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Original Research Ocular Infections Prevalence of Ocular Chlamydial Infections in South Florida Darlene Miller, Jorge Mesa-Maestre, Edith Perez, Benjamin David Wilson and Eduardo C Alfonso Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, US O cular chlamydia in the US is a sexually transmitted disease. The true public health burden is unknown. We used a combination of culture and culture independent tests to document disease prevalence over a 28-year (1986–2014) period. Methods: Laboratory records of patient’s samples (n=3,112) submitted to rule out chlamydia were reviewed. Data were extracted for patient’s demographics (age, sex), age and positivity rates for historical methods (1986–2004), direct fluorescent antibody (DFA; n=1,774), culture (n=1,619), nucleic acid amplification tests (NAAT; n=274) and enzyme immunoassay tests (EIA; n=609) from historical data (1986–2014) versus the most recent 10 years, (DFA: n=845) and culture (n=523) (2005–2014). A multiplex polymerase chain reaction assay was used to determine species diversity among 128 random samples (1994–2014). Results: Chlamydial positivity rates ranged from 6.0% to 13.4%, with an average of 10.2%. The highest rates were documented for neonates (33.5%) and the age group 15–29 (14.6%, 24.5%). Culture positivity was highest for nonculture tests (historical): NAAT (43.4%), EIA (23.5%), DFA (13.4%) followed culture (8.5%) and current DFA 7.6% versus 3% for culture. Mixed chlamydial infections were observed in 3.1% of samples. A high prevalence and diversity of ocular chlamydia were evident in patients presenting with ocular surface infections in South Florida. Keywords Chlamydia, chlamydophila, positivity rate, direct fluorescent test, nucleic acid amplification test, enzyme immunoassay, prevalence. Disclosure: Darlene Miller, Jorge Mesa-Maestre, Edith Perez, Benjamin David Wilson, and Eduardo C Alfonso have nothing to disclose in relation to this article. No funding was received in the publication of this article. Compliance with Ethics: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in this study. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: August 1, 2016 Accepted: September 14, 2016 Citation: US Ophthalmic Review, 2016;9(2):102–6 Corresponding Author: Darlene Miller, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, Florida, 33136, US. E: dmiller@med.miami.edu Few, if any studies are available on the prevalence and spectrum of ocular chlamydial disease in the US. Current estimates of ocular disease are predominantly anecdotal. The majority of disease is associated with urogenital transmission, with conservative estimated rates of one case for every 300 genital cases. According to Kalayoglu, 50–90% of adults with ocular chlamydia have concomitant genital disease. 1 Two thirds of neonates born to infected mothers will become colonized and one third of these will develop clinical evidence of neonatal inclusion conjunctivitis. The true prevalence and public health burden, however, is unknown. None of the US sexually transmitted disease (STD) screening programs or clinics screen for ocular chlamydia. Nor do ophthalmologists and other ophthalmic healthcare providers routinely ask or screen for genital or extragenital infections. The chlamydiae are non-mobile, gram negative, obligate, intracellular, energy parasites recovered from a variety of hosts, systemic, and ocular infections. Chlamydial species possess a unique and complex multiphasic developmental cycle, which requires living tissue for cultivation and growth. A variety of ocular diseases are associated with chlamydia and chlamydia-like microorganisms worldwide. The order, Chlamydiales includes nine families, Chlamydiaceae, Clavichlamydiaceae, Criblamydiaceae, Piscicchlamydiacea, Parachlamydiaceae, Rhadochlamydiaceae, Simkaniaceae, Wadddliaceae and 'Candidatus' Parilichlamydiae more than 20 species. 2 Currently, only members of two families (Chlamydiaceae and Parachlamydiaceae) and five species (C. trachomatis, C. pneumoniae, C. psittaci, Neochlamydia and Parachlamydia) have been associated with ocular infections. 3–10 C. trachomatis causes the majority of ocular disease, including trachoma, 2 neonatal and adult inclusion conjunctivitis, 11,12 keratitis, 1,13 uveitis, 14 and lymphoma. 15 C. pneumoniae is a major respiratory pathogen. Seroprevalence ranges from 40–80%. Reports of ocular disease is rare. It has been recovered in patients in endemic trachoma area, 16 patients with follicular conjunctivitis, 17 and adults with keratoconjunctivitis. 17 C. psittaci is endemic in pet and wild birds including parrots, pigeons, and parakeets. It causes psittacosis and or orthniosis, a systemic disease involving the conjunctiva. C. psittaci has been 102 TOUCH ME D ICA L ME D IA