What is Trachoma?
Trachoma (Ancient Greek: "rough eye") is an infectious eye
disease, and the leading cause of the world's infectious
blindness. Globally, 84 million people suffer from active
infection and nearly 8 million people are visually impaired as a
result of this disease. Globally this disease results in
considerable disability.
Trachoma Symptoms
The bacterium has an incubation period of 5 to 12 days, after
which the affected individual experiences symptoms of
conjunctivitis, or irritation similar to "pink eye." Blinding
endemic trachoma results from multiple episodes of reinfection
that maintains the intense inflammation in the conjunctiva.
Without reinfection, the inflammation will gradually subside. The
Simplified WHO Grading System is summarized below:
Trachomatous inflammation, follicular (TF) – Five or more
follicles of >0.5 mm on the upper tarsal conjunctiva
Trachomatous inflammation, intense (TI) – Papillary hypertrophy
and inflammatory thickening of the upper tarsal conjunctiva
obscuring more than half the deep tarsal vessels
Trachomatous trichiasis (TT) – At least one ingrown eyelash
touching the globe, or evidence of epilation (eyelash removal)
Corneal opacity (CO) – Corneal opacity blurring part of the pupil
margin
Further symptoms include:
Eye discharge
Swollen eyelids
Trichiasis (turned-in eyelashes)
Swelling of lymph nodes in front of the ears
Corneal scarring
Further ear, nose and throat complications.
Trachoma Causes
Trachoma is caused by ''Chlamydia trachomatis'' and it is spread
by direct contact with eye, nose, and throat secretions from
affected individuals, or contact with fomites (inanimate objects),
such as towels and/or washcloths, that have had similar contact
with these secretions. Flies can also be a route of mechanical
transmission. Untreated, repeated trachoma infections result in
entropion—a painful form of permanent blindness when the eyelids
turn inward, causing the eyelashes to scratch the cornea. Children
are the most susceptible to infection due to their tendency to
easily get dirty, but the blinding effects or more severe symptoms
are often not felt until adulthood.
Blinding endemic trachoma occurs in areas with poor personal and
family hygiene. Many factors are indirectly linked to the presence
of trachoma including lack of water, absence of latrines or
toilets, poverty in general, flies, close proximity to cattle,
crowding and so forth. However, the final common pathway seems to
be the presence of dirty faces in children that facilitates the
frequent exchange of infected ocular discharge from one child’s
face to another. Most transmission of trachoma occurs within the
family.
Without intervention, trachoma keeps families shackled within a
cycle of poverty, as the disease and its long-term effects are
passed from one generation to the next.
National governments in collaboration with numerous non-profit
organizations implement trachoma control programs using the
WHO-recommended SAFE strategy, which includes:
Surgery to correct advanced stages of the disease;
Antibiotics to treat active infection, using Zithromax (azithromycin)
donated by Pfizer Inc through the International Trachoma
Initiative;
Facial cleanliness to reduce disease transmission;
Environmental change to increase access to clean water and
improved sanitation.
Surgery: For individuals with trichiasis, a bilamellar
tarsal rotation procedure is warranted to direct the lashes away
from the globe. Early intervention is beneficial as the rate of
recurrence is higher in more advanced disease.
Antibiotic therapy: WHO Guidelines recommend that a region
should receive community-based, mass antibiotic treatment when the
prevalence of active trachoma among one to nine year-old children
is greater than 10 percent. Subsequent annual treatment should be
administered for three years, at which time the prevalence should
be reassessed. Annual treatment should continue until the
prevalence drops below five percent. At lower prevalences,
antibiotic treatment should be family-based.
Antibiotic selection: (single oral dose of 20 mg/kg) or
topical tetracycline (one percent eye ointment twice a day for six
weeks). Azithromycin is preferred because it is used as a single
oral dose. Although it is expensive, it is generally used as part
of the international donation program organized by Pfizer through
the International Trachoma Initiative. Azithromycin can be used in
children from the age of six months and in pregnancy.
In 1913, President Woodrow Wilson signed an act designating funds
for the eradication of the disease. The people that went through
Ellis Island had to be checked for trachoma. By the late 1930s, a
number of ophthalmologists reported success in treating trachoma
with sulfonamide antibiotics. In 1948, Vincent Tabone (who was
later to become the President of Malta) was entrusted with the
supervision of a campaign in Malta to treat trachoma using
sulfonamide tablets and drops.
Although by the 1950s, trachoma had virtually disappeared from the
industrialized world, thanks to improved sanitation and overall
living conditions, it continues to plague the developing world.
This potentially blinding disease remains endemic in the poorest
regions of Africa, Asia, and the Middle East and in some parts of
Latin America and Australia. Currently, 8 million people are
visually impaired as a result of trachoma, and 84 million suffer
from active infection.
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