title: Bacterial infection in scarring trachoma.
abstract: OBJECTIVE
  To assess whether non-chlamydial bacterial infection is associated with trachomatous scarring in adults.
  
  
  METHODS
  This was a case-control study of 360 cases with trachomatous scarring but without trichiasis, and 360 controls without scarring. All participants underwent clinical examination, and a swab was taken from the inferior conjunctival fornix. Samples were inoculated onto blood and chocolate agar later that day.
  
  
  RESULTS
  Bacterial isolates were identified in 54.0% of cases compared with 34.6% of controls (P < 0.001). A multivariate logistic regression model adjusted for age and lack of education showed that scarring was associated with the presence of commensal organisms (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.01-2.09) and was strongly associated with the presence of pathogenic organisms (OR, 4.08; 95% CI, 1.59-10.45). There was an increasing prevalence of all bacterial isolates with increasing severity of scarring (P(trend) < 0.001).
  
  
  CONCLUSIONS
  Trachomatous scarring is strongly associated with non-chlamydial bacterial infection compared with controls. The role of such infection with regard to scarring progression should be investigated and may have important implications for trachoma control strategies and prevention of blindness.
authors.affiliation: International Centre for Eye Health, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. victor.hu@lshtm.ac.uk
authors.forename: Victor H
authors.initials: VH
authors.lastname: Hu
authors.forename: Patrick
authors.initials: P
authors.lastname: Massae
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Caroline
authors.initials: C
authors.lastname: Chevallier
authors.forename: Jecinta J
authors.initials: JJ
authors.lastname: Onyango
authors.forename: Isaac A
authors.initials: IA
authors.lastname: Afwamba
authors.forename: David C W
authors.initials: DC
authors.lastname: Mabey
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bailey
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification*; D016022:Case-Control Studies; D003228:Conjunctiva / Q000382:microbiology; D003234:Conjunctivitis, Bacterial / Q000382:microbiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014141:Trachoma / Q000382:microbiology* / Q000503:physiopathology; D058457:Trichiasis / Q000382:microbiology; D055815:Young Adult