PART TWO
Diagnostic Cytology
Fig. 7.63
(A)
Adenovirus infection.
Note the numerous intranuclear basophilic inclusions within the endocervical cells. Vaginopancervical smear
(Papanicolaou stain x HP). (B) Adenovirus infection with eosinophilic inclusions. Vaginopancervical smear (Papanicolaou x HP).
associated with
C. trachomatis
infection; perihepatitis, endocar-
ditis, and gastroenteritis have all been associated. The cases are
few, and precise data are lacking. The clinical chlamydial dis-
eases are summarized in Table 7.9. The precise role of
C. tracho-
matis
infection in all of the clinical diseases mentioned in Table
7.10 is variable. Taylor-Robinson and Thomas summarized the
data presented in Table 7.10.53
Chlamydia trachomatis
is an obligate intracellular organism.
It shares certain bacterial and viral characteristics. The organism
does not stain with a Gram stain. It contains both RNA and DNA,
is susceptible to antibodies, divides by binary fusion, and has a
rigid cell wall. A comparison of some of the common character-
istics of
Chlamydia,
bacteria, and viruses is given in Table 7.11.
Chlamydia
organisms occur in two major forms: the infec-
tive, extracellular elementary body, and the intracellular initial
and intermediate forms or bodies, also referred to as reticulate
particles. Elementary bodies measure about 300 nm. These
are liberated from the infected cells and are phagocytosed by
the susceptible cells, which most frequently are squamous
metaplastic or endocervical columnar cells. There is some evi-
dence of
Chlamydia
organisms infecting the parabasal cells of
the lower genital tract. Shurbaji and associates44,120 have doc-
umented the occurrence of
Chlamydia
organisms within the
prostate epithelium and urothelium. As seen by life cycle stud-
ies, once within the infected cells, the elementary bodies reor-
ganize and enlarge. They repeatedly replicate by binary fision
and, after undergoing the intermediate stages of development,
produce intracytoplasmic inclusions that are large pockets of
numerous elementary bodies. The infected cell finally lyses, lib-
erating numerous elementary bodies to restart the cycle. This
life cycle in a cell culture, e.g. McCoy cell line, is completed
within 48 to 60 hours.
The infected epithelial cell can undergo a number of proplas-
tic and retroplastic changes. These include enlargement of the
nuclei and cytomegaly, hyperchromasia, and nucleolar promi-
nence. Multinucleation may occur. The retroplastic changes
commonly include cytoplasmic vacuolation and protein pre-
cipitation that may appear as nonspecific inclusions. Some sero-
logic evidence exists for the possible association of
C. trachomatis
infection and cervical dysplasia, but it is not well accepted.
In a symptomatic patient, the body reacts to
C. trachomatis
infection, and the occurrence of intense polymorphonuclear
Table 7.9
Chlamydial diseases
Infections
in men
Infections
in women
Infections
in infants
Nongonococcal
urethritis
Cervicitis
Conjunctivitis
Postgonococcal
urethritis
Conjunctivitis
Pneumonia
Conjunctivitis
Subclinical genital
infection
Gastroenteritis
(possibly)
Subclinical genital
infection
Salpingitis
Epididymitis
Dysplasia (possibly)
Reiter's syndrome
Infertility
Systemic disease
Systemic disease
Table 7.10
Relationship of
C hlam ydia trachom atis
and various associated
diseases
Acute and chronic cervicitis
Established
Follicular cervicitis
Established
Salpingitis
Established
Lymphogranuloma venereum
Established
Nongonococcal urethritis
Established
Postgonococcal urethritis
Established
Reiter's syndrome
Established
Neonatal pneumonia
Established
Conjunctivitis
Established
Epididymitis
Questionable
Cervical atypia
Questionable
Abortion
Questionable
leukocytic response in the vaginopancervical smears is the most
common single feature of symptomatic
C. trachomatis
infection.
This was one of the major features observed among chlamy-
dial cases by Kiviat and associates.121 Quinn and co-workers
found the presence of intense polymorphonuclear leukocytic
120
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