Recent Trachoma Studies

AMERICAN JOURNAL OF OPHTHALMOLOGY Published Monthly by the Ophthalmic Publishing Company EDITORIAL STAFF DERRICK VAIL,

S. RODMAN IRVINE

Editor-in-Chief

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WILLIAM H. CRISP, Consulting Editor

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JAMES E. LEBENSOHN

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LAWRENCE T. POST, Consulting Editor

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WILLIAM L. BENEDICT

DONALD J. LYLE

FREDERICK C. CORDES

IDA MANN

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The Mayo Clinic, Rochester, Minnesota

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WILLIAM A. MANN

SIR STEWART DUKE-ELDER

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PHILLIPS THYGESON

EDWIN B. DUNPHY

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HARRY S. GRADLE

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F. HERBERT HAESSLER

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ALAN C. WOODS

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KATHERINE FERGUSON CHALKLEY, Manuscript Editor

Lake Geneva, Wisconsin

Directors: LAWRENCE T. POST, President; WILLIAM L. BENEDICT, Vice-President; WILLIAM A.

MANN, Secretary and Treasurer; WILLIAM H. CRISP, FREDERICK C. CORDES, DERRICK VAIL.

Address original papers, other scientific communications including correspondence, also books for review to Dr. Derrick Vail, 700 North Michigan Avenue, Chicago 11, Illinois; Society Proceedings to Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Manuscripts should be original copies, typed in double space, with wide margins. Exchange copies of medical journals should be sent to Dr. F. Herbert Haessler, 561 North 15th Street, Milwaukee 3, Wisconsin. . . . Subscriptions, application for single copies, notices of changes of address, and communications with reference to advertising should be addressed to the Manager of Subscriptions and Advertising, 664 North Michigan Avenue, Chicago 11, Illinois. Copy of advertisements must be sent to the manager by the fifteenth of the month preceding its appearance. Author's proofs should be corrected and returned within forty-eight hours to the Manuscript Editor, Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Twenty-five reprints of each article will be supplied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Company, 450-458 Ahnaip Street, Menasha, Wisconsin, if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted. RECENT TRACHOMA STUDIES In reviewing wartime trachoma studies for the two volumes of Ophthalmology in the War Years, edited by D r . Meyer Wiener, I was impressed by the dearth of significant reports on the disease still considered by many to be the eye disease of greatest worldwide importance. Since the war, however, a number of significant studies have appeared, notably by Professor Mitsui and his collaborators in Japan and by Professor Bietti and his collaborators in Italy. T h e Japanese studies were actually r e ported during wartime but only became

available to English readers in 1948. They are summarized in an article by Professor Mitsui in this issue of the JOURNAL. These investigators confirmed anew that human volunteers could be inoculated with trachoma. I n their experience the average incubation period was from 5 to 6 days. T h e onset was always acute and ProwazekHalberstaedter inclusion bodies were always present, in numbers proportionate to the severity of the clinical signs. T h e question of t h e frequency of inclusion bodies in the chronic stage of the disease was reëxamined. Typical inclusions were

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EDITORIALS

found in 537, or 65 percent, of 823 chronic cases and in 85 percent of 392 cases with typical clinical symptoms. Tissue sections were positive for inclusions in 108, or 92 percent of 117 cases. Inclusions were demonstrated in the epithelium of the lacrimal sacs of 5 of 6 patients with early conjunctival trachoma and were noted in the canaliculi of 2 additional cases. The inclusions were never found in the subepithelial tissues and the absence of trachoma virus in these tissues was proven in 10 cases of typical trachoma: subepithelial tissue, obtained in all 10 cases without penetration of the conjunctiva, was shown to be noninfective for human volunteers ; control inoculations with conjunctival tissue from the same cases resulted in typical infection. Furthermore, subconjunctival inoculation of volunteers with infective material failed to induce trachoma ; whereas, a control inoculation of the conjunctiva with the same material resulted in typical experimental trachoma. In tissue-culture experiments, the Japanese investigators were unable to obtain growth of the virus in serial cultures, although the first two cultures of trachomatous epithelium were infective. On the basis of inoculation experiments on blind infant eyes, they claim to have established an identity between inclusion blennorrhea and trachoma but their evidence on this point is inconclusive. Interestingly enough, they were able to infect the human cervix with trachomatous materials, a finding comparable to that of Braley who obtained infection of the cervix of the female baboon with trachoma virus. The experiments of Bietti and his collaborators dealt primarily with the therapy of trachoma, although Bietti covered all aspects of the disease in a monograph entitled "II Trachoma," published in Rome in December, 1947. In a resume of his studies on the sulfonamide and penicillin therapy of trachoma ( Revue Internationale du Trachoma, 25 : 115, 1948), Bietti concluded that all the ordinary sulfonamides were active against

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trachoma but that he preferred paraminophenylsulf amide. He recommended an oral dosage of 2.5 gm. daily for 10 days or longer; topical applications he found less valuable. The drug was most effective against the secreting forms of the disease and against pannus and corneal ulcιration. He found that 50 percent of all cases were cured completely and that about 10 percent of the actively secreting forms and 40 percent of the chronic hyperplastic forms were resistant. He stated that recurrences were frequent after short treatment periods and that reinfections occurred in about 5 percent of cases. He noted that about 10 percent of subjects had an intolerance to the sulfonamides but that vitamins XT and B complex were useful in reducing the intolerance. He was able to show that patients on sulfonamide therapy were noninfective for monkeys and man. Professor Bietti found that penicillin had some curative effect on trachoma but that it was less effective than the sulfonamides. He noted the disappearance of epithelial inclusions within 72 hours. The effect of penicillin on secondary infection was marked. Streptomycin also had a marked effect on secondary infection but little if any on trachoma virus itself. Tyrothricin was of no value. Of special interest is an article by Bietti and Pasca (Boll. Soc. ital. biol. Sper., 24:82, 1948) reporting the inerficacy in trachoma of paraminobenzoic acid, a substance which is highly reactive against the Rickettsiae. The investigators concluded that this lack of sensitivity of trachoma virus to paraminobenzoic acid, combined with its sensitivity to the sulfonamides and penicillin and its negative Weil-Felix reaction, ruled out the existence of any close relationship between trachoma virus and the Rickettsiae. These etiologic and therapeutic studies constitute important contributions to our knowledge of this still most destructive of eye infections. Phillips Thygeson.