[Determining antimicrobial resistance to Chlamydia trachomatis and applying present findings in daily practice]

Chlamydia trachomatis (C. trachomatis) is the most common bacterial causative agent of sexually transmitted diseases today. Treatment outcome will depend on the choice of antimicrobial drug. Therefore, it is very important to know antimicrobial sensitivity of this pathogen. Cultivation in cell culture is a method of choice for diagnosis of C. trachomatis infection, in terms of medico-legal investigations and follow-up after completed therapy, but also serves for determining the antimicrobial sensitivity of C. trachomatis. Tetracyclines, macrolides and kinolones are commonly used in the treatment of the C. trachomatis infection. Resistance to these antibiotics was described for strains isolated from unsuccessfully treated patients. All described resistant clinical strains demonstrated in vitro heterotypic resistance. To date no homotypic resistance was described for human isolates. An evaluation of antimicrobial resistance and treatment outcome in C. trachomatis infection is complicated by the lack of standardized tests, as well as by the fact that in vitro resistance does not correlate with clinical outcome. In case of any suspicion of unsuccessful treatment of genitourinary infection caused by C. trachomatis isolation should be attempted and isolated strains forwarded to a specialized laboratory.

Effects of baicalin on Chlamydia trachomatis infection in vitro

Baicalin has emerged as a promising agent for the therapy of infectious diseases due to the increasing number of pathogenic microbial strains resistant to several antibiotics. In this study, we investigated the inhibitory activity of baicalin on Chlamydia infection in vitro. We found that baicalin blocked the infection of HeLa cells in vitro when added to the infected cells. In order to shed light on the inhibitory effects of baicalin on the Chlamydia-infected cells, the expression of RFX5 and Chlamydia protease-like activity factor (CPAF) mRNAs and proteins in the Chlamydia-infected cells were examined using Western blot and real-time RT-PCR analysis. The results demonstrated that RFX5 and CPAF were upregulated and downregulated, respectively, by baicalin. Because CPAF is responsible for degrading RFX5, it is suggested that CPAF is a primary target of baicalin and plays an important role in downregulating RFX5. In conclusion, our findings demonstrated that baicalin can effectively inhibit Chlamydia Trachomatis in HeLa cells and therefore can be considered a potential agent for the therapy of infectious diseases caused by C. trachomatis.

Penicillin induced persistence in Chlamydia trachomatis: high quality time lapse video analysis of the developmental cycle

BACKGROUND

Chlamydia trachomatis is a major human pathogen with a unique obligate intracellular developmental cycle that takes place inside a modified cytoplasmic structure known as an inclusion. Following entry into a cell, the infectious elementary body (EB) differentiates into a non-infectious replicative form known as a reticulate body (RB). RBs divide by binary fission and at the end of the cycle they redifferentiate into EBs. Treatment of C.trachomatis with penicillin prevents maturation of RBs which survive and enlarge to become aberrant RBs within the inclusion in a non-infective persistent state. Persistently infected individuals may be a reservoir for chlamydial infection. The C.trachomatis genome encodes the enzymes for peptidoglycan (PG) biosynthesis but a PG sacculus has never been detected. This coupled to the action of penicillin is known as the chlamydial anomaly. We have applied video microscopy and quantitative DNA assays to the chlamydial developmental cycle to assess the effects of penicillin treatment and establish a framework for investigating penicillin induced chlamydial persistence.

PRINCIPAL FINDINGS

Addition of penicillin at the time of cell infection does not prevent uptake and the establishment of an inclusion. EB to RB transition occurs but bacterial cytokinesis is arrested by the second binary fission. RBs continue to enlarge but not divide in the presence of penicillin. The normal developmental cycle can be recovered by the removal of penicillin although the large, aberrant RBs do not revert to the normal smaller size but remain present to the completion of the developmental cycle. Chromosomal and plasmid DNA replication is unaffected by the addition of penicillin but the arrest of bacterial cytokinesis under these conditions results in RBs accumulating multiple copies of the genome.

CONCLUSIONS

We have applied video time lapse microscopy to the study of the chlamydial developmental cycle. Linked with accurate measures of genome replication this provides a defined framework to analyse the developmental cycle and to investigate and provide new insights into the effects of antibiotic treatments. Removal of penicillin allows recovery of the normal developmental cycle by 10-20 hrs and the process occurs by budding from aberrant RBs.

Trachoma surveillance annual report, 2008. A report by the National Trachoma Surveillance and Reporting Unit

The National Trachoma Surveillance and Reporting Unit has reported data for trachoma endemic regions and communities in the Northern Territory, South Australia and Western Australia for 2006 to 2008. Aboriginal children aged 1-9 years were examined using the World Health Organization grading criteria. Screening in the Northern Territory was conducted by the primary health care staff from the Healthy School Age Kids program, the Australian Government Emergency Intervention and Aboriginal Community Controlled Health Services. Forty-three of 92 communities in 6 regions were screened and reported data (2,462 children). In South Australia, the Eye Health and Chronic Disease Specialist Support Program and a team of eye specialists visited 11 of 72 communities in regions serviced by 6 Aboriginal Community Controlled Health Services (365 children). In Western Australia, population health unit and primary health care staff screened and reported data for 67 of 123 communities in 4 regions (1,823 children). Prevalence rates of active trachoma varied between the regions with reported prevalence ranging from 4%-67% in the Northern Territory, 0%-13% in South Australia and 8%-25% in Western Australia. Statistical comparisons must be viewed with caution due to the year-to-year variation in the coverage of children examined and the small numbers. Comparisons of 2006, 2007 and 2008 regional prevalence of active trachoma showed that many communities had no change in prevalence, though there were a few statistically significant increases and decreases (P<0.05). The number of communities screened and the number of children examined has improved but still remains low for some regions. The implementation of the World Health Organization Surgery (for trichiasis), Antibiotics (with azithromycin), Facial cleanliness and Environmental improvement (SAFE) strategy has been variable. Few data continue to be reported for the surgery and environmental improvement components. In general, the availability of the community programs for surgery, antibiotic treatment, and facial cleanliness has improved. Reporting of antibiotic treatment has improved from 2006 to 2008. No significant changes were noted in bacterial resistance reported by pathology services from 2007 to 2008; these rates are comparable to national data collected by the Advisory Group on Antibiotic Resistance in 2005.

Chlamydia trachomatisand male fertility

There is increasing evidence that the function of human spermatozoa can be significantly affected by direct exposure to the bacterium Chlamydia trachomatis. This may contribute to sub-fertility in infected individuals by a route that is independent of any damage to the reproductive epithelium. In addition, if a C. trachomatis infection is undiagnosed it could contribute to poor outcomes in assisted conception techniques such as in vitro fertilization. The antibiotics routinely used in IVF culture systems are largely ineffective against chlamydia, emphasizing the importance of screening patients prior to treatment. Moreover, given the many thousands of semen samples provided for analysis by men in primary care (many of which will never undergo assisted conception treatment), it is suggested that this may represent a wasted opportunity to provide screening (and treatment) for the infection using an appropriate test specimen and without the need for additional hospital visits.

When can antibiotic treatments for trachoma be discontinued? Graduating communities in three African countries

BACKGROUND

Repeated mass azithromycin distributions are effective in controlling the ocular strains of chlamydia that cause trachoma. However, it is unclear when treatments can be discontinued. Investigators have proposed graduating communities when the prevalence of infection identified in children decreases below a threshold. While this can be tested empirically, results will not be available for years. Here we use a mathematical model to predict results with different graduation strategies in three African countries.

METHODS

A stochastic model of trachoma transmission was constructed, using the parameters with the maximum likelihood of obtaining results observed from studies in Tanzania (with 16% infection in children pre-treatment), The Gambia (9%), and Ethiopia (64%). The expected prevalence of infection at 3 years was obtained, given different thresholds for graduation and varying the characteristics of the diagnostic test.

RESULTS

The model projects that three annual treatments at 80% coverage would reduce the mean prevalence of infection to 0.03% in Tanzanian, 2.4% in Gambian, and 12.9% in the Ethiopian communities. If communities graduate when the prevalence of infection falls below 5%, then the mean prevalence at 3 years with the new strategy would be 0.3%, 3.9%, and 14.4%, respectively. Graduations reduced antibiotic usage by 63% in Tanzania, 56% in The Gambia, and 11% in Ethiopia.

CONCLUSION

Models suggest that graduating communities from a program when the infection is reduced to 5% is a reasonable strategy and could reduce the amount of antibiotic distributed in some areas by more than 2-fold.

[Diagnosis of urethritis in men. A 3-year review]

OBJECTIVES

The aim of this study is to know the prevalence and tendency of microorganisms producing urethritis, in men, in the City Centre of Madrid.

METHODS

Cross-sectional study. The urethral samples of 1.248 men were analyzed, for 3 years. The samples were studied for: GRAM stain, when secretion exists; culture in habitual plates; detection of C. trachomatis, U. urealyticum and M. hominis, when there was suspicious, study of T. vaginalis and when suspicious injuries exist, study of virus Herpes simplex.

RESULTS

The percentage of positive samples was 22.60%. The isolated microorganisms were: U. urealyticum 7.61%, N. gonorrhoeae 6.33%, C. trachomatis 4.81%, M. hominis 0.24%, H. parainfluenzae 1.76%, H. influenzae 1.12%, Candida spp 0.48%, S. pyogenes 0.16% and Herpes virus simplex (2) 0.08%. Two or more microorganisms were isolated in 1.68%. The percentage of positive samples in 2003 was 17.41% and N. gonorrhoeae the most frequent microorganism (6.22%). In 2004 was 25.57% and the most frequent U. urealyticum (10.18%). In 2005 the 24.50% of the samples were positive and U. urealyticum the most frequent (7.92%). The 79.41% of N. gonorrhoeae were susceptible to all antibiotics tested. It is not found resistance to ceftriaxone, claritromicine and amoxicilline/clavulanic acid. The 11.76% were betalactamase- producing. The 26.47% of Haemophilus spp. were betalactamase- producing and all strains were susceptible to cefotaxime.

CONCLUSIONS

The isolated microorganisms most frequently were: U. urealyticum, N. gonorrhoeae and C. trachomatis. There is an increase of 7% of prevalence between the years 2003 and 2005. Ceftriaxone, claritromicine and amoxicilline/clavulanic acid were susceptible to all the strains studied and cefotaxime to all Haemophilus spp.

[Analysis of the infection status and the drug resistance of mycoplasma and chlamydiae in genitourinary tracts of children with suspected nongonococcal urethritis]

OBJECTIVE

To investigate the infection and the drug resistance status of mycoplasma and chlamydiae in genitourinary tracts of children with suspected nongonococcal urethritis (NGU) and provide information for clinical rational administration of antimicrobial agents.

METHODS

Samples of genitourinary tract secretion from 146 children who were suspected of having nongonococcal urethritis or colpitis were collected and tested for mycoplasma via culture and for chlamydia with antigen detection. Meanwhile, susceptibility test was carried out on the samples which were positive in mycoplasma cultivation. Chlamydia antigen was detected by the polymer conjugate-enhanced (PCE) indirect enzyme immunoassay (EIA) (IDEIA PCE Chlamydia; DAKO). The mycoplasma culture medium was produced by Nanjing Liming Biological Products Co,. Ltd. Antibiotics used for susceptibility test were erythromycin, roxithromycin, josamycin, leucomycin, meleumycin, rovamycin, azithromycin, clarithromycin, cycloate erythromycin, and clindamycin.

RESULTS

Fifteen samples were positive for Chlamydia trachomatis (Ct) by antigen detection (10.3%), 82 samples were positive in mycoplasma cultivation (56.2%), and among the 82 samples, 58 were positive for Ureaplasma urealyticum (Uu, 39.7%), 9 were positive for Mycoplasma hominis (Mh, 6.2%), and 15 were positive for Uu and Mh (10.3%). Of all the samples, 4 were positive for both Uu and Ct (2.7%). The rates of drug resistance of the 10 commonly used antibiotics were as follows: erythromycin 32.9%, roxithromycin 41.5%, josamycin 19.5%, leucomycin 22.0%, meleumycin 28.0%, rovamycin 30.5%, azithromycin 37.8%, clarithromycin 26.8%, davercin 24.4%, and clindamycin 26.8%, respectively. The results indicated that drug resistance rates of josamycin and leucomycin were the lowest, and the rates of roxithromycin and azithromycin were the highest.

CONCLUSIONS

The infection rates of mycoplasma and chlamydia in children suspected NGU were high. Mycoplasma showed drug resistance to a different degree to 10 common antibiotics. The results of chemosensitivity showed that josamycin had the highest susceptibility rate.

The cell-penetrating peptide, Pep-1, has activity against intracellular chlamydial growth but not extracellular forms of Chlamydia trachomatis

OBJECTIVES

In the course of studies to identify novel treatment strategies against the pathogenic bacterium, Chlamydia, we tested the carrier peptide, Pep-1, for activity against an intracellular infection.

METHODS

Using a cell culture model of Chlamydia trachomatis infection, the effect of Pep-1 was measured by incubating the peptide with extracellular chlamydiae prior to infection, or by adding Pep-1 to the medium at varying times after infection, and assaying for inhibition of inclusion formation.

RESULTS

Pep-1 had a concentration-dependent effect on chlamydial growth with 100% inhibition of inclusion formation at 8 mg/L peptide. There was a window of susceptibility during the chlamydial developmental cycle with a maximal effect when treatment was begun within 12 h of infection. Pep-1 treatment caused a severe reduction in the production of infectious progeny even when started later, when the effect on inclusion formation was minimal. Furthermore, electron micrographs showed a paucity of progeny elementary bodies (EBs) in the inclusion. In contrast, pre-incubation of EBs with Pep-1 prior to infection did not affect inclusion formation. Taken together, these findings indicate that the antichlamydial effect was specific for the intracellular stage of chlamydial infection. By comparison, Pep-1 had no antimicrobial activity against Escherichia coli and Staphylococcus aureus or the obligate intracellular parasite, Toxoplasma gondii.

CONCLUSIONS

Pep-1 has antichlamydial activity by preventing intracellular chlamydial growth and replication but has no effect on extracellular chlamydiae.

Sonodynamic therapy

Recently, there have been numerous reports on the application of non-thermal ultrasound energy for treating various diseases in combination with drugs. Furthermore, the introduction of microbubbles and nanobubbles as carriers/enhancers of drugs has added a whole new dimension to therapeutic ultrasound. Non-thermal mechanisms for effects seen include various forms of energy due to cavitation, acoustic streaming, micro jets and radiation force which increases possibilities for targeting tissue with drugs, enhancing drug effectiveness or even chemically activating certain materials. Examples such as enhancement of thrombolytic agents by ultrasound have proven to be beneficial for acute stroke patients and peripheral arterial occlusions. Non-invasive low intensity focused ultrasound in conjunction with anti-cancer drugs may help to reduce tumor size and lessen recurrence while reducing severe drug side effects. Chemical activation of drugs by ultrasound energy for treatment of atherosclerosis and tumors is another new field recently termed as "Sonodynamic therapy". Lastly, advances in molecular imaging have aroused great expectations in applying ultrasound for both diagnosis and therapy simultaneously. Microbubbles or nanobubbles targeted at the molecular level will allow medical doctors to make a final diagnosis of a disease using ultrasound imaging and then immediately proceed to a therapeutic ultrasound treatment.

Effects of levofloxacin and doxycycline on interleukin-6 production of Chlamydia trachomatis-infected human synovial fibroblasts

BACKGROUND

A large amount (80,000-100,000 pg/ml) of interleukin-6 (IL-6) was detected in cultures of human synoviocytes infected with Chlamydia trachomatis. In this study, we investigated the effect of antibiotics on the IL-6 production of C. trachomatis-infected human fibroblast-like synovial cells (HFLS).

METHODS

The minimum inhibitory concentrations of levofloxacin and doxycycline against C. trachomatis were determined in either HFLS or HeLa 229 cells. The number of live Chlamydia was also examined. IL-6 in the supernatants of infected cultures was quantified by capture ELISA.

RESULTS

The production of IL-6 was suppressed to as low as 1,800 pg/ml in the infected HFLS treated with levofloxacin or doxycycline immediately or early after infection. In HFLS treated with levofloxacin and doxycycline, the IL-6 levels decreased to 37,000 and 21,000 pg/ml, respectively, 48 h after infection, and levofloxacin was thus found to be less effective than doxycycline. In addition, the number of viable C. trachomatis in the infected cultures treated with levofloxacin 24 h after infection was higher than when treated with doxycycline.

CONCLUSIONS

The early administration and proper selection of antibiotics is important for the suppression of inflammatory cytokine production. These findings indicate that antibiotic therapy will not only work in treating infections but might also be useful in treating reactive arthritis secondary to the infection.

Can nucleic acid amplification tests be used to test for chlamydia and gonorrhoea in microbicide trials?

Microbicides may interfere with detection of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) in urine samples from women who use microbicides. The inhibitory effects of BufferGel, PRO2000 and PRO2000 placebo, in urine samples, were determined by nucleic acid amplification tests (NAATs). Uninfected urine was inoculated with different concentrations (10(5)-10(1) organisms/mL); microbicides were added to achieve final concentrations from 5% to 0.1%. Specimens were tested using strand displacement amplification (SDA) for Ct and Ng. Samples with BufferGel demonstrated no inhibition. Samples with PRO2000 showed inhibition at the 5% concentration when tested for Ct, whereas for Ng, PRO2000 showed inhibition at 5%, 2% and some 1% concentrations. The placebo showed no inhibition when detecting Ct, and variable inhibition at the 5% and 2% concentrations for Ng. The potential inhibitory effects of microbicides on the NAATs selected for detection of Ct and Ng should be considered in clinical trials involving topical microbicides.

Efficacy of a dish detergent in reducing populations of STI organisms in inoculated female condoms

We assessed the efficacy of dish detergent in removing Neisseria gonorrhoeae, HIV-1, herpes simplex virus type 2 and Chlamydia trachomatis organisms from the surface of inoculated female condoms. The reductions achieved in organism counts with dish detergent were compared with those for household bleach and water. New (out-of-package) and pre-washed/re-lubricated female condoms were used. Dish detergent was as efficacious as bleach in reducing organism counts from the surface of inoculated female condoms. Both bleach and dish detergent performed better than water, although >3 log(10) reductions were achieved with water alone. There was little difference in organism reduction between new and pre-washed condoms. Furthermore, 30 seconds of mechanical agitation (washing) had minimal added impact on organism removal. Reduction in organism counts with water alone suggests that dilution effect may have been as important in organism removal as the microbicidal properties of the detergent.

Characterization of in vitro chlamydial cultures in low-oxygen atmospheres

To mimic in vivo conditions during chlamydial infections, Chlamydia trachomatis serovar D and Chlamydia pneumoniae CWL029 were cultured in low-oxygen atmospheres containing 4% O(2), with parallel controls cultured in atmospheric air. Both were enriched with 5% CO(2). The results showed a dramatic increase in the growth of C. pneumoniae but not of C. trachomatis.

[Analysis of detection and antimicrobial resistance of pathogens in prostatic secretion from 1186 infertile men with chronic prostatitis]

OBJECTIVE

To investigate the distribution and the antimicrobial resistance of the bacteria, mycoplasma and Chlamydia trachomatis isolated from the prostatic secretion of infertile men with chronic prostatitis, and to provide clinicians with grounds for choosing antibiotic agents.

METHODS

The bacteria obtained were isolated and identified, the Chlamydia trachomatis was detected by FLO-PCR, and the results were analysed statistically.

RESULTS

In 1 186 specimens of EPS, the total positive rate of isolates was 51.7%. Among them, there were 364 strains of gram-positive coccus, 20 gram-negative bacillus, 5 other strains and 157 mycoplasma, including 116 Ureaplasma urealyticum and 41 Mycoplasma hominis, and 67 Chlamydia trachomatis DNA. As for the isolated staphylococci, their antimicrobial resistance was the lowest against vancomycin (0.0%), but the highest against penicillins (76.9%-100%); for the Streptococcus agalactiae, it was the highest against erythromycin and clindamycin (100%), and the lowest against beta-lactams, aminoglycosides, trimethoprim + sulfamethoxazole, rifampin and vancomycin (0.0%); for the Ureaplasma urealyticum, it was the highest against ciprofloxacin (59.5%), and the lowest against josamycin, tetracycline and fosfomycin (1.7%); for the Mycoplasma hominis, it was the highest against erythromycin (100%), and the lowest against doxycycline and fosfomycin (0.0%).

CONCLUSION

Bacteria, mycoplasma and Chlamydia trachomatis are the possible etiological factors of male infertility. Isolated bacterial strains differ greatly in their resistance against different antibiotics.

The treatment of pharyngeal gonorrhoea with a single oral dose of cefixime

An audit of the efficacy treatment of pharyngeal gonorrhoea with a single oral dose of 400 mg of cefixime was undertaken; 83% of patients also received a single oral dose of azithromycin to treat possible concurrent anogenital chlamydial infection. Of the 54 patients studied, only one of 45 patients who attended for at least one test of cure had a positive culture seven days after treatment; the possibility of reinfection could not have been excluded. Two tests of cure were obtained from 18 patients. Cefixime, therefore, seems to be effective in the treatment of pharyngeal gonorrhoea.

Reversal of the antichlamydial activity of putative type III secretion inhibitors by iron

INPs, which are chemically synthesized compounds belonging to a class of acylated hydrazones of salicylaldehydes, can inhibit the growth of Chlamydiaceae. Evidence has been presented that in Yersinia and Chlamydia INPs may affect the type III secretion (T3S) system. In the present study 25 INPs were screened for antichlamydial activity at a concentration of 50 muM, and 14 were able to completely inhibit the growth of Chlamydia trachomatis serovar D in McCoy and HeLa 229 cells. The antichlamydial activities of two of these INPs, INPs 0341 and 0400, were further characterized due to their low cytotoxicity. These compounds were found to inhibit C. trachomatis in a dose-dependent manner; were not toxic to elementary bodies; were cidal at a concentration of > or =20 microM; inhibited all Chlamydiaceae tested; and could inhibit the development of C. trachomatis as determined by the yield of progeny when they were added up to 24 h postinfection. INP 0341 was able to affect the expression of several T3S genes. Compared to the expression in control cultures, lcrH-1, copB, and incA, all middle- to late-expressed T3S genes, were not expressed in the INP 0341-treated cultures 24 to 36 h postinfection. Iron, supplied as ferrous sulfate, as ferric chloride, or as holo-transferrin, was able to negate the antichlamydial properties of the INPs. In contrast, apo-transferrin and other divalent metal ions tested were not able to reverse the inhibitory effect of the INPs. In conclusion, the potent antichlamydial activity of INPs is directly or indirectly linked with iron, and this inhibition of Chlamydia has an effect on the T3S system of this intracellular pathogen.

Chlamydia trachomatis OmcB protein is a surface-exposed glycosaminoglycan-dependent adhesin

The OmcB protein of Chlamydia trachomatis is a cysteine-rich outer membrane polypeptide with important functional, structural and antigenic properties. The entire gene encoding the OmcB protein from C. trachomatis serovar LGV1 was cloned and expressed in Escherichia coli and the full-length protein used to raise polyclonal antibodies. Recombinant OmcB was used to show that OmcB is a surface-exposed protein that functions as a chlamydial adhesin. Infectivity inhibition assays carried out using HeLa cells with serovar LGV1 in the presence of purified anti-OmcB serum showed inhibition of infectivity, suggesting that some of the OmcB was surface exposed. Moreover, using recombinant OmcB in infectivity inhibition assays resulted in 70% inhibition of infectivity, confirming that OmcB plays a role as an adhesin in C. trachomatis. Furthermore, recombinant OmcB protein bound to the surface of HeLa and Hec1B cells, but binding to glycosaminoglycan (GAG)-deficient cells (pgsA-745 and pgsD-677) was markedly reduced, indicating that OmcB binds to GAG-like receptors on host cells.

[Effects of Salvia miltiorrhiza on Chlamydia trachomatis mice of salpingitis]

OBJECTIVE

To study the effects of Salvia miltiorrhiza on treatment of Chlamydia trachomatis salpingitis (CTS) and fibrosis.

METHOD

A mouse model for CTS was estahlished in C3H/He by intravaginal inoculation. after 3 weeks mice were randomly divided into 3 groups. Only Azithromyxin was given orally, Azithromyxin and early S. miltiorrhiza given, or Azithromyxin and later S. miltiorrhiza given. After 10 weeks, observe the change of oviduct of mice, observe the histopathologic change and analysis collagen histochemical index.

RESULT

3 Treatment groups induce tubal occlusion and hydrosalpinx decreased and the collagen histochemical index decreased significantly than those of no treatment given (P < 0.05). Early S. miltiorrhiza given group induce tubal occlusion and hydrosalpinx decreased and the collagen histochemical index decreased significantly than only Azithromyxin group or later S. miltiorrhiza given group (P <0.05).

CONCLUSION

When we treat CTS genital infection with Azithromyxin, if we can give S. miltiorrhiza treatment as early as possible, it may decrease tubal occlusion and hydrosalpinx. significantly inhibit fibrosis maybe one of its pharmacologic mechanismin.

Small molecule inhibitors of type III secretion inYersiniablock theChlamydia pneumoniaeinfection cycle

Intracellular parasitism by Chlamydiales is a complex process involving transmission of metabolically inactive particles that differentiate, replicate, and re-differentiate within the host cell. A type three secretion system (T3SS) has been implicated in this process. We have here identified small molecules of a chemical class of acylated hydrazones of salicylaldehydes that specifically blocks the T3SS of Chlamydia. These compounds also affect the developmental cycle showing that the T3SS has a pivotal role in the pathogenesis of Chlamydia. Our results suggest a previously unexplored avenue for development of novel anti-chlamydial drugs.

Lipid Membrane; A Novel Target for Viral and Bacterial Pathogens

Lipid rafts are defined as specialized, dynamic microdomains that can be found in plasma membrane, and they are enriched with cholesterol and sphingolipids. Since lipid rafts' first debut in the mid 1990's, their existence, function and biological relevance have been a subject of intense scrutiny within the scientific community. Throughout this debate, we have learned a great deal regarding how cargos (both pathogens and cellular factors) are transported into and out of the cell through raft-dependent or raft-independent pathways. It is now apparent that a number of toxins, bacterial-, and viral-pathogens are able to exploit cholesterol and/or lipid rafts to gain a foot hold in their target hosts. The objective of this review is to describe our current appreciation on how selected pathogens utilise cholesterol and/or lipid rafts to support their propagation and to speculate on how some of these observations can be explored for the development of novel strategies that target plasma membrane lipids to control the spread of these viral- and bacterial-pathogens.

An early event in the herpes simplex virus type-2 replication cycle is sufficient to induce Chlamydia trachomatis persistence

Epidemiological studies have demonstrated that co-infections of herpes simplex virus type 2 (HSV-2) and Chlamydia trachomatis occur in vivo. Data from a tissue culture model of C. trachomatis/HSV-2 co-infection indicate that viral co-infection stimulates the formation of persistent chlamydiae. Transmission electron microscopic (TEM) analyses demonstrated that in both HeLa and HEC-1B cells, co-infection caused developing chlamydiae to exhibit swollen, aberrantly shaped reticulate bodies (RBs), characteristically observed in persistence. Additionally, HSV-2 co-infection suppressed production of infectious chlamydial elementary bodies (EBs) in both host cell types. Co-infection with HSV type 1 (HSV-1) produced similar morphologic alterations and abrogated infectious EB production. These data indicate that virus-induced chlamydial persistence was neither host cell- nor virus strain-specific. Purification of crude HSV-2 stocks demonstrated that viral particles were required for coinfection-induced chlamydial persistence to occur. Finally, co-infection with either UV-inactivated, replication-incompetent virus or replication-competent HSV-2 in the presence of cyclohexamide reduced chlamydial infectivity without altering chlamydial genomic DNA accumulation. These data demonstrate that productive viral replication is not required for the induction of chlamydial persistence and suggest that HSV attachment and entry can provide the necessary stimulus to alter C. trachomatis development.

Treatment of Chlamydia trachomatis with a small molecule inhibitor of the Yersinia type III secretion system disrupts progression of the chlamydial developmental cycle

The obligate intracellular bacterium Chlamydia trachomatis possesses a biphasic developmental cycle that is manifested by differentiation of infectious, metabolically inert elementary bodies (EBs) to larger, metabolically active reticulate bodies (RBs). The cycle is completed by asynchronous differentiation of dividing RBs back to a population of dormant EBs that can initiate further rounds of infection upon lysis of the host cell. Chlamydiae express a type III secretion system (T3SS) that is presumably employed to establish and maintain the permissive intracellular niche by secretion of anti-host proteins. We hypothesize that T3SS activity is essential for chlamydial development and pathogenesis. However, the lack of a genetic system has confounded efforts to establish any role of the T3SS. We therefore employed the small molecule Yersinia T3SS inhibitor N'-(3,5-dibromo-2-hydroxybenzylidene)-4-nitrobenzohydrazide, designated compound 1 (C1), to examine the interdependence of the chlamydial T3SS and development. C1 treatment inhibited C. trachomatis but not T4SS-expressing Coxiella burnetii development in a dose-dependent manner. Although chlamydiae remained viable and metabolically active, they failed to divide significantly and RB to EB differentiation was inhibited. These effects occurred in the absence of host cell cytotoxicity and were reversible by washing out C1. We further demonstrate that secretion of T3S substrates is perturbed in C1-treated chlamydial cultures. We have therefore provided evidence that C1 can inhibit C. trachomatis development and T3SS activity and present a model in which progression of the C. trachomatis developmental cycle requires a fully functional T3SS.

Lateral gene transfer in vitro in the intracellular pathogen Chlamydia trachomatis

Genetic recombinants that resulted from lateral gene transfer (LGT) have been detected in sexually transmitted disease isolates of Chlamydia trachomatis, but a mechanism for LGT in C. trachomatis has not been described. We describe here a system that readily detects C. trachomatis LGT in vitro and that may facilitate discovery of its mechanisms. Host cells were simultaneously infected in the absence of antibiotics with an ofloxacin-resistant mutant and a second mutant that was resistant to lincomycin, trimethoprim, or rifampin. Selection for doubly resistant C. trachomatis isolates in the progeny detected apparent recombinant frequencies of 10(-4) to 10(-3), approximately 10(4) times more frequent than doubly resistant spontaneous mutants in progeny from uniparental control infections. Polyclonal doubly resistant populations and clones isolated from them in the absence of antibiotics had the specific resistance-conferring mutations present in the parental mutants; absence of the corresponding normal nucleotides indicated that they had been replaced by homologous recombination. These results eliminate spontaneous mutation, between-strain complementation, and heterotypic resistance as general explanations of multiply resistant C. trachomatis that originated in mixed infections in our experiments and demonstrate genetic stability of the recombinants. The kind of LGT we observed might be useful for creating new strains for functional studies by creating new alleles or combinations of alleles of polymorphic loci and might also disseminate antibiotic resistance genes in vivo. The apparent absence of phages and conjugative plasmids in C. trachomatis suggests that the LGT may have occurred by means of natural DNA transformation. Therefore, the experimental system may have implications for genetically altering C. trachomatis by means of DNA transfer.