Incidence of Chlamydia infection in pregnant women attending antenatal clinic in Sir Yahaya Memorial Hospital Birnin-Kebbi, Northern Nigeria.
Ankuma S.J, Joshua A R and Opaluwa S A
Department, of Medical Microbiology Ahmadu Bello University Teaching Hospital Shika- Zaria.
Mary S.
Department of Nursing Services, Ahmadu Bello University Teaching Hospital, Shika-Zaria.
Akpulu S.P.
Department of Human Anatomy Ahmadu Bello University Zaria.
Correspondences to: Ankuma S.J. Department, of Medical Microbiology Ahmadu Bello University Teaching Hospital Shika- Zaria.
ABSTRACT
The study was conducted with the view to determining the occurrence of Chlamydia
trachomatis (C.trachomatis) infection among pregnant women attending antenatal clinic in Sir Yahaya Memorial Birnin-Kebbi, Kebbi state, Nigeria. In the study, Diaspot Chlamydia Rapid Diagnostically swabs test kit which is a rapid chromatographic immunoassay for the qualitative detection of Chlamidia antigens from female cervical swabs was used. Out of 100 subjects recruited for the study, two women within the age group 25-30 tested positive for C.trachomatis antigens, giving a prevalence rate of 2%. The study found that the infection was not endemic in the study area.
Key Word: Chlamydia trachomatis, infection, and pregnant women.
INTRODUCTION
Chlamydiae are small obligate intracellular parasites that were formerly considered to be viruses. However, since they contain DNA, RNA, ribosomes and make their own proteins and nucleic acids,
they are now considered to be true bacteria. They possess an inner and outer membrane similar to Gram-negative bacteria and a lipopolysaccharide but do not have a peptidoglycan layer. Although they synthesize most of their metabolic intermediates, they are unable to make their own ATP and thus are energy parasites (1). Chlamydiae derived their name from the Greek word “Chlamys” meaning “cloak draped around the shoulder”, which describes how the intracytoplasmic inclusions causes by the bacterium are “draped” around the infected cell’s nucleus (2). The family Chlamydiaceae consists of two
genera. One species of Chlamydia and two species of Chlamydophila which are important in causing disease in humans. C. trachomatis causes urogenital infections, trachoma, conjunctivitis, pneumonia and lymphogranuloma venereum (LGV). Chlamydophila pneumoniae causes bronchitis, sinusitis, pneumonia and possibly atherosclerosis, while Chlamydophila psittaci, causes Psittacosis (1). Of the three species, C. trachomatis is the species of interest. It is a sexually transmitted microorganism responsible for a wide spectrum of diseases that include cervicitis, salpingitis, endometritis, urethritis, epididymitis, conjunctivitis and neonatal pneumonia (3), Fitz-Hugh-Curtis syndrome (inflammation of the liver capsule), and trachoma, the world’s leading cause of acquired blindness which is spread from eye-to-hand-to-eye and cause by serotypes A, B and C (4). According to (5), C. trachomatis is one of the most common sexually transmitted bacterial pathogen in the world, causing serious adverse events on women’s reproductive health including complication of pregnancy, pelvic inflammatory disease and infertility. The Centre for Disease Control and Prevention (6) also reported Chlamydia as one of the most
frequently bacterial sexually transmitted disease with over three million new cases estimated to occur annually in the United States.
Infection during pregnancy is associated with adverse outcomes, including fetal loss, premature rupture of membranes, preterm labor, low birth weight, infant mortality, neonatal infection and postpartum endometritis (7, 8). Chlamydia can be transmitted during vaginal, anal, or oral sex and any sexually active person can be infected with the disease. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to uterus) of teenage girls and young women is not fully matured and is probably more susceptible to the infection, they are particularly high risk for infection if
sexually active (6). The infection is most prevalent in persons aged 15-24 years (4). Chlamydia is also known as a “silent” disease because the majority of infected people (up to 70%) have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure. Even though symptoms of Chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur “silently” before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man (6, 9). In women, the bacteria initially infect the cervix and the urethral. Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes, some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis (6). According to (4), deaths due to C. trachomatis infection are rare and are caused by progression to salpingitis and tuboovarian abscess with rupture and peritonitis.The most significant morbidity occurs when repeated episodes of Chlamydia lead to obstruction and scarring of the fallopian tubes, resulting in partial or total sterility. Chlamydia is an indirect cause of mortality from ectopic pregnancies. Mortality due to ectopic pregnancy is probably more common than death due to tuboovarian abscess. Chlamydia may also increase the chances of becoming infected with HIV, if exposed (6). Furthermore, Chlamydia death statistics for various regions worldwide as reported by the (10) shows that about 1,000 deaths from Chlamydia in Africa, 8,000 deaths in South East Asia, and about 1,000 deaths in Eastern Mediterranian.
Materials and method
Diaspot Chlamydia Rapid Diagnostic test kit was used mainly for its sensitivity (88.5%), specificity (96.7%) and accuracy (93.7%) relative to Polymerase Chain Reaction (PCR) when used on female cervical swabs. It is also said to detect all known Chlamydia serovars (Package insert, 2015). In this test, antibody specific to the Chlamydia antigen is coated on the test line region of the device. The extracted antigen solution reacts with an antibody to Chlamydia that is coated onto particles. The mixture then
migrates up to react with the antibody to Chlamydia on the membrane and generates a colored line in the test line region. The presence of colored line indicates a positive test while its absence indicates a negative test. To serve as a procedural control, a colored line will always appear in the control line region, indicating that proper volume of specimen has been added and membrane wicking has occurred (Package insert, 2015).
Table 1: Showing occurrence of C. trachomatis infection in relation to number of subjects.
Table 2: In relation to age, all the 2-positive subjects were within the age group 25-30 years
Furthermore, all the subjects of the study were married women (Table-3).
Table 3: Showing occurrence of C. trachomatis infection in relation to marital status.
Specimen collection: Endocervical swabs (ECS) were collected at the maternity unit of Sir Yahaya Memorial Hospital in Birnin Kebbi. As soon as they were collected, they were labeled appropriately and taken to the laboratory for immediate processing.
Results: One hundred women attending antenatal clinic in Sir Yahaya Memorial Hospital Birnin Kebbi were recruited for the study, out of which 2-women were tested positive for C. trachomatis antigen, giving 2% disease prevalence (table-1).
DISCUSSION
The prevalence of C. trachomatis infection as found in this study is 2.0%. The prevalence is much lower than the 5.9% earlier reported by (11) in Gonder, North-West Ethiopia, 5.2% in Dhaka, Bangladesh by (12), 12.2% in Nanjing China, 6.4% in Lima, Peru, 10.4% in Moscow, Russia, 2.5% in Harare, Zimbabwe as reported by (5, 8), and also, 4.7% prevalence in Baltimore, USA. The prevalence is however much higher than the 0.1% reported by (5) in Chennai India. Even though the level of infection as found
by this study appears to be very low (2%), one thing that was evident is the fact that many people have not even heard of the infection before. And because the symptoms if there is, resembles that of gonorrhea, many people may have unknowingly presumed any infection giving such symptoms to be gonorrhea and may have suffered silent morbidity as a result of such ignorance. With respect to age
group, all the positive subjects were in the age group 25-30 years. This finding is slightly at variance with the findings of (13, 14) and several other workers who reported that age group 19-24 years is most at risk of Chlamydia infection. The study however agrees with (8) and who are of the view that factors other than age may impact upon the diagnosis of C. trachomatis in pregnant women and that more comprehensive testing strategy should be considered. On whether untreated C. trachomatis infection could lead to miscarriage, one of the positive subjects, a 28 years old woman who previously had 4-successful births just had a miscarriage in her first trimester, the reason for she came to the hospital. This finding confirms earlier reports by (15, 7 & 16), all linking infection with Chlamydia during pregnancy to early miscarriage or premature birth of the baby.
CONCLUSION
The 2% prevalence obtained in this study suggests that C.trachomatis infection is not endemic in Birnin-Kebbi, the study area. This finding is however not conclusive as factors such as specimen collection may have play a role in the low prevalence rate, as the quality of specimen obtained is of extreme importance. Even though guidelines for specimen collection were given, the rigorous and thorough collection technique that provides cellular material rather than just body fluid may not have been strictly followed. Also, it should be noted that all the women screened were married which has reduced the possibility of having multiple sex partners, and consequently could have influenced the low prevalence rate. A follow up to this study is therefore recommended.
ACKNOWLEDGMENT
The authors sincerely thank the management and staff especially the maternity unit of Sir Yahaya Memorial Hospital, Birnin Kebbi, for permission and support during this work.
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