Division of Pediatric Infectious Diseases, College of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Adv Exp Med Biol. 2013;764:109-22. doi: 10.1007/978-1-4614-4726-9_8.
The "silent epidemic" of Chlamydia trachomatis threatens to cause reproductive damage and infertility in many of the 50 million women who acquire it each year. Female reproductive tract infection has more recently been linked to stillbirth and premature delivery. Innate immune cells and mediators appear to be the primary players in pathogenesis, with neutrophils playing a prominent role in disease development. Although adaptive antibody and CD4 T cell responses appear primarily protective, these responses are inefficient. Infections are frequently chronic as a result, and when infection is diagnosed and treated with appropriate antibiotics, repeated infection is the rule. The lack of acute symptoms in many infected individuals contributes to the high prevalence of chlamydial infection. Although chronic sequelae are relatively rare in men, and many women sustain infection without developing pelvic inflammatory disease or chronic sequelae, the extremely high prevalence of chlamydial infection leads to significant morbidity and healthcare costs. A vaccine is urgently needed to prevent infection, but given the difficulties of inducing a CD4 T cell memory response that can home quickly to the genital tract, induction of sterilizing immunity may not be possible. A vaccine that prevents disease by lowering bacterial burden and dampening production of tissue-damaging responses may be possible. Until an efficacious vaccine is developed, screening and treatment programs appear to be the best method of disease prevention.
沙眼衣原体引起的“无声流行病”每年威胁着 5000 万感染该病原体的女性，可能导致生殖系统受损和不孕。最近有研究表明，生殖道感染与死胎和早产有关。先天免疫细胞和介质似乎是发病机制的主要参与者，中性粒细胞在疾病发展中起着突出的作用。虽然适应性抗体和 CD4 T 细胞反应似乎主要具有保护作用，但这些反应效率低下。因此，感染常常呈慢性，并且当感染通过适当的抗生素进行诊断和治疗时，重复感染是常见的。许多感染者缺乏急性症状，这导致了沙眼衣原体感染的高流行率。虽然慢性后遗症在男性中相对较少见，而且许多女性在没有发展为盆腔炎或慢性后遗症的情况下持续感染，但极高的沙眼衣原体感染率导致了显著的发病率和医疗保健费用。迫切需要一种疫苗来预防感染，但鉴于诱导能够迅速归巢到生殖道的 CD4 T 细胞记忆反应的困难，诱导绝育免疫可能是不可能的。一种通过降低细菌负荷和抑制组织损伤反应产生的疫苗可能是可行的。在开发出有效疫苗之前，筛查和治疗计划似乎是预防疾病的最佳方法。
