Chlamydial hepatitis
Last reviewed: 23.04.2024
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[Prevalence
Chlamydia infection is one of the most widespread all over the world, including in Russia. In the population of childbearing age, the clamidiosis of the urinary tract is detected with a high frequency. In pregnant women the frequency of detection of Chlamydia infection varies from 10 to 70%.
In newborns, chlamydial infection is recorded in 5-38% of cases.
What causes chlamydial hepatitis?
To the genus Chlamydie belonged to the Z type of pathogens: C. Psiitaci, S. Pneumoniae and C. Trachomatis. The latter, sexually transmitted, causes diseases of the genito-urinary tract, gastrointestinal tract, respiratory tract, eyes, etc. Chlamydia occupy an intermediate position between bacteria and viruses, they are obligate intracellular energy parasites. C. Trachomatis is introduced into the host cell by pinocytosis, uses for its growth and reproduction the ATP produced by it and is protected from destruction by the phagosome membrane. Getting into the human body, chlamydia can simultaneously exist in different stages of development, including persistent forms. When infected during pregnancy, the woman appears mucopurulent discharge from the cervical canal, colpitis, dysuric phenomena, and in cervical secret and urine a large number of leukocytes is detected. The risk of developing an infectious process in a fetus and newborn depends on the time of infection or exacerbation of chlamydia in a pregnant woman. The most dangerous in terms of infection of the fetus is the development of chlamydial infection in the mother in the third trimester of pregnancy.
Chlamydial infection in pregnant women leads to chronic placental insufficiency, which adversely affects the growth and development of the fetus. In women infected with chlamydia, pregnancy in most cases still ends in urgent labor, but even with a newborn in infants, intrauterine infection is often diagnosed with damage to various organs and systems.
The ascending path (through the cervix and the membranes of the fetal egg) is characteristic for intrauterine infection with chlamydia. The causative agent enters the mucous membranes of the urethra, the upper respiratory tract, is swallowed with infected amniotic fluid, causes gastrointestinal lesions.
Intrauterine chlamydial infection is characterized by depression of T-cell immunity with deficiency of T-helpers, dysfunction of mononuclear phagocytes and a moderate increase in the activity of natural killers. With intrauterine infection with chlamydia, many organs and systems, including the liver, are affected, while infection of the liver with chlamydia is documented with a very high frequency - up to 16.7%.
Morphology
When the liver is damaged as a result of intrauterine infection with chlamydia, a picture of hepatitis appears.
Macroscopically: the liver is enlarged in size, dense in consistency, brownish-yellow in color. Biliary tracts are passable. Histological examination reveals the discomplexation of hepatic beams, foci of hepatic cell necrosis with lymphoid-leukocyte infiltration in the periportal zone, foci of extramedullary hematopoiesis; there are protein degeneration of parenchymal cells, intracellular cholestasis, in places - regeneration of gspagocytes.
Symptoms of chlamydial hepatitis
Children with intrauterine chlamydial infection are often born prematurely, with an Apgar score of <6-7 points, with signs of morphofunctional immaturity. If at the time of delivery the disease is in the initial stage, then the infection manifests in the first 3 days, if in the middle - the child at birth has clinical manifestations of chlamydia.
Children have general toxicity symptoms. In this case, various lesions of organs and systems. Typical are intrauterine pneumonia, respiratory distress syndrome, conjunctivitis, gastroenteropathy, generalized forms of this infection.
Hepatitis and lesion of the bile ducts with intrauterine chlamydia are observed infrequently.
The condition of children is estimated as moderate, sometimes severe. They are listless, anxious. Children badly eat, regurgitate.
From the first day after the birth jaundice appears, it can intensify for several days. Almost all are diagnosed with hepatolyenal syndrome. The liver protrudes from the hypochondrium 3-5 cm, of moderate density, with a smooth surface. In half the cases, children have conjunctivitis; often an increase in several groups of lymph nodes.
In the biochemical analysis of blood in patients with cholestasis, there is usually a 1.5-2-fold increase in the level of bilirubin with a predominance of the conjugated fraction, an uneven (2-3-fold) increase in the activity of hepatic cell enzymes - ALT, ACT, LDH, and GGT.
Congenital chlamydial hepatitis can manifest acute with cholestasis syndrome. Against the background of general infectious intoxication, jaundice of moderate or severe degree develops, hemorrhagic syndrome in the form of petechial rash, hemorrhages at injection sites may appear. All children show an enlarged liver, often from the hypochondrium, a spleen 1-2 cm.
In the biochemical analysis of blood, an increase in the level of total bilirubin by a factor of 5-10 is recorded, while the conjugated fraction does not always prevail (simultaneous significant free bilirubin content in the serum indicates a deficiency in the bilirubin conjugation system). The activity of hepatic cell enzymes usually slightly exceeds the norm, but there is a 2-fold increase in the activity of AP and GGTP.
With ultrasound, there is an increase in liver size, increased echogenicity of the parenchyma, and often thickening of the gallbladder walls.
Variations of chlamydial hepatitis
Basically congenital chlamydial hepatitis has an acute course with a gradual (2-3 months) normalization of the biochemical parameters of the blood. The increase in liver size persists significantly longer, up to the 12th month. In the syndrome of cholestasis, the resolution of jaundice is prolonged, it can persist until the 5th month.
There are descriptions of cases of undulated chlamydial hepatitis, with exacerbations of the flow, when, after initial clinical and biochemical symptoms of the disease, normalization occurs in 2-3 months, and then after a few months a marked hepatitis syndrome lasting 1-2 months reappears, and only the appointment of etiotropic therapy leads to the resolution of the disease. Chronic course of chlamydial hepatitis is not observed.
Diagnosis of chlamydial hepatitis
Chlamydia infection is diagnosed on the basis of the detection of the causative agent Chlamydia trachomatis from the eyes and the urethra, but more often as the titers of specific class antibodies increase, antibodies to IgM class chlamydia are not always detected. With the help of PCR chlamydial DNA can be identified in biological substrates, including in blood serum.
Differential diagnosis is performed with congenital hepatitis of a different etiology. Currently, with the detection of specific markers, it is almost always possible to establish the etiology of congenital hepatitis, although the picture of the disease with different pathogens is very similar. In chlamydial antenatal infection, obstetric-gynecological history of the mother and the indication of the presence of clinico-laboratory signs in her infection are important.
It should be noted that in newborns, antenatal infection is often detected, due to two, and sometimes even more, pathogens. For example, in 23% of cases intrauterine mixed infection was detected in the form of a combination of cytomegalovirus and chlamydia. This fact should be taken into account when ascertaining congenital hepatitis and planning therapy.
Treatment of chlamydial hepatitis
Chlamydia infection is very successfully treated with antibiotics from the macrolide group. When ascertaining the chlamydial nature of congenital hepatitis, children are given erythromycin or azithromycin (sumamed). Erythromycin is used in a daily dose of 40-50 mg per 1 kg of body weight for 7 days, azithromycin (sumamed) - on the 1st day at a dose of 10 mg / kg, and the next 4 days - at a dose of 5 mg / kg. With severe intoxication, infusion detoxification therapy is performed. The appointment of hepatoprotectors is indicated, for example, phosphoglucin. Children with congenital chlamydial hepatitis often have conjunctivitis and urethritis of the same etiology. In this regard, along with antibiotic therapy, sanation of local inflammatory processes is carried out.
Prevention of chlamydial hepatitis
Prevention of antenatal chlamydial infection is to identify and treat hdamidiosis in pregnant women.