L. J. Yeh

The authors' epidemiologic studies of trachoma on Taiwan and experimental monkey eye infections with and without Chlamydia trachomatis immunization are reviewed for the data they provide on the pathogenesis of trachoma. These studies indicate that trachoma is an immunopathologic disease in which the more severe progressive trachoma infections with pannus and scar formation occur only after reinfection. This hypothesis is supported by a 10-year study of 32 family households that were followed with repeated clinical and laboratory observations. Although most cases of active trachoma healed spontaneously, there were 26 persons in nine families who developed clinical and laboratory evidence of 29 episodes of new trachoma eye infection. On the basis of the clinical disease, its persistence, and the laboratory findings, these 29 new infections could be divided into 10 primary, nine secondary, and 10 tertiary infections. Details of the different stages of infection leading to chronic trachoma are presented.

Following a clinical trial in 1959-60 and a prevalence survey in 1960-61, a community-wide trachoma treatment programme was instituted in Taiwan. A reexamination in 1968-69 of a subsample of the localities included in the 1960-61 survey provided the basis for a clinical evaluation of the programme.Except in areas of very high endemicity in 1960-61, trachoma appears to have ceased to be, or is in the process of ceasing to be, an important public health problem. A reduction in the number of cases that were active in 1960-61 has since resulted in reducing both the incidence and the severity of the disease. Cases showing signs of past experience of the disease (healed cases), as well as cases with grave irreversible sequelae or complications, belong to the pretreatment cohort and are moving along "time" without being replaced.In communities with an initially very high endemicity it is open to question whether the incidence of the disease has been reduced to the level at which it will fail to perpetuate itself. The results of a very limited survey conducted in 1970 are encouraging: a repeat sample survey is planned for 1972.

Abstract Acute disseminated encephalomyelitis (ADEM) is a rare disease affecting the central nervous system (CNS), and it is difficult to diagnose clinically because of vague prodromal presentations. The therapeutic aim for ADEM is to inhibit the CNS inflammatory reaction as quickly as possible. Treatments may include high-dose corticosteroids and anti-inflammatory and immunosuppressant therapies such as plasmapheresis and high-dose intravenous immunoglobulin. ADEM usually has a good prognosis. Here, we report a rare case of ADEM secondary to Mycoplasma pneumoniae infection mimicking extrapyramidal symptoms.

This study was undertaken to clarify the natural history and pathogenesis of trachoma. A group of families who live in a formerly trachoma hyperendemic area of Southern Taiwan were placed under continuous surveillance. The development in recent years of the micro immunofluorescence test for trachoma antibody, along with improved cell culture isolation methods, have allowed this surveillance to include repeated effective laboratory studies in addition to clinical observations. After four years' study of one group of families and three years of another, a number of interesting findings have been obtained. Evidence is presented supporting our hypothesis that trachoma is a disease of immumopathology and results from repeated reinfections with the trachoma organisms. The clinical findings of papillae, especially those of an acute nature, has been the clinical finding most closely associated with the isolation of the organism and the demonstration of antibody. Evidence is presented that transmission of the organism is usually within the family group. Although only trachoma immunotypes B and C previously had been associated with trachoma infection on Taiwan, data is presented from one family in which type D infections occurred. While a series of new and reinfections with trachoma organisms were demonstrated in some of the families under observation, the majority of the families not only showed no new infections but showed spontaneous healing or disappearance of clinical and laboratory evidence of trachoma infection. This tendency of active trachoma infection to disappear from a family in the absence of transmission of the organism parallels the rapid fall and prevalence of active trachoma on Taiwan during the past decade.