BACTERIOLOGICAL AND CLINICAL STUDIES OF AN EPIDEMIC OF KOCH-WEEKS BACILLUS CONJUNCTIVITIS ASSOCIATED WITH CELL INCLUSION CONJUNCTIVITIS

1. There are cases in which epithelial cell inclusions may alone be present in the conjunctival smears. In such cases no other pathogenic organisms, such as the Koch-Weeks bacillus or the pneurnococcus, can be demonstrated in smears or cultures. 2. The conjunctiva can become simultaneously infected with the inclusion bodies and Koch-Weeks bacilli or other organisms. 3. In cases of acute or subacute conjunctival inflammations due to mixed infections the clinical features of each infection may be present. The course of the inflammation is, however, more prolonged. 4. Within recent years, the Koch-Weeks bacillus has only seldom been found in our routine examinations. 5. The epidemic studied was of a severe type. 6. Clinically it is practically impossible to distinguish pneurnococcal conjunctivitis from the Koch-Weeks conjunctivitis. Bacteriological examination of smears and cultures is the only means by which the etiological diagnosis can be definitely established. 7. Conjunctivæ of certain species of monkeys are susceptible to the von Prowazek inclusion bodies, but not to the hemoglobinophilic bacilli isolated from cases of epidemic conjunctivitis. 8. The injection of conjunctival scrapings containing the von Prowazek cell inclusions into the testicles of rabbits produces no cell inclusions in the latter, while the injection of a pure culture of the hemoglofcinophilic bacilli causes an acute inflammation accompanied by numerous clumps of the organisms, simulating the von Prowazek bodies at certain stages of their evolution. 9. There exists an apparent morphological similarity between the degenerated forms of this variety of the hemoglobinophilic bacilli and the cell inclusions, both in cultures and in experimental orchitis in the rabbit. But, as a rule, the elementary bodies of the latter are much smaller and more sharply defined than the smallest granules of the former, while the initial bodies are bigger, more intensely stainable, and less definite in their contour than the hemoglobinophilic bacilli found in the infected conjunctivæ.