Pediatric Chlamydial Infections 

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Background

Chlamydia infection can cause disease in many organ systems. The most frequent disease caused by Chlamydia trachomatis is a sexually transmitted infection (STI) that affects the cervix, urethra, salpinges, uterus, nasopharynx, and epididymis.[1, 2, 3] C trachomatis infection causes other diseases, including conjunctivitis, pneumonia or pneumonitis, afebrile pneumonia syndrome (in infants born vaginally to infected mothers), Fitz-Hugh-Curtis syndrome (inflammation of the liver capsule), and trachoma, the world's leading cause of acquired blindness,[4] which is spread from eye-to-hand-to-eye and caused by serotypes A, B, and C.

Chlamydophila pneumoniae infection is spread via respiratory droplets and causes pharyngitis, bronchitis, and pneumonia. Chlamydophila psittaci infection is spread by bird droppings and aerosols and causes psittacosis. These infections are not discussed in this article.

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Pathophysiology

C trachomatis is an obligate intracellular bacterium that infects the urethra and cervix. The bacterium is usually spread through sexual activity and can be vertically spread, causing conjunctivitis and pneumonia in newborns (see Afebrile Pneumonia Syndrome). If untreated, genital disease can progress to epididymitis in males and upper genital tract disease in females. Chlamydia infects columnar epithelial cells, which places the adolescent female at particular risk of infection because of the presence of the squamocolumnar junction on the ectocervix present until early adulthood.

An infected male has a 25% chance per sexual encounter of transmitting the infection to an uninfected female. The transmission rate from infected mother to newborn is 50%, causing conjunctivitis (most cases) or pneumonia (10-20%). The incubation period is 1-5 weeks compared with 0-2 weeks for Neisseria gonorrhoeae infection, which is the most significant STI in the differential diagnosis of conjunctivitis in newborns.

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Epidemiology

Frequency

United States

Approximately 3 million episodes of chlamydia are reported each year, making it the most prevalent STI. More than half of reported cases occur in females aged 15-24 years.[5] Sexually active female populations average carriage rates of about 20%. Many patients are asymptomatic. The incidence rate is 2-3 times that of N gonorrhoeae.

International

Recent serosurveys document similar incidence in Australia,[6] New Zealand,[7] France,[8] Germany,[9] and the Netherlands.[10]

Mortality/Morbidity

Deaths are rare and are caused by progression to salpingitis and tuboovarian abscess with rupture and peritonitis. The most significant morbidity occurs when repeated episodes of chlamydia lead to obstruction and scarring of the fallopian tubes, resulting in partial or total sterility. Chlamydia is an indirect cause of mortality from ectopic pregnancies.[11] Mortality due to ectopic pregnancy is probably more common than is death due to tuboovarian abscess.

Race

Chlamydia is more common in blacks, Hispanics, and Native Americans in the United States. Variability in socioeconomic groups may explain racial differences because of the lack of ability to obtain adequate health care.

Sex

The male-to-female ratio is 1:1.

Age

Chlamydia is most prevalent in persons aged 15-24 years.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

Marc James Grella, MD  Clinical Instructor, Department of Pediatrics, Massachusetts General Hospital

Marc James Grella, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Medical Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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CT scan of an adolescent with chlamydial Fitz-Hugh-Curtis syndrome demonstrating a perihepatic fluid collection anterior to the liver.
CT scan of an adolescent with chlamydial Fitz-Hugh-Curtis syndrome demonstrating free peritoneal fluid.
 
 
 
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