Follicular Trachoma Research Articles

Face washing promotion for preventing active trachoma.

Trachoma remains a major cause of avoidable blindness among underprivileged populations in many developing countries. It is estimated that about 146 million people have active trachoma and nearly six million people are blind due to complications associated with repeat infections. The objective of this review is to assess the effects of face washing on the prevalence of active trachoma in endemic communities. We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group trials register) on The Cochrane Library (Issue 2, 2004), MEDLINE (1966 to February 2004), EMBASE (1980 to February 2004), the reference lists of identified trials and the Science Citation Index. We also contacted investigators and experts in the field to identify additional trials. We included randomised or quasi-randomised controlled trials, comparing face washing with no treatment or face washing combined with antibiotics against antibiotics alone. Participants in the trials were people normally resident in endemic trachoma communities. Two reviewers independently extracted data and assessed trial quality. Study authors were contacted for additional information. Two clinically heterogeneous trials are included, therefore a meta-analysis was considered inappropriate. This review includes two trials with data from a total of 2560 participants. Face washing combined with topical tetracycline was compared to topical tetracycline alone in three pairs of villages in one trial. The trial found a statistically significant effect for face washing combined with topical tetracycline in reducing 'severe' active trachoma compared to topical tetracycline alone. No statistically significant difference was observed between the intervention and control villages in reducing ('non-severe') active trachoma. The prevalence of clean faces was higher in the intervention villages than the control villages and this was statistically significant. Another trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. The trial found no statistically significant benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children with follicular trachoma. There is some evidence that face washing combined with topical tetracycline can be effective in reducing severe trachoma and in increasing the prevalence of clean faces. Current evidence does not however support a beneficial effect of face washing alone or in combination with topical tetracycline in reducing active trachoma.

Immune response to chlamydial 60-kilodalton heat shock protein in tears from Nepali trachoma patients.

Although the host immune response to the 60-kDa chlamydial heat shock protein (hsp60) has been implicated in trachoma pathogenesis, no studies have examined mucosal immune responses to hsp60 in populations for which chlamydia is endemic. Tears and sera from Nepali villagers were reacted against hsp60 fusion proteins, whole hsp60, and the major outer membrane protein (MOMP). Tears from villagers without disease were anti-hsp60 immunoglobulin G (IgG) reactive in 6 (38%) of 16 villagers compared with 36 (90%) of 40 with follicular trachoma (TF) (P < 0.001); 47 (89%) of 53 with inflammatory trachoma (TI) (P < 0.001); and 31 (84%) of 37 with conjunctival scarring (TS) (P = 0.002). By multivariate analysis, odds ratios for tear hsp60 IgG immunoreactivity in villagers with TF, TI, and TS were 49.2 (confidence interval [CI], 2.7 to 898), 22.6 (CI, 3 to 170), and 13.6 (CI, 1.4 to 133), respectively. There were no significant differences for tear IgA or secretory IgA (sIgA) reactivity to hsp60 or for tear sIgA and IgG reactivity to MOMP. Serum anti-hsp60 IgG immunoreactivity was associated with TI only. These data suggest that anti-hsp60 IgG immunoreactivity represents largely locally derived antibodies, which may promote disease pathology. In contrast, nonspecific high rates of anti-hsp60 sIgA antibodies suggest chronic or repeat stimulation from an endemic source of organisms.

Trichiasis in Aboriginal people of the Kimberley region of Western Australia.

Trachoma is a significant public health problem in the Kimberley region of Western Australia. The prevalence of follicular trachoma in the region has been well documented and control of active trachoma is well established. In contrast, trichiasis prevalence in recent years is less well documented. This study aimed to determine trichiasis prevalence in the Kimberley population and to document an appropriate intervention. A collaborative programme was established involving the Kimberley Public Health Unit, Kimberley Aged Care Services and the visiting ophthalmology service. After training, medical students screened the aged-care population for trichiasis and the aged-care services staff were educated about identification and referral procedures for patients with trichiasis. The Kimberley Public Health Unit was responsible for ensuring specialist assessment, and correction, of trichiasis and appropriate post-treatment follow up. A total of 597 Kimberley Aboriginal people aged 50 years or more were screened for trichiasis, representing 42% of that age group. Trichiasis was suspected in 40 people. Of the 28 people with suspected trichiasis who underwent ophthalmological assessment, 17 were found to have trachomatous trichiasis. The observed prevalence of trachomatous trichiasis was 2.8%. The trichiasis screening programme has been adopted by most aged-care organizations in the Kimberley. The results show that trichiasis continues to affect elderly Aboriginal people, especially those from Halls Creek Shire. Health professionals and aged-care workers should be alert to the possibility of this preventable cause of blindness and work collaboratively to ensure that patients receive timely and appropriate treatment.

A targeted, single-dose azithromycin strategy for trachoma.

To evaluate the impact of treating children with acute trachoma and their contacts with oral azithromycin. Open, uncontrolled, prospective evaluation of a community-based treatment strategy. Central Australian semi-desert Aboriginal community (1995-1996). 216 school- and pre-schoolchildren aged 6 months and up to 15 years. All children with acute trachoma and their contacts (co-resident siblings aged between 6 months and 15 years) received single-dose oral azithromycin suspension (20 mg/kg, to a maximum of 1000 mg). Prevalence of acute trachoma (World Health Organization trachoma diagnostic criteria). Trachoma prevalence at baseline was 42% (71/169) and 55% (18/33) for schoolchildren and pre-schoolchildren, respectively: 103 schoolchildren and 21 pre-schoolchildren, comprising 77 with follicular trachoma and their 47 contacts, were treated with azithromycin over an 8-week period. Acute trachoma prevalence in schoolchildren fell to 22% at 6-8 months (P < 0.0001) and was 31% at 12 months (P < 0.05 compared with baseline). Pre-schoolchildren were followed up for 6 months after treatment, and their trachoma prevalence fell from 55% to 25% (P < 0.05). Further treatment was given to children with trachoma at 12 months, and the point prevalence of trachoma for schoolchildren at 24 months was 34%. In contrast to mass-treatment strategies, significant reductions in trachoma prevalence at 6 months were achieved by screening 35% of community members (216) and treating 20% (124). The subsequent prevalence increases support the need for more comprehensive treatment programs, including health promotion and efforts to improve living conditions.

Characterization of B-cell responses to Chlamydia trachomatis antigens in humans with trachoma.

The circulating B-cell responses to Chlamydia trachomatis of 60 children and 34 adults in The Gambia were characterized in a cross-sectional study of different grades of trachoma, using the enzyme-linked immunospot (ELISPOT) assay. Antibody-secreting cells (ASCs) specific to chlamydial major outer membrane protein (MOMP), heat shock protein 60, and whole elementary bodies were detected in children with no evidence of ocular disease, and the immunoglobulin (IgA) response was significantly increased in those with follicular trachoma. In marked contrast, children with the most intense ocular inflammation paradoxically had an almost completely absent B-cell response of all isotypes and to all chlamydial antigens, but with normal serum IgG and IgA responses, which was even lower than in the group with no ocular inflammation. Adults with or without evidence of trachomatous scarring had equivalent numbers of circulating B cells, principally IgA, to all chlamydial antigens. Plasmablasts secreting antibodies to MOMP were present in the urine of children in the absence of urogenital infection detectable by PCR, and relative numbers were 8 to 25 times higher than in blood, suggesting site-specific homing within a common mucosal immune system. These results suggest that ELISPOT assay of ongoing B-cell responses detects suppression of chlamydia-specific IgA ASCs during the proinflammatory response to ocular chlamydial infection seen in intense trachoma, which may play a role in tissue damage leading to trachomatous scarring.

Absence of a relationship between malnutrition and trachoma in preschool children

Purpose: To determine if there is an association between malnutrition and clinical trachoma among children in a trachoma endemic region of Tanzania.Methods: 189 children age one to five were examined by a trained eye nurse for the presence of active trachoma, using the WHO simplified grading scheme. One examiner also measured the arm circumference of the mid-aspect of the upper left arm on the same children. Trachoma was defined as the presence of follicular trachoma (TF) and/or severe trachoma (TI). Malnutrition was defined two ways: a mid-arm circumference of less than 12.5 cm, and a value one standard deviation below the age-specific mean.Results: Overall, 57% of children had trachoma, and 9% had severe trachoma. The percentage of children with arm circumference below 12.5 cm varied with age from 96% in the one-year-olds to 35% in the six-year-olds. Using either method of classifying malnutrition, there was no association with trachoma, nor with severe trachoma.Conclusion: Trachoma and malnutrition are both common in this sample of children, although no relationship between the two was observed. Further work on the nutritional status in those with subclinical infection may be warranted.

Prevalence and risk factors for trachoma in Sarlahi district, Nepal.

To estimate the prevalence of trachoma in preschool children in Sarlahi district, Nepal, and to identify risk factors for the disease. A stratified random sample of 40 wards was selected for participation in a trachoma survey. Within each ward, a systematic 20% sample of children 24-76 months of age was chosen to determine the presence and severity of trachoma using the World Health Organisation grading system. A total of 891 children were selected and 836 (93.8%) were examined for trachoma from December 1990 to March 1991. The prevalence of active trachoma was 23.6% (21.9% follicular and 1.7% intense inflammatory). Cicatricial trachoma was not seen in this age group. The prevalence of trachoma ranged from 0 to 50% across wards with certain communities at much higher risk for trachoma than others. Three year old children had the highest prevalence of follicular (25.5%) and intense inflammatory trachoma (4.3%). Males and females had similar prevalence rates. Wards without any tube wells were at higher risk than those with one or more tube wells. Lower rates of trachoma were seen in families who lived in cement houses, had fewer people per room, more servants, more household goods, animals, and land. Hence, less access to water, crowding and lower socioeconomic status were risk factors for trachoma. Although follicular trachoma is prevalent, intense inflammatory trachoma is relatively rare and scarring was not observed in this preschool population. Hence, this population may not be at high risk for repeat infections leading to blindness in adulthood.

Trends in the prevalence of trachoma, South Australia, 1976 to 1990.

The eye health of rural Aboriginal Australians is known to be poor. Over the past 20 years, Aboriginal communities in remote parts of Australia have had increasing access to eye health services through the National Trachoma and Eye Health Program (NTEHP). Using published and unpublished data, we examined trends in the prevalence of inflammatory trachoma in the Anangu Pitjantjatjara of South Australia. Comparisons using a generalised linear model of surveys in 1976, 1985 and 1990 indicate that there has been a significant reduction in the age-standardised prevalence of inflammatory trachoma in 0- to 20-year-olds. When the 1990 survey was compared with 1976 interim report data from the NTEHP survey, the odds of inflammatory trachoma in 1990 were 0.25 (95 per cent confidence interval (CI) 0.18 to 0.35). When the comparison was with data from the NTEHP survey of the Red Centre, the odds of follicular trachoma in 1990 were 0.51 (CI 0.42 to 0.62), and in comparison with the 1985 NTEHP review data, the odds of inflammatory trachoma in 1990 were 0.28 (CI 0.20 to 0.39). In the older age groups (20 and over), an increase in the prevalence of inflammatory trachoma was found. Although significant, the increase affected a small proportion of the population and may have been because of difficulty in standardising the trachoma grading between surveys, or systematic grading error in the 1990 survey. This study therefore shows that the eye health of Aboriginal people in Central Australia may be improving. The decline in trachoma is welcome and may be caused by improvements in socioeconomic conditions, community development and increasing access to medical care.

Diagnosis of Chlamydia trachomatis eye infection in Tanzania by polymerase chain reaction/enzyme immunoassay

Detection of Chlamydia trachomatis eye infection is largely unsatisfactory by standard laboratory methods. A polymerase chain reaction/enzyme immunoassay (PCR-EIA) that had previously been successful for diagnosis of genital C trachomatisinfection was compared with direct antibody immunofluorescence (DFA) for detection of the organism in conjunctival scrapes. 234 Tanzanian children aged 1-7 years living in a village that had had no previous trachoma control programme were classified clinically as having no sign of trachoma (0) n=97, follicular trachoma (TF) n=100, or intense inflammatory trachoma with or without TF (TI ± TF) n=37. PCR-EIA detected C trachomatis in 24%, 54%, and 95% of subjects, respectively, compared with elementary body (EB) detection by DFA of 1%, 28%, and 60%, respectively. Overall prevalence of chlamydial eye infection was 22% by DFA compared with 48% by PCR-EIA. Of subjects with chlamydial DNA at pretreatment, 103 (92%) had no detectable chlamydial DNA at the end of 4 weeks of ocular tetracycline. The findings show that PCR-EIA is likely to affect trachoma diagnosis and epidemiology because of the increased sensitivity for detection of C trachomatis in all clinical groups; the less stringent requirements for specimen collection and transport make this method suitable for field use. Moreover, the semi-quantitative aspect of PCR-EIA may be useful for monitoring a decrease in chlamydial DNA after treatment.

Reliability of photographs for grading trachoma in field studies.

The validity and reliability of the use of photographs to assess active trachoma and scarring was studied in a village where the disease was hyperendemic. One hundred and thirty six subjects were graded clinically and had photographs taken of the upper tarsal plate. Agreement between the clinical grade in the field and the grade on the photograph was very good for follicular trachoma, severe trachoma, and scarring (kappa statistic values were 0.71, 0.74, and 0.73 respectively). In field studies photographic documentation of trachoma appears to be a valid and reliable approach.

Trachoma: 1985 update in Western Australia.

Aboriginal preschool and school children were surveyed in the Eastern Goldfields Region and the Eastern Kimberley Region of Western Australia between 1979 and 1985. Statistics from these surveys show that there has been an apparent change in pattern of follicular trachoma since the National Trachoma and Eye Health Programme in some of the communities. The prevalence of follicular trachoma in the 0 to 9 year old age groups had declined from 26.4% in 1977 to 8.8% in 1984/1985 in the Eastern Goldfields and Red Centre combined (0.10 greater than p greater than 0.05). The prevalence reduction occurred in areas where there have been improvements in school hygiene and housing. The prevalence of cicatricial trachoma has also apparently declined from 65% in 1977 to 39% in 1985 in the Red Centre, from 39% in 1977 in the Eastern Goldfields to 21.7% in 1985, and from 58% in 1977 to 24.9% in 1985 in the Eastern Kimberley, Communities at risk were identified and recommendations made for frequency of continued screening, depending on age, distribution and location.

The Treatment of Trachoma with Sulfanilamide: A Report of 31 Cases

In February 1938 Dr. Fred Loe, of Rosebud, S. D., notified us of his successful treatment of trachoma in Indian subjects with sulfanilamide, the details of which he has recently published. 1 Favorable results were also reported by Lian. 2 After obtaining marked improvement with this treatment in certain isolated cases and rapid cure in 2 cases of experimental trachoma in baboons, we decided to test the drug on a series of persons with previously untreated active follicular trachoma in whom corneal progress could be followed by means of the slit lamp and the corneal microscope. Accordingly, we selected 14 Apache Indian children with active follicular trachoma, 12 to be treated and 2 to be kept untreated as controls. All children had pannus and exhibited corneal activity, as evidenced by dilated pannus vessels, subepithelial infiltrates and fluorescein-staining punctate epithelial lesions. Typical epithelial cell inclusions, characteristic of active trachoma, were demonstrated

Treatment of Trachoma with Sulfanilamide

In February 1938 Dr. Fred Loe, of Rosebud, S. D., notified us of his successful treatment of trachoma in Indian subjects with sulfanilamide, the details of which he has recently published. 1 Favorable results were also reported by Lian. 2 After obtaining marked improvement with this treatment in certain isolated cases and rapid cure in 2 cases of experimental trachoma in baboons, we decided to test the drug on a series of persons with previously untreated active follicular trachoma in whom corneal progress could be followed by means of the slit lamp and the corneal microscope. Accordingly, we selected 14 Apache Indian children with active follicular trachoma, 12 to be treated and 2 to be kept untreated as controls. All children had pannus and exhibited corneal activity, as evidenced by dilated pannus vessels, subepithelial infiltrates and fluorescein-staining punctate epithelial lesions. Typical epithelial cell inclusions, characteristic of active trachoma, were demonstrated

TREATMENT OF TRACHOMA WITH SULFANILAMIDE

In February 1938 Dr. Fred Loe, of Rosebud, S. D., notified us of his successful treatment of trachoma in Indian subjects with sulfanilamide, the details of which he has recently published. 1 Favorable results were also reported by Lian. 2 After obtaining marked improvement with this treatment in certain isolated cases and rapid cure in 2 cases of experimental trachoma in baboons, we decided to test the drug on a series of persons with previously untreated active follicular trachoma in whom corneal progress could be followed by means of the slit lamp and the corneal microscope. Accordingly, we selected 14 Apache Indian children with active follicular trachoma, 12 to be treated and 2 to be kept untreated as controls. All children had pannus and exhibited corneal activity, as evidenced by dilated pannus vessels, subepithelial infiltrates and fluorescein-staining punctate epithelial lesions. Typical epithelial cell inclusions, characteristic of active trachoma, were demonstrated

TRACHOMA, ITS RELATIVE INFREQUENCY IN SOUTHERN CALIFORNIA.

Although there is not a perfect agreement among pathologists as to identity or non-identity of follicular conjunctivitis and trachoma (that is, as to whether they are independent affections), still recent text-books on ophthalmology are almost unanimous in making a clinical if not a pathologic distinction between these manifestations. It is not my intention, nor is it necessary in a paper of this description, and on such an occasion, to enter into a dissertation giving details of arguments that have been, and are still being brought forward to prove sameness or dissimilarity of these diseases. It is sufficient for purposes of this article to state my own position in controversy without giving reasons for the faith that is in me, and thus prevent any misunderstanding of terms. Granular lids is a phrase that I but rarely use, and then always as a synonym