Table 6.
Studies of Conjunctival Bacterial Infection in Children in Trachoma Endemic Communities
| Country (Year) | Study Population and Design | Findings | Comments |
|---|---|---|---|
| Taiwan (1962)16 | Three separate trachoma endemic areas; conjunctival swab samples from preschool and first-grade children; about half had active trachoma; cultured (blood and chocolate agar) | Culture positive; normal, 42/144 (29%); active trachoma, 74/201 (37%); organisms: Staphylococcus pneumoniae, 15.6%; α-streptococci, 11.6%; Haemophilus, 6.4%; Staphylococcus spp., 5.0% | Sampling frame not specified, drawn from a number of different settings; variation of MacCallan's trachoma grading system used, making it difficult to relate to current clinical grades (to derive an approximation to active trachoma, Tr-D, Tr-I Tr-II, Tr-III, and CFC have been combined here); no Chlamydia trachomatis test data presented; reanalysis of the data suggests a significant association between active trachoma and bacterial infection (OR, 2.58; 95% CI, 1.6–4.0; P < 0.0010) |
| USA (1967)17 | School children (140) enrolled in a treatment trial for active trachoma; cultured (blood agar); microbiology results from before and after treatment combined | Culture positive; normal/Tr-4, 41%, and Tr-I, Tr-II, and Tr-III, 43% | Sampling frame not specified; MacCallan's trachoma grading system used; microbiology results from before and after treatment combined; no C. trachomatis test data presented. |
| Morocco (1968)18 | Sample from 16 communities enrolled in a trachoma control study; in each community, 160–180 children 0–8 years of age were randomly selected; conjunctival scrapings were Gram stained; no culture | Positive slide: Haemophilus, 81%; Moraxella, 20%; S. pneumoniae, 19% | MacCallan's trachoma grading system used; denominator not stated; no C. trachomatis test data presented; no analysis of bacterial infection in relation to active trachoma |
| Tunisia (1974)19 | Two villages—(A) 151 children 6–9 years with active trachoma; (B) 44 children <15 years, randomly selected; conjunctival swab (cultured blood agar); conjunctival smear, Giemsa stain for chlamydial inclusions | Culture positive: S. viridans, 65%; Diphtheroids, 52%; Haemophilus spp., 40%; S. epidermidis, 13% | The number of children contributing data to the reported culture results was 277, and this is higher than the 195 children described in the subject description; the age and clinical status of the additional 82 children is not presented; Haemophilus was found to be the major cause of mucopurulent conjunctivitis; no analysis of bacterial infection in relation to active trachoma |
| Tunisia (1975)20 | Single village—151 children initially having active trachoma were enrolled into a treatment trial; conjunctival scraping with Giemsa staining; no culture; each child had both eyes sampled on three occasions | Results of 927 slides presented; slides positive for bacteria: 48% (Haemophilus, 25% and Moraxella, 16%) | Difficult to interpret, because multiple data from both eyes are presented together; no analysis of bacterial infection in relation to active trachoma |
| Nepal (1999)21 | Single village—122 children 1–10 years of age; conjunctival swab (cultured blood agar) | Active trachoma in 38%; S. pneumoniae, 22%; Haemophilus spp., 7%; Moraxella, 16% | The focus of this study was the change in bacterial antibiotic sensitivity patterns after azithromycin treatment; no C. trachomatis test data presented; no analysis of bacterial infection in relation to active trachoma |