SUMMARY The epidemiological and clinical features of primary herpes simplex virus ocular infection in 108 patients were studied. Of these, 69 (64%) were aged 15 or over and only eight (7%) were under the age of 5. Associated upper respiratory tract infection was found in 38 (35%) patients and systemic disorders such as mild malaise, fever, and aching in 34 (31%) patients. Common symptoms were redness, watering, discharge, itching, irritation, and lid swelling, whereas pain, photophobia, lid vesicles and ulcers, and blurred vision were less frequent. The major signs consisted of vesicles and ulcers on the lids, papillary responses which were more severe in the upper lid conjunctiva, follicles which were more common in the lower lid conjunctiva, fine and coarse epithelial punctate keratitis, and subepithelial punctate keratitis. Dendritic ulcers and disciform keratitis were found in 16 (15%) and two (2%) patients respectively. The clinical forms of primary herpes simplex virus ocular infection varied. Moderate or severe disease was observed in 41 (38%) and 16 (15%) patients respectively. In eight (7%) patients the disease presented as an acute follicular conjunctivitis without characteristic lid or corneal lesions. A chronic blepharoconjunctivitis which lasted for months developed in 16 (15%) patients. The epidemiological and clinical features in our patients were compared with features of the disease reported previously.

A modification of the microimmunofluorescence test to provide a practicable routine serodiagnostic test for detecting and characterising chlamydial infection is described which uses four antigen pools, one of which corresponds with each of the four main clinical and epidemiological types of chlamydial infection. The three subgroup A Chlamydia (Chlamydia trachomatis) pools are: pool 1, hyperendemic trachoma TRIC agent serotypes A, B, and C; pool 2, paratrachoma TRIC agent serotypes D, E, F, G, H, I, and K; pool 3, lymphogranuloma venereum (LGV) agent serotypes L1, L2, and L3. Pool 4 contained four representative isolates of subgroup B Chlamydia (Chlamydia psittaci). For routine purposes sera need be screened only against these four representative antigen pools. This will detect antibody and indicate which clinical and epidemiological type of chlamydial infection is implicated, thereby clearly distinguishing those infections that are due to C. psittaci. The pattern of the cross-reactions may indicate the individual serotype involved, and further titration requiring a maximum of four individual antigens is sufficient to determine the serotype. The slight loss in sensitivity (twofold) is more than compensated for by the reduction in cost and the tenfold increase in the total number of sera which can be examined.

The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community.

SUMMARY Recent isolation studies have shown Chlamydia trachomatis to be an important aetiological agent in acute salpingitis in women. The present serological study indicates that C. trachomatis is the probable aetiological agent in two-thirds of 143 women with pelvic inflammatory disease (PID). In general, high levels of chlamydial antibody were found in sera and fluids aspirated from the pouch of Douglas and such antibody titres were shown to correlate with the severity of clinically graded tubal inflammation.

No abstract