The persistence of chlamydial inclusions in clinically quiescent trachoma

Most of the trachoma patients seen at the Guinness Eye Clinic in Kaduna, Northern Nigeria today are in the healed or quiescent stages of evolution and disease intensity is largely trivial. A significant proportion however, seem to have recrudescence of the active stages, a phenomenon that is usually attributed to reinfection. Giemsa cytology of conjunctival scrapings obtained from a cross section of our patients however indicates that a significant proportion still harbour inclusions in spite of clinical inactivity and that some of these inclusion positive cases demonstrate no obvious host inflammatory response, suggesting persistence of infection and host immunocytological tolerance. This brings up the possibility of a spontaneous self perpetrating reactivation cycle which may account for the multicyclicity of trachoma without a reinfecting source in susceptible individuals.