LADAKH STUDIES 14, Autumn 2000 - International Association for ...

could be minimized, training amchis and other responsible individuals in the villages in the use and
interpretation of these kits would set the stage for rapid diagnosis and treatment of youngsters with
sore throat. School-based throat culture programs among communities on the eastern slope of the
Rocky Mountains in the United States helped 40 or 50 years ago to substantially reduce the
incidence of post-streptococcal rheumatic fever.
Pulmonary Infections:
Ambient and indoor air pollution are certainly the most prominent contributors but the steady
increase in tobacco smoking will add substantially to chronic respiratory irritation and inflammation
(10). Bronchitis is far and away the most common lower respiratory tract infection in our clinics.
Old-fashioned lobar pneumonia is rare. The pneumococcus is, around the world, the most common
pathogen causing purulent otitis media. I wonder if the high prevalence of ear infections in children
is a factor in the relative infrequency of pneumococcal (lobar) pneumonia. There are many
serotypes of the pneumococcus and infection results in antibody formation directed against specific
capsular compounds, and thus future immunity to infection by that particular serotype of
pneumococcus. The capacity to immunize against the capsular antigens is the basis for the
widespread use of pneumococcal vaccine in Europe and North America. Frequent ear and sinus
infections by the pneumococcus during childhood would accomplish the same thing but at the price
of impaired hearing. Modifications of pneumococcal polysaccharide vaccines have opened the
possibility of childhood immunization which offers the possibility of reducing both ear and
pulmonary infections.
Tuberculosis:
The World Health Organization estimates that about one-third of the earth's human population is
latently infected with Mycobacterium tuberculosis (12). In the past three years we have started
routine skin testing for tuberculosis in the villagers where we establish clinics. The data from
Lingshed (Table 2) indicates that about a quarter of the population (teenagers and older adults)
have been exposed to tuberculosis. How many cases of active tuberculosis are present is impossible
to determine without facilities for x-rays and microbiologic diagnosis.
Strong positive tuberculin skin tests in individuals given BCG as children suggest repetitive
exposure to M. tuberculosis, supporting the conclusion that tuberculosis is an active problem in
Ladakh.(13). Because records of immunization are not well preserved it is impossible to determine
how many individuals had been given BCG vaccine.
Table 1 Positive Tuberculin Skin Test Results in Lingshed Area
Monks
Nuns
Villagers
Positive
intermediate
strength PPD
6
5
6
PPD reaction
2.0 cm or more
1
1
2
History of
BCG vaccine
1
1
Totals
6/37 (16%)
5/20 (25%)
6/21 (29%)
17/78 (22%
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