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Nature Reviews. Disease Primers May 2022Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically,... (Review)
Review
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
Topics: Blindness; Child; Chlamydia trachomatis; Gonorrhea; Humans; Trachoma; Trichiasis
PubMed: 35618795
DOI: 10.1038/s41572-022-00359-5 -
Lancet (London, England) Dec 2014Trachoma is the most common infectious cause of blindness. Repeated episodes of infection with Chlamydia trachomatis in childhood lead to severe conjunctival... (Review)
Review
Trachoma is the most common infectious cause of blindness. Repeated episodes of infection with Chlamydia trachomatis in childhood lead to severe conjunctival inflammation, scarring, and potentially blinding inturned eyelashes (trichiasis or entropion) in later life. Trachoma occurs in resource-poor areas with inadequate hygiene, where children with unclean faces share infected ocular secretions. Much has been learnt about the epidemiology and pathophysiology of trachoma. Integrated control programmes are implementing the SAFE Strategy: surgery for trichiasis, mass distribution of antibiotics, promotion of facial cleanliness, and environmental improvement. This strategy has successfully eliminated trachoma in several countries and global efforts are underway to eliminate blinding trachoma worldwide by 2020.
Topics: Chlamydia trachomatis; Cost of Illness; Humans; Trachoma
PubMed: 25043452
DOI: 10.1016/S0140-6736(13)62182-0 -
BMJ Clinical Evidence Feb 2016Active trachoma is caused by chronic infection of the conjunctiva by Chlamydia trachomatis, and is the world's leading infectious cause of blindness. Infection can lead... (Review)
Review
INTRODUCTION
Active trachoma is caused by chronic infection of the conjunctiva by Chlamydia trachomatis, and is the world's leading infectious cause of blindness. Infection can lead to: scarring of the tarsal conjunctiva; inversion of the eyelashes (trichiasis), so that they abrade the cornea; and corneal opacity, resulting in blindness. Trachoma is a disease of poverty, overcrowding, and poor sanitation. Active disease affects mainly children, but adults are at increased risk of scarring.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of interventions to prevent scarring trachoma by reducing the prevalence of active trachoma? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, searching of electronic databases retrieved 170 studies. After deduplication and removal of conference abstracts, 96 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 61 studies and the further review of 35 full publications. Of the 35 full articles evaluated, three previously included systematic reviews were updated, one systematic review and two RCTs were added at this update, and two RCTs and one further report were added the Comment sections. We performed a GRADE evaluation for nine PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for seven interventions based on information about the effectiveness and safety of antibiotics, face washing (alone or plus topical tetracycline), fly control (through the provision of pit latrines, and using insecticide alone or plus antibiotics), and health education.
Topics: Chlamydia trachomatis; Health Education; Humans; Insect Control; Sanitation; Tetracycline; Trachoma
PubMed: 26860629
DOI: No ID Found -
Nature Reviews. Disease Primers May 2022
Topics: Gonorrhea; Humans; Prevalence; Trachoma
PubMed: 35618865
DOI: 10.1038/s41572-022-00369-3 -
Lancet (London, England) Jul 2003Trachoma is the most common infectious cause of blindness. It is caused by ocular serovars of Chlamydia trachomatis. Transmission is favoured in poor communities, where... (Review)
Review
Trachoma is the most common infectious cause of blindness. It is caused by ocular serovars of Chlamydia trachomatis. Transmission is favoured in poor communities, where crowding is common and access to water and sanitation inadequate. Repeated reinfection over many years causes dense scarring of the upper eyelid. The resultant inversion of the lashes abrades the eyeball, and the abrasion leads to corneal opacification and visual impairment. The host immune response is probably at least partly the cause of this process. The "SAFE" strategy is used for the control of trachoma: surgery for in-turned lashes, antibiotics for active disease, facial cleanliness, and environmental improvement. The demonstration that a single oral dose of the antibiotic azithromycin is as effective as 6 weeks of topical tetracycline was an important advance in trachoma control. By means of the SAFE strategy, WHO and its partners aim to eliminate trachoma as a public-health problem by the year 2020.
Topics: Chlamydia trachomatis; Communicable Disease Control; Humans; Trachoma; World Health Organization
PubMed: 12885486
DOI: 10.1016/S0140-6736(03)13914-1 -
Current Opinion in Ophthalmology Sep 2018To review current practices for trachoma treatment with a focus on recent studies, particularly those discussing trachoma trichiasis surgery. (Review)
Review
PURPOSE OF REVIEW
To review current practices for trachoma treatment with a focus on recent studies, particularly those discussing trachoma trichiasis surgery.
RECENT FINDINGS
Azithromycin eye drops twice daily for 3 days may be as efficient as oral azithromycin in treating active trachoma. Facial cleanliness and environmental improvement programming should employ a variety of behavior change techniques to give sustained improvements. Posterior lamellar tarsal rotation carries a lower risk for trichiasis recurrence and is more effective in severe trachoma trichiasis than bilamellar tarsal rotation. Tarsoconjunctival incision can play a pivotal role in trichiaisis recurrence. Tarsus-sparing procedures continue to be refined with good success rates. Concurrent correction of lid abnormalities that commonly occur with trachoma trichiasis may maximize the result of surgery.
SUMMARY
Better understanding of the pathophysiology of trachoma and postoperative trichiasis recurrence is critical for effective trachoma control. Progressive tarsoconjunctival scarring in trachoma and high recurrence rates following tarsal rotation procedures raise the importance of adopting a procedure that spares tarsus/conjunctiva.
Topics: Global Health; Humans; Incidence; Ophthalmologic Surgical Procedures; Recurrence; Trachoma
PubMed: 29965850
DOI: 10.1097/ICU.0000000000000504 -
International Ophthalmology May 1990Trachoma causes one-quarter of the world's blindness and, although it has disappeared from many developed areas, it remains a major problem, especially in... (Review)
Review
Trachoma causes one-quarter of the world's blindness and, although it has disappeared from many developed areas, it remains a major problem, especially in underprivileged rural areas in developing countries. Recent advances in the understanding of the molecular biology of chlamydia offer encouragement for the eventual development for an effective trachoma vaccine. Advances in the understanding of the epidemiology of trachoma, particularly of the importance of reinfection and the intrafamily transmission of infection, have led to the identification of the key importance of simple hygiene measures such as facial cleanliness in preventing the transmission of trachoma. Community-based health education intervention programs are being developed to assess the efficacy of a public health approach to the control of trachomatous blindness.
Topics: Chlamydia trachomatis; Developing Countries; Health Education; Humans; Tetracycline; Trachoma
PubMed: 2188922
DOI: 10.1007/BF00158319 -
The American Journal of Tropical... Feb 2023
Topics: Humans; Trachoma
PubMed: 36623481
DOI: 10.4269/ajtmh.22-0760 -
Clinical Evidence Jun 2003
Review
Topics: Anti-Infective Agents; Face; Humans; Hygiene; Trachoma
PubMed: 15366166
DOI: No ID Found -
British Medical Bulletin Apr 1983
Review
Topics: Adolescent; Adult; Blindness; Child; Child, Preschool; Conjunctiva; Cornea; Female; Humans; Infant; Male; Trachoma
PubMed: 6347318
DOI: 10.1093/oxfordjournals.bmb.a071801