Trachoma

Notes

## Basic Introduction

  • Trachoma is an infectious eye disease that is caused by the bacterium Chlamydia trachomatis
  • It is the leading cause of preventable blindness globally (and in Kenya)
  • Regions in Kenya where trachoma is endemic are Baringo, Isiolo, Kajiado, Kitui, Koibatek, Makueni, Marsabit, Mbeere, Meru North, Moyale, Murang’a, Mwingi, Narok, Samburu, Transmara, Turkana, and West Pokot.
  • Chlamydia trachomatis is spread through:

_Direct personal contact

_Shared towels and cloths

_ Flies that have come in contact with an infected person

## Pathogenesis

  • Repeated Chlamydial infections of the eyes cause the inside of the eyelid to be scarred and eventually leads to trachomatous trichiasis.
  • Trichiasis, in turn, causes constant pain, light intolerance, and scarring of the cornea.
  • The scarring of cornea leads the formation of irreversible opacities and visual impairment or blindness.

## Statistics

  • Trachoma is responsible for 19% of blindness in Kenya
  • Globally, almost 1.9 million people are visually impaired by trachoma
  • Globally, 200 million people are at risk of blindness from Trachoma
  • Globally, trachoma is endemic in 42 countries (mostly developing countries)
  • Trachoma is common among preschool-aged children.
  • The prevalence of trachoma is 4 times more in women than men (possibly due to their close contact with infected children)

## Environmental risk factors that influence the transmission of trachoma: 

  • Poor hygiene
  • Crowded households
  • Water shortage
  • Inadequate latrines and sanitation facilities.
Symptoms
  • Mucopurulent eye discharge
  • Scarring of conjunctiva and cornea
  • Inward turning of eyelids (entropion) and eye lashes (trichiasis) causing pain, ulceration, and irreversible blindness
Diagnosis
  • Clinical review
  • Swab, culture, and sensitivity
Differential
  • Conjunctivitis (viral, bacterial, vernal or allergic)
  • Trichiasis due to other causes (such as chronic inflammatory conditions and idiopathic causes)
  • Corneal opacity due to other causes
  • Chlamydial inclusion conjunctivitis
  • Chemical injury to eye
  • Trauma injury to eye
  • Ocular cicatricial pemphigoid
  • Stevens-Johnson syndrome
Prevention

## The World Health Organization has formulated a multi-faceted public health strategy known as S.A.F.E

  • Surgery to correct trichiasis
  • Antibiotics to treat active infection
  • Facial cleanliness
  • Environmental improvements in the areas of water and sanitation
Reference

1. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

2. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

3. Resnikoff, S., et al. Global data on visual impairment in the year 2002. Bull World Health Organ, 2004. 82(11): p. 844-51.

4. World Health Organization. Alliance for the Global Elimination of Blinding Trachoma by 2020. Report of the 2nd Global Scientific Meeting on Trachoma, Geneva, 25-27 August 2003. (WHO/PBD/GET.03.1). 2003.

Management
  • Tetracycline ointment 1% apply TID x 6/52
  • Mass treatment: Tabs Azithromycin 1gm STAT annually for 3yrs
  • Surgical correction of entropion and trichiasis
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