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V. Cevallos, C. Donnellan, Z. Zhou, E.H. Yi, M. Melese, W. Alemayehu, S.E. Lee, B. Gaynor, J.P. Whitcher, T. Lietman; Conjunctival Flora in Patients With Trichiasis Due to Trachoma . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5057.
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Purpose: Bacterial organisms comprise the normal flora of the healthy eye, however under certain conditions these organisms may become opportunist and cause infection. Streptococcus pneumonia, Haemophilus influenza and Staphylococcus aureus and many other organisms can produce infections such as conjunctivitis and corneal ulcers. Trachomatous trichiasis is a risk factor for corneal ulceration, likely from superinfection of the cornea by the organisms that are already present. There is little data available on the bacterial organisms comprising the flora of eyes with trachomatous trichiasis. Methods: Individuals >40 years old in Gurage Zone, Ethiopia were examined for presence or absence of trichiasis and their conjunctiva swabbed for aerobic bacterial cultures. Swab specimens were taken on 102 people with trichiasis (TT group) and 95 without trichiasis (controls) from the same villages. Swabs were stored in 1 ml of STGG (skim–milk–tryptone–glucose–glycerin) medium and transported frozen to the US for culture work up. Results: Bacteria was recovered from 91% of cultures in the TT group vs. 54% in the controls (P<0.01). Ocular pathogens H. influenza and S. pneumonia occurred in 20% and 17% respectively of cultures in the TT group. These same organisms occurred less frequently in the non–trichiasis group, H. influenza in 2% and S. pneumonia in 8% of cultures. The organisms present most frequently in both groups were Streptococcus viridans group and diphtheroids (67% and 43% respectively for the TT group and 33% and 20% for the control group). Conclusions: Persons with trichiasis are more likely to harbor ocular pathogenic bacteria in their conjunctiva (as well as other organisms) when compared to persons without trichiasis. The presence of trichiasis either itself predisposes these eyes to colonization or is a marker of more severe trachomatous scarring. The high prevalence of potentially pathogenic bacteria in eyes with trichiasis is worrisome and suggests a possible role for topical prophylactic antibiotics or antiseptics to prevent the corneal ulcers that cause blinding trachoma.
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