Severe endemic trachoma in Tunisia. I. Effect of topical chemotherapy on conjunctivitis and ocular bacteria.

In areas where trachoma occurs as an endemic, blinding disease, it is often associated with bacterial conjunctivitis which occurs in spring and autumn epidemics (Wilson, 1932; W.H.O., 1973; Maxwell-Lyons, I953; Huet, I958). It is accepted that trachoma is due to infection with a member of the Chlamydia (psittacosis-lymphogranuloma) group of organ- isms, but when it occurs in the absence of bacterial conjunctivitis, as is now the case in American Indians, the disease rarely leads to major visual loss (Hoshiwara, Powers, and Krutz, I 97 I). Although the ways in which bacterial conjunctivitis and trachoma interact have not been determined, it has been suggested that one of the principal mechanisms of topical chemotherapy in severe endemic trachoma is the suppression of bacterial conjunc- tivitis which reduces the blinding complications of trachoma (Reinhards, Weber, Nizeti6, Kupka, and Maxwell-Lyons, I968).