pigeons, causing sporadic disease in other mammals (except man), as
well as turtles. According Prukner-Radovcić E. , et al. [8], in the big cities
infected pigeons reached 15.83% in the absence of antigen-positive individuals
among wild birds. As a potential source of infection for humans is important
for the elderly, children and immunocompromised patients, as well as poultry.
Serovars C. psittaci C and D are occupational hazards for workers and for the
slaughter of people in close contact with birds. Serovar E (also known as
Cal-10, MP or MN) isolated from different poultry flocks around the world.
Although he was connected with the epidemic psittacosis in people 20-30s of the
last century, the concrete tank had not been identified [9, 10].
Psittacosis often begins with flu-like symptoms and
becomes life-threatening in the development of chlamydial pneumonia. It is
sometimes not quite right referred to as "atypical." Very rarely is
believed to be possible specific arthritis, pyelonephritis, entsefalomiokardit.
Although these data are now being actively monitored. Infected birds treated
with tetracycline or special forms of chlortetracycline in the form of granules
that are added to the feed for 45 days. In addition, you must disinfect the
cage, dishes, and care items (such as Lysol solution).
Below mentioned microorganisms, previously
positioned as a human infection, but is currently excluded from among them:
1. Chlamydophila abortus - cause
disease only in animals and epidemichny of ruminants - causes abortion (fetal
death) in horses, rabbits, guinea pigs, mice. Is widespread in cattle and is
associated with clinical mastitis cows. Transmitted among mammals, and oral
infections, but not detected in birds. Currently, there is a question of
general vaccination of cattle since the disease brings significant economic
losses [3, 11]
2. Chlamydophila pecorum - cause
disease in animals, such as Ch. abortus (including the cow mastitis). Cows,
horses, goats, pigs, and koalas. Different serotypes cause infertility,
inflammation of the urinary tract, as well as abortion, conjunctivitis,
encephalomyelitis, enteritis, pneumonia and polyarthritis [11, 12].
3. Chlamydophila felis - the cat
causes rhinitis and conjunctivitis, which is also transmitted in the form of
specific, but does not require treatment, conjunctivitis people. According to
some reports, infection of cats with conjunctivitis is 12-30%, and among
unvaccinated domestic cats antibodies were detected in 10%. Infection without
symptoms is, according to the PCR, 2-3% [2, 13].
4. Chlamydophila caviae - guinea
pigs cause inflammation of the eye and conjunctival sac. It is specific to them
and non-invasive for other animals. It is also possible infection of the
genital tract with the development of clinical pigs, similar to human infection
Ch. trachomatis. The microorganism affects only the mucosal epithelium and is
not invasive. Despite extensive research 2003-2006, failed to show C. caviae as
a pathogen for humans [14].
Epidemiology. In
general, the role of pathogen Chlamydia trachomatis is a ubiquitous Ch.
trachomatis. Extensive studies show that only young people who are infected
with chlamydia in the world no less than 30%. At the same time in the
reproductive age of women in different regions from 30 to 60% and men - at
least 50%. The incidence of chlamydia in Russia does not have an epidemic
level, some, such as gonorrhea, but is 2.5 times lower incidence of
trichomoniasis - 99-101 case per 10,000 inhabitants. In Ukraine, it is more
than 50 cases per 100 000 population. In the country, according to some
estimates, roughly 4-8% of infected population [15, 16].
In the UK, chlamydia is the most common of all
sexually transmitted infections. 4-4.5 thousand are diagnosed each year of
diseases with a tendency to increase their number and frequency of complicated
forms (about 2.6%). Most often the disease is detected in the groups of men and
women 20-24 years - 16-19 years [2, 7] (Fig. 1).
Fig. 1. The incidence of chlamydia in index
DALY (a weighted measure of death, illness and disability) in different regions
of the world (per 100 thousand population)
In the United States become ill each year 3-4
million people with chlamydia with a tendency to increase. Ch. trachomatis is
the cause of half of NGU in men. It is detected in 3-5% of healthy men who were
hospitalized in ordinary hospitals and up to 15-20% of men admitted to the STI
clinic. Do gay men Ch. trachomatis in the urethra is found in 4-5% of cases,
and in the rectum - 4-7%. The material, taken from the cervix, Chlamydia were
detected in 5% of women without any symptoms of the disease and at least 20% of
women receiving treatment at STI clinics. The highest infection was observed
among the population aged 17-25 years, where Ch. trachomatis detected 10 times
more common than gonorrhea. According to various estimates, about 5% of U.S.
adults are infected with chlamydia. In this infection is the greatest factors
belonging to the following groups: 1) people under 25 years old, 2) the citizens,
and 3) African-Americans and 4) people with low socio-economic status. In
50-70% of children born to mothers ifitsirovannymi, get an infection from
birth. In a number of specific cases are reported of the eyes, rectum, vagina
and the back of the neck. And 30-40% of these children develop complications of
chlamydia in the form of conjunctivitis and pneumonia [3, 13].
Established ways of transmission of chlamydia are:
1. Sexual contact (vaginal or anal sex, much less -
oral). Characteristic of Ch. trachomatis.
2. Airborne (characteristic under special
conditions, for Ch. Pneumoniae, as well as Ch. Psittaci).
Contact-household, in which the infection is
transferred with contaminated hands, objects, etc. currently denied. Therefore,
the cause of contamination can not be toilet seats, swimming pools, sauna,
common utensils and towels. Understandable exception to this rule is trachoma,
which is characteristic for some African countries.
The probability of infection through unprotected
sexual contact (vaginal, anal) with patients with chlamydia is about 50%. At
the same time, we know that in monogamous sexual relationships of about 3-5% of
cases of chlamydia occur in only one partner. In the presence of mixed
infections are more likely to gonorrhea or trichomoniasis disease with a
decrease in the likelihood of chlamydia. One study showed that women, patients
with gonorrhea, infected their sexual partners of men in 81% of cases, while
suffering from chlamydial cervicitis passed the infection in only 28% of cases.
And if the women had both infections, the transmission of gonorrhea occurred
more frequently (77%) than that of chlamydia (28%). The incubation period of
chlamydia is from 1 to 3 weeks.
Symptoms
of chlamydiosis are very diverse, as relates to persistent chlamydia
infections, ie, flowing long and asymptomatic. In the latter case, this
concerns 25-50% of affected men and 67-80% of women. In other cases, as a rule,
the manifestations of the disease is minimal. This may be a discomfort in
the abdomen, a violation of urination (itching or pain,
frequent urge), whitish or clear discharge from the urethra.
Women can change the nature of menstrual bleeding (their shortening and change
of color) and intermenstrual appear. The appearance of scanty discharge from
the urethra and vagina are usually short-lived and observed after 7-30 days
after infection. It was asymptomatic chlamydia causes a significant risk of
specific complications. Although it is worth noting that they are much more
pronounced for women [2, 7, 15].
Proctitis is more
typical for homosexuals and is manifested in different severity of pain in the
rectum and false desires (tenesmus), but can occur without subjective symptoms.
And the most frequent clinical manifestation of infection in women is cervicitis,
which is observed in 30-60% of cases in combination with gonorrhea.
Independently, he normally bessimptomen. Scarce leucorrhoea observed in only
37% of women. Most often there is a slight itching or discomfort in the genital
area.
A very specific symptoms determines the articular
syndrome with chlamydia in both men (mostly) and women. Historically,
it is called Reiter's syndrome or oculo-urethro-synovial syndrome. Previously,
it was linked to Shigella, Yersinia and Salmonella, but now clearly understood
as the result of chlamydia. Clinically, Reiter's syndrome is a combination of
symptoms of urethritis (all patients), joints (in 90-95% of patients) and eyes
(conjunctivitis in 30-40%). Symptoms do not always appear simultaneously, but
it begins with urethritis, and then joined by other symptoms. Most - 1-2 weeks
after the start of urethritis, and occasionally a few months later. When
articular pain syndrome with predominant involvement of multiple major joints
(usually 4-5). Involved, rather than simultaneously, one after another. The
most commonly affected knee (70%), followed by ankle (50-60%), small joints of
the feet (40%), shoulder (20%), wrist (15%), hip (15%), elbow (n = 7 % of
patients). There is Unsharp pain in the joints, the skin over it becomes hot to
the touch, sometimes congested. Maybe there is swelling of the joints, very
rarely - effusion. Many patients develop pain after physical exertion, often
accompanied by myositis, muscle atrophy. He suffers from a general state of
health of patients. In 20% of patients with articular syndrome temperatures can
reach 38-40 ° C.
Possible damage to the skin and mucous membranes.
The most typical are clinic balanitis, changes in the oral mucosa
with erosions and desquamation of the plots, and keratoderma. It
begins with a rash of red spots on the palms, soles, or across the skin
surface. The spots turn into blisters, then pimples conical horn, or thick,
crusted plaques. Often the affected nails (thickening, brittleness nail plate).
For Ch. pneumoniae, as mentioned above, in 10-30%
of infection is characterized by the development of mild forms of pneumonia. At
the same time all the possible development of joint syndrome and, less
frequently, other lesions. But they all proceed more smoothly compared to Ch.
trachomatis.
Complications. For
men, the risk of specific complications is much lower, but increases with
repeated infection with chlamydia. Previously it was thought that chlamydia in
men often leads to prostatitis, which is now not recognized. Similarly, question
the possibility of infertility in the background scarring of the vas deferens
[6, 17].
Epididymitis.
Chlamydial infection is prevalent in much the role of the causes of
inflammation of the epididymis in young men. Only after 35 years, as evidenced
by the literature, begin to dominate the bacterial agents. For such a
combination of epididymitis necessarily with urethritis. There is swelling,
tenderness and pain in the scrotum (usually on one side only), often with
fever. The pain is so severe that the patient does not walk, but may be weak,
whining, and not cutting nature.
Endometritis
and salpingitis develops in
the absence of adequate treatment for women and are the result of the further
spread of chlamydia from the cervix. It is now established the prevalence of
chlamydial infection is, and not as previously thought, the bacterial
microflora. In certain cases, the infection spreads to the surface of the liver
with the development of perigepatita
(about 5% of women with salpingitis and endometritis). Develops pain in the
upper right quadrant of the abdomen, which is accompanied by nausea, vomiting
and fever. As a result of chronic inflammation of the fallopian tubes,
infertility can develop. According to various estimates, its incidence is
10-40% of untreated cases of chlamydia in women. In addition, the background of
specific inflammation (salpingitis) increases the risk - in descending order -
an ectopic pregnancy, chronic pelvic pain, pelvic peritonitis, miscarriages and premature births. About 5% of the
women of this population have a form of liver disease - perihepatitis - which
is considered as a separate form of chlamydia, and as a complication [4, 18]
Diagnosis. Each of the methods of
diagnosis of chlamydia has a number of advantages and disadvantages, have
varying degrees of sensitivity depending on the duration of the disease and the
localization process. For this reason, use at least two ways from different
groups.
Methods for direct detection
Microscopy of stained preparations. Stained cytological smears by the method of Romanovsky - Giemsa.
The culture diagnosis.
Isolation of the pathogen to the cell culture medium McCoy or HeLa. The
advantage is its high sensitivity and specificity, and lack of - the high cost
due to the requirements for material and technical equipment of laboratories
and staff.
Methods for DNA diagnostics.
Have high sensitivity and specificity. Require the taking of material for
analysis directly from the source localization of the pathogen.
A method of direct immunofluorescence (DFA) allows to identify chlamydial inclusions by the characteristic
yellow-green glow. A significant drawback is the subjectivity of evaluation,
which is largely dependent on the skills lab, and low sensitivity for small
amounts of antigens of Chlamydia. At the present time is rarely used.
Methods of indirect detection
Immunosorbent
assay (ELISA). A widely used method, although the accuracy did
not exceed 50-70%. Based on the detection of antibodies produced in response to
the introduction of the pathogen. In the presence of a combination of
antibodies of classes A, M and G gives an indication of advanced disease. For
example, the IgG titers indicate the presence of chlamydia, and IgA titers
indicates infection within the previous 2 weeks.
The
method of polymerase chain reaction (PCR). It is also widely
used technique, the accuracy of which reaches 90-95%. For several reasons the
method is strongly recommended to combine with ELISA.
Using these methods due to their rather difficult
reproducibility. Methodological violations in conjunction with a false-positive
reactions of some diagnostic kits manufacturers, according to some reports,
cause up to 30% of the overdiagnosis of the disease. What makes the prescribed
treatment is not justified. And that is why there is often recurrence of
diagnostic recommendations in two different laboratories [15, 16].
In addition to these subjective reasons rather
inaccurate diagnosis of chlamydia, there are more substantial. For, despite the
high accuracy of the PCR, it does not reach 100%, which are required to exclude
infection. In this context, low titres of antibodies (1:20 and below) is
recommended to repeat the study after 1 month. At the same time, while
maintaining a negative PCR and monotone low titers of antibodies in the blood
according to the ELISA is possible to ascertain the absence of infection. And
to avoid unnecessary treatment with a positive ELISA result is absolutely
necessary to confirm the PCR-scrapings. In this case a negative PCR test does
not exclude the presence of chlamydia, which requires monitoring (more frequent
and repeated) is according to the EIA. Among other reasons, some errors should
also mention increasing titer of IgG to a recent infection, especially those
newly transferred, against the effect of immunosuppressive viruses. Similar
effects occur after antibiotic treatment, which also have immunosuppressive
properties. However, in the latter case, such an increase in titer is not
beyond the laboratory error (rate fluctuations).
Do not forget to check other sexually transmitted
diseases, since the frequency of a combination of chlamydia with gonorrhea or
trichomoniasis is very high.
Treatment
for chlamydiosis is quite simple and in most cases does not cause
problems. The basis of treatment is antibiotics - macrolides, tetracyclines, or
- although, contrary to popular opinion, can be used, and representatives of
other groups. For 95% of patients a course of antibiotics will be sufficient
for a complete cure. If there are complications, as a rule only in women who
may need treatment, supplementing antibiotics (immunotherapy, restorative
drugs, physical therapy, etc.), but this therapy is situational. The definition
of "sensitivity" of chlamydia to antibiotics is not required because
they are absolutely sensitive to tetracyclines and macrolides.
Tetracyclines (doxycycline) and macrolides (azithromycin) is officially considered drugs of choice for treatment of chlamydia. For an alternative means include erythromycin (erythromycin and erythromycin ethyl succinate), and some fluoroquinolones (Table 3). But be aware that some drugs from the last-mentioned group, such as ciprofloxacin, are not sufficiently effective [7, 18].
Tetracyclines (doxycycline) and macrolides (azithromycin) is officially considered drugs of choice for treatment of chlamydia. For an alternative means include erythromycin (erythromycin and erythromycin ethyl succinate), and some fluoroquinolones (Table 3). But be aware that some drugs from the last-mentioned group, such as ciprofloxacin, are not sufficiently effective [7, 18].
Table 3 identifies some of the most commonly used
in the present treatment regimens.
Table 3.
Used antibiotic regimens
Against
chlamydiosis on background of chronic respiratory disease (COPD,
asthma, etc.) are recommended regimen of antibiotics for at least 14 days.
Shorter courses of treatment, as experience shows, these conditions do not
provide adequate sanitation, and do not protect against recurrent chlamydiosis.
In pregnancy, macrolides, and
used as an exception, allowed the use of penicillin (amoxicillin). At the same
time features of the effect of the latter on the life cycle of chlamydia, with
their inherent incidental activation of dendritic cells and the secondary
immune response, causes the growth rate of the articular and Reiter syndrome.
In addition, they are not efficient enough. That is why the use of penicillins
involves the need to re-culture results in 3-4 weeks. As an alternative, you
can use in pregnancy clindamycin, which provides a high cure rate (99%), but
this strategy is much more expensive therapy [17, 19].
A single dose. A number of
randomized trials confirm the high efficacy of azithromycin after a single oral
dose of 1 g (treated in 97-100% of cases), a significant reduction in the
incidence of side effects from the gastrointestinal tract and the absence of
adverse effects on the fetus. Also
recommended during pregnancy [15, 20].
With concomitant gonorrhea is
recommended to further single dose fluoroquinolone (ciprofloxacin 500 mg, 500
mg of levofloxacin or gatifloxacin 400 mg), if other treatment is antibiotics.
The combination of the infection with chlamydia commonly observed in
approximately 50% of cases. There are data that show an increase in the
frequency of transmission of gonococcal infection of the partner against
chlamydia. This requires in most cases, a more thorough preventive re-infection
[5, 16, 21].
In
the accompanying mycoplasmosis correction schemes mentioned above is not
required because they provide a cure both infections simultaneously.
The
prognosis for cure for chlamydiosis favorable. As a rule, only long-term
untreated chlamydial infection over time leads to the emergence of various
types of complications caused by the spread of germs to other organs and
tissues. And much more likely in those women.
Prevention
of chlamydiosis and its complications. The same as for other sexually transmitted diseases. It should be
clearly aware that the infection is no way to contact-household (with the usual
kiss, taking baths, a towel, utensils, toilet seats, etc.). Available in the
popular literature of the nature of the warnings are sometimes too much to
prevent unsanitary conditions.
In most
cases, within the next two months after the recovery should proceed with the
surrender of strokes (once a month to check for recurrence of chlamydia appears
to be sufficient). Titers of antibodies to chlamydia decreased by ELISA for
6-12 months.
Recommendations for prevention of primary
infection.
1. Use only
latex condoms during sexual intercourse. Most of the implemented during outside
the pharmacy distribution network ("no latex") are not a barrier to
chlamydia.
2. Avoid
sexual contact with partners "high risk". These are men and women 20-25
years, persons, leading promiscuous and people of lower socioeconomic status.
Recommendations
for prevention of secondary infection
3. Report
the infection you have found all their sexual partners. They also need to be
diagnosed for further treatment (if necessary). This way you tell your
re-infection.
4. Regular
sexual partners - after examination - must be treated simultaneously.
5. Inspect
again if symptoms of chlamydia and continued there after some time. The
presence of the disease in the past does not give immunity, ie, does not
protect you from re-infection.
6. Be sure
to completely finish the entire course of antibiotics that is prescribed for
you even though you feel fine and have no symptoms.
Further
research and some scientific data. With regard to
potency, promotions and pathogenetic effects of chlamydia on a number of
diseases rather large-scale studies have been underway for more than 30 years.
In this respect, particular interest is Ch. pneumoniae, disease manifestations
in humans is mediated by a variety of conditions. Not so long ago have been
completed in-depth study of the relationship between chlamydial infection and
the development of atherosclerosis and associated coronary heart disease.
Despite some data, where it was shown that infection with Ch. pneumoniae may be
a factor in the development atherosclerotic plaques, it was recognized that
significant differences between groups of patients were detected. But research
in the prevention of complications of atherosclerosis (myocardial infarction,
stroke) with antibiotics still in progress [5, 12].
There is evidence on the impact of Ch. pneumoniae
in the formation of arterial aneurysms. Suffice common in the age groups 65
years and older, as well as atherosclerotic narrowing of blood vessels, they
are often the cause of various complications. Back in 1996 Ong et al. [22]
reported the detection of microorganisms in 11 out of 25 investigated abdominal
aneurysms. Since that time held more than 12 special studies, which also
confirmed certain laws, including those in the experiment [18, 23].
Ch. pneumoniae with increased frequency is detected
in the cerebrospinal fluid of patients with multiple sclerosis. In this
treatment tetracycline antibiotics has given some encouraging results. Although
those who do not yet allow clear to talk about the role of chlamydia in the
etiopathogenesis of this disease [4, 6].
A significant number of studies conducted to determine
the relationship of infection Ch. pneumoniae with lung cancer. In a
meta-analysis found a slight increase in incidence in the background
serologically confirmed the presence of infection. But while the need for more
extensive study of this issue. Similar, very interesting data were obtained in
respect of diabetes mellitus type 2 and some forms of obesity. However, all
these studies are so far beyond the practical applications [14, 21, 24].
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