3. History
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Walkee in 1833 first identified
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Caddy 1902 “Climatic bubo” India
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Durand-Nicolas-Favre 1913 “LGI”
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Frei 1925 – Intradermal Test
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1927 Chlamydia Trachomatis causal agent
4. DEFINITION
•
•
•
•
•
•
Sexually transmitted disease
A disease affecting the Lymphatic System
Caused by Chlamydia Trachomatis Serovars
L1-L2-L3
Regional Suppurative LAN preceded by a
small transient inconspicuous lesion at
Inoculation Site
5. EPIDEMIOLOGY
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6% Prevalence Rate in Clinics
•
Endemic to India
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20 - 40 yrs.
•
Male : female = 5 :1
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Urban, sexual promiscuity, low socio- economic
status.
6. AETIOLOGY
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Chlamydia Biovar LGV Serovar L1/L2/L3
•
Obligate intracellular, Gram negative bacillus with
humans as Natural Hosts by Sexual Transmission /
Perinatal infection
•
Intracytoplasmic inclusion bodies
•
Controls the organelles of host cells for own growth
and protein synth
•
Cell cycle – 48 to 72 hrs
8. PATHOGENESIS
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•
•
•
•
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Entry into cell as Metabolically inactive
elementary body (Eb) by receptor mediated
endocytosis.
Conversion to Active Reticulate Bodies which
multiply , condense and form Eb burst out of
host cells
Lymphangitis, perilymphangitis, necrosis of
lymph nodes
PMN stellate abscess- bubo
Healing by fibrosis - esthiomene, adhesions
Dissemination rare
16. SECONDARY STAGE
•
‘Stage of Diagnosis’
? Women
Dissemination (Rare, hematogenous)
•
Arthritis
•
Ocular inflammatory disease
•
Pneumonitis
•
Hepatitis
•
EN / EM
17. TERTIARY STAGE
•
•
Develops in 25% of untreated
GENITO-ANO-RECTAL syndrome, more common in
women / MSM
Clinical features
•
•
Hyperplastic Ulcerative lesions
Proctocolitis
• Bloody purulent discharge
• Pruritis Ani
• Tenessemus
23. Extragenital manifestations
Ocular manifestations
•
Can occur at any stage
common with L2
Conjunctivitis, Episcleritis, Keratitis, Iritis
Submaxillary, post auricular LN
•
•
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Cutaneous manifestations
Id eruptions
Ilio-Psoas Abscess
27. Management
General measures
Medical Cap Doxycycline 100 mg bd
Tab Erythromycin 500 mg qid
Tab Azithro 1gm/wk
21days
Erythromycin 7.5- 12.5 mg/kg qid for 2-3wk for
children and pregnant patients
28.
Surgical
Bubo aspiration preferred over I & D
Sx - elephantiasis, esthiomene, sinus,
fistulae,
stricture dilatation
Partner management (All contacts in 60
days)
azithromycin 1 gm orally single dose or
doxycycline 100 mg BD X 07 days