Studies on trachoma. 11. Evaluation of laboratory diagnostic methods under field conditions

The severity of trachoma in endemic areas has, in general, a tendency to decrease as a consequence of control measures and gradual improvements in sanitation and living conditions. The number of mild cases seen where the disease is prevalent is thus increasing and it is becoming more difficult to establish a differential diagnosis in certain cases, and to determine the degree of endemicity of the disease in a given area or community.In order to ascertain whether available laboratory methods could contribute useful data from this point of view, a clinical and laboratory study was carried out on the school population of the island of Djerba, off the south coast of Tunisia, during the school year 1963-64.The ophthalmological findings confirmed that, notwithstanding the large-scale treatment campaigns which had been in operation for 10 years, trachoma was then still highly endemic in the island, but relatively mild.The laboratory studies included microscopical examination of conjunctival scrapings for inclusion bodies, complement-fixation tests on serum specimens and-on a subsample of the populations studied-attempts to isolate the trachoma agent. The results indicated that the tests are more likely to be positive when the clinical signs are more pronounced. In individual cases, laboratory tests can at best confirm an already established clinical diagnosis and contribute little to the differential diagnosis of borderline cases.However, this study also indicated that the laboratory tests may provide useful quantitative indications on the endemicity of the disease in a community or in an area, from the point of view of the density of the agent and of the response to its presence. The techniques used must obviously be uniform enough to allow for a comparison with results obtained elsewhere or at different times.