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Section 3. Summaries of Infectious Diseases
CHLAMYDIAL INFECTIONS
Chlamydia trachomatis
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Chlamydia trachomatis is associated with a range of clinical manifestations, including neonatal conjunctivitis, trachoma, pneumonia in young infants, genital tract infection, and lymphogranuloma venereum (LGV). Neonatal chlamydial conjunctivitis is characterized by ocular congestion, edema, and discharge developing a few days to several weeks after birth and lasting for 1 to 2 weeks and sometimes much longer. In contrast to trachoma, scars and pannus formation are rare.
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Trachoma is a chronic follicular keratoconjunctivitis with neovascularization of the cornea that results from repeated and chronic infection. Blindness secondary to extensive local scarring and inflammation occurs in 1% to 15% of people with trachoma. Trachoma is rare in the United States.
Pneumonia in young infants usually is an afebrile illness occurring between 2 and 19 weeks after birth. A repetitive staccato cough, tachypnea, and rales are characteristic but not always present. Wheezing is uncommon. Hyperinflation usually accompanies the infiltrates seen on chest radiographs. Nasal stuffiness and otitis media may occur. Untreated disease can linger or recur. Severe chlamydial pneumonia has occurred in infants and some immunocompromised adults.
Vaginitis in prepubertal girls; urethritis, cervicitis, endometritis, salpingitis, and perihepatitis in postpubertal females; epididymitis in males; and Reiter syndrome (arthritis, urethritis, and bilateral conjunctivitis) also can occur. Infection can persist for months to years. Reinfection is common. In postpubertal females, chlamydial infection can progress to acute or chronic pelvic inflammatory disease and result in ectopic pregnancy or infertility.
Lymphogranuloma venereum is an invasive lymphatic infection with an initial ulcerative lesion on the genitalia accompanied by tender, suppurative, inguinal and/or femoral lymphadenopathy that is most common unilaterally. Anorectal infection and hemorrhagic proctitis resulting in fistula and
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