[Persistence of Chlamydia trachomatis in patients with chronic therapy refractory conjunctivitis]

We report three patients with recurrent Chlamydia-associated conjunctivitis. The clinical course of the Chlamydial infection was documented by positive conjunctival smears (direct immunofluorescence staining) and the evaluation of the IgA-titer in the sera (immunoperoxidase assay). The recovery of the ocular symptoms after therapy onset correlated well with the negative results of the conjunctival smears and the decrease in IgA level in the sera. The recurrence of the conjunctivitis was accompanied by an increase in the IgA titer in the sera of all three patients and the presence of Chlamydial elementary bodies in the conjunctival scrapings in two cases. Three patients showed immunologic pecularities: two had an allergic diathesis; the third patient developed Wegener disease 3 months after the onset of ocular inflammation. Inclusion bodies or Chlamydial DNA can persist in conjunctival cells. Anderson suggested that a recurrence of active Chlamydial infection may be induced by external causes, which lead to reconstitution of elementary bodies from the persisting DNA. The extraordinary immune situation of our patients might be one cause of the recurrent conjunctivitis.