Association of conjunctival bacterial infection and female sex in cicatricial trachoma.
OBJECTIVE
Conjunctival infection with non-chlamydial bacteria may play an important role in the progression of trachoma, especially with regard to the development of corneal opacity and blindness. To further characterize the microbiological profile of bacterial conjunctival infections in cicatricial trachoma, a conjunctival swabbing of adults in rural Ethiopia was performed.


METHODS
In a cross-sectional study conducted in nine Ethiopian villages with hyperendemic trachoma, persons 40 years of age or older with signs or symptoms consistent with trichiasis were recruited and conjunctival swabbing for bacterial pathogens was performed.


RESULTS
Conjunctival examination and swabbing on 112 females and 36 males were performed. Of the 148 study participants, 101 (68.2%) were confirmed to have trichiasis, and 118 (80%) had conjunctival swabs positive for bacteria. In multivariate analyses, growth of pathogenic conjunctival bacteria was independently associated with trichiasis (odds ratio [OR] 6.93; 95% confidence interval [CI] 2.71-17.7) and female sex (OR 5.90; 95% CI 2.09-16.7). Females were more likely to have swabs positive for Streptococcus pneumoniae or Haemophilus influenzae than were males (OR 9.09; 95% CI 1.17-70.8).


CONCLUSIONS
In a region of Ethiopia with endemic trachoma, conjunctival bacterial growth was more common in females than that in males. S. pneumoniae and H. influenzae, both of which frequently colonize the nasopharynx of children, were more common in females, suggesting that the preponderance of infection in females may be attributable to close contact with children. This finding is consistent with the theory that childcare activities may preferentially expose females to ocular chlamydial infection. (ClinicalTrials.gov number, NCT00221364.).
Francis I. Proctor Foundation, San Francisco, California 94143-0412, USA.
Vicky
V
Cevallos
John P
JP
Whitcher
Muluken
M
Melese
Wondu
W
Alemayehu
Elizabeth
E
Yi
Jaya D
JD
Chidambaram
Scott
S
Lee
Harsha
H
Reddy
Bruce D
BD
Gaynor
Thomas M
TM
Lietman
Jeremy D
JD
Keenan
D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000382:microbiology*; D003228:Conjunctiva / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D006192:Haemophilus Infections / Q000382:microbiology; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000382:microbiology; D012737:Sex Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014141:Trachoma / Q000382:microbiology*; D058457:Trichiasis / Q000382:microbiology