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    4 Trachoma

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    Marshet Gete
    Trachoma is a chronic infectious keratoconjunctivitis caused by Chlamydia trachomatis that is the leading cause of preventable blindness worldwide. It is common in developing countries with poor sanitation and spreads through direct contact or flies. Repeated infections during childhood can cause scarring of the inner eyelid that turns eyelashes inward causing corneal damage and blindness in adulthood. The WHO recommends the SAFE strategy of surgery, antibiotics, facial cleanliness, and environmental improvement to control trachoma.

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    4 Trachoma

    Uploaded by

    Marshet Gete
    68 views27 pages
    Trachoma is a chronic infectious keratoconjunctivitis caused by Chlamydia trachomatis that is the leading cause of preventable blindness worldwide. It is common in developing countries with poor sanitation and spreads through direct contact or flies. Repeated infections during childhood can cause scarring of the inner eyelid that turns eyelashes inward causing corneal damage and blindness in adulthood. The WHO recommends the SAFE strategy of surgery, antibiotics, facial cleanliness, and environmental improvement to control trachoma.

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    Trachoma is a chronic infectious keratoconjunctivitis caused by Chlamydia trachomatis that is the leading cause of preventable blindness worldwide. It is common in developing countries with poor sanitation and spreads through direct contact or flies. Repeated infections during childhood can cause scarring of the inner eyelid that turns eyelashes inward causing corneal damage and blindness in adulthood. The WHO recommends the SAFE strategy of surgery, antibiotics, facial cleanliness, and environmental improvement to control trachoma.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    68 views27 pages

    4 Trachoma

    Uploaded by

    Marshet Gete
    Trachoma is a chronic infectious keratoconjunctivitis caused by Chlamydia trachomatis that is the leading cause of preventable blindness worldwide. It is common in developing countries with poor sanitation and spreads through direct contact or flies. Repeated infections during childhood can cause scarring of the inner eyelid that turns eyelashes inward causing corneal damage and blindness in adulthood. The WHO recommends the SAFE strategy of surgery, antibiotics, facial cleanliness, and environmental improvement to control trachoma.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    TRACHOMA

    MAJOR CAUSES OF BLINDNESS and LOW VISION


    TRACHOMA
    Definition:
    • Trachoma is a chronic infectious kerato-conjunctivitis caused by
    Chlamydia trachomitis serotypes A,B,C,Ba.
    • It is a Greek word meaning ‘rough’ which describes the surface
    appearance of the conjunctiva.
    Epidemiology
    • Very common, particularly in developing countries
    • Spread in dry areas of Africa, India, middle East & SEA
    • The second leading cause of blindness in Ethiopia, after cataract.
    • The Leading cause of preventable infectious blindness
    2
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    In Ethiopia- 1.6% (2006) prevalence of blindness

    3
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA
    Bacteriology
    • Chalamidia Trachomitis soreovars
     A,B,C,Ba--------Trachoma
     D-K-------------------Inclusion conjuctivits in newborns, Non
    gonococcal urethritis, epydidimitis & PID in adults, Neonatal
    conjunctivitis and Atypical pneumonia in children
     L1-L2 ------------------LGV
     L3--------------Pneumonia in mice

    Incubation period--- 7 days in average


    4
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA
    How does the disease develop?
    • In communities where trachoma is common, infection starts in early
    childhood.
    • The first signs can be found in children of less than one year of age.
    • Trachomatous inflammation becomes increasingly intense in children up to
    the age of six to eight years.
    • Scars on the inside of the eye lids (tarsal conj/TS/), caused by trachoma,
    can be found in children from the age of four years.
    • Scarring is increasingly common in older children, but the serious
    complication of inturned eyelashes and corneal scarring do not usually
    appear before adult age.
    ▫ Thus, blindness due to trachoma is most commonly seen in adults.
    • The disease is characterized by repeated infections, progressive
    exacerbations and & remissions 5
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA
    Trachoma in the community
    • The severity of trachoma can vary from one community to
    another
    • Repeated infections with C. trachomitis, or other causes of
    conjunctivitis, increase the intensity of inflammation, which
    leads to more scarring and blindness.
    • Children are the main reservoir of the infection, as they are
    commonly and heavily infected.
    • Women tend to have more severe trachoma, including
    inturned eyelashes and blindness than men
    6
    MAJOR CAUSES OF BLINDNESS and LOW VISION

    Risk factors
    • Poverty (forgotten disease of the forgotten people)
    • Poor hygiene at individual, family or community level
    • Lack of water supply
    • Age and sex; common in children and women
    • Environmental factors Ds (Dust, Dry, Dirty, Dung, Discharge)
    Transmission
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA

    Transmission of trachoma
    • Flies - eye to fly to eye
    – (Musca sorbens )
    • Fomite - eye to clothing to eye
    • Finger - eye to finger to eye

    9
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA

    Common symptoms
    • Vary from a mild condition with hardly any
    symptoms at all, to a severe and blinding disease
    • Slightly mucopurulent discharge
    • Tearing
    • Foreign body sensation
    • In severe cases, eyelid edema, pain, ded eye and
    photophobia
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA

    Signs:
    • Follicle (whitish spots beneath the tarsal conjunctiva)
    • Edematous and thickened tarsal conjunctiva
    • Upper tarsal conjunctival scaring
    • Pannus - Fibrovascular growth into the cornea
    • Herbert’s pits – depressed limbal area scars; result in
    Irregular upper limbus
    • Trichiasis (misdirected eyelash with or without entropion)
    • Corneal opacity

    11
    TRACHOMA – Disease Progression and Signs

    12
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA

    Diagnosis
    • Trachoma is diagnosed clinically
    • For research purpose or in suspicious cases in non
    endemic areas laboratory diagnosis may be helpful in
    active disease
    • The bacteria may be stained with Giemsa from scrapings
    of tarsal conjuctiva- Basophylic cytoplasmic inclusion
    bodies
    • DNA PCR--- more sensitive than culture

    15
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA
    Simplified WHO Grading of Trachoma
    1. Active trachoma with follicles/TF/
    1. Must be at least five follicles in the upper tarsal plate (>0.5 mm)
    2. Blood vessels of the conjunctiva are visible
    2. Active trachoma intense/TI/
    ▫ Edematous and thickened tarsal conjunctiva obscuring > 50% of blood vessels
    3. Trachomatous scarring/TS/
    ▫ White scar in the upper tarsal plate (linear)
    4. Trachomatous Trichiasis/TT/
    ▫ Evidence of one or more eye lash rubbing or touching the eye ball.
    ▫ History of eye lashes Epilation.
    5. Corneal opacity/CO/
    ▫ Central and sufficiently dense to obscure the part of pupil (with VA< 6/18)
    16
    MAJOR CAUSES OF BLINDNESS and LOW VISION

    TRACHOMA

    • Active Trachoma - implies the presence of ongoing


    Trachomatous inflammation, corresponding to TF,
    with or without TI
    • “Cicatricial”, “healed” or “inactive” Trachoma - Signs
    of trachomatous inflammation are not visible, but
    scarring (TS with or without TT) is present.

    17
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA

    Aims of the simplified trachoma grading system


    1. To facilitate the recognition of the signs and complications
    of trachoma by all health workers
    2. To enable undertaking simple community surveys in a
    uniform (comparable) ways to identify communities in need
    of measures to control blindness from trachoma.
    3. To allow for easy evaluation, by health workers, of results
    of trachoma control efforts in identified communities.

    18
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA

    Key measurement variables for assessing the significance of


    trachoma in a given community
    1. The proportion of Trachomatous inflammation (TF: ≥ 10%
    with or without TI) among children less than 10 years of
    age
    ▫ demonstrates how wide spread the infection is in the community
    2. The proportion of intense Trachomatous inflammation (TI:
    ≥ 5%) in children less than 10 years
    ▫ demonstrates how severe the disease is in the community

    19
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA
    Key measurement variables for assessing the significance of
    trachoma in a given community
    1. The proportion of Conjunctival scarring (TS);
    ▫ demonstrates how common trachoma was in the past
    2. The number of people with Trichiasis (TT: ≥ 1%)
    ▫ indicates the immediate surgical services need for lid correction
    3. The proportion of people with Corneal opacity (CO: ≥
    0.1%)
    ▫ demonstrates the impact of trachoma in the community in terms
    of Visual Impairment/ Blindness

    20
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA

    21
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    Management of Trachoma
    Topical Treatment - Tetracycline 1% eye ointment
    • Continuous : Twice per day for six weeks
    • Intermittent : Twice a day for five consecutive days or once
    daily for 10 consecutive days, each month for
    at least six consecutive months per year

    22
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    Management of Trachoma
    Proportion of Basic Treatment Additional
    children (1-10) Therapy
    with trachoma
    TF: ≥ 10% OR TI: ≥ Mass Therapy with 1% TTC for
    5% azitromycin annually for 3 yrs children
    then reasses the prevalence <6months and
    after 3yrs pregant women
    TF: 5% - 10% Individual & Family
    (household) treatment
    TF: < 5% Individual Topical Therapy,
    Mass Treatment not
    recommended

    Herd immunity develops after 80% of the population is treated 23


    MAJOR CAUSES OF BLINDNESS and LOW VISION
    Management of Trachoma

    • Mass Community Treatment – To all members of all


    Households in the community
    • Family Treatment - Identify and treat families where
    there are one or more members with TF or TI
    • TS - No treatment
    • TT - surgical correction (BTR, PLR)
    • CO - may benefit from corneal transplant, but most
    patients with trachomatous CO are not good candidates

    24
    SAFE strategy
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    Management of Trachoma
    Selective systemic antibiotics:
    1. Azithromycin 20 mg/kg PO Single dose - Maximum dose
    1gram and may require repeat dose after six months
    2. Doxycycline 100mg PO/day for 21 days
    3. Tetracycline 250 mg PO QID for 21 days
    4. Erythromycin 250mg QID for 3 weeks

    NB: Don’t use systemic Doxycycline or Tetracycline to:


    – Children younger than 7 years
    – Pregnant women
    – Lactating (Breast feeding) mothers
    26
    MAJOR CAUSES OF BLINDNESS and LOW VISION
    TRACHOMA Control Strategy
    SAFE Strategy - It stands for:
    • Surgery – Trichiasis surgery
    • Antibiotics –Tetracycline ointment, Systemic Azithromycin, tetracycline
    or Doxycycline
    – It may be given on a community or individual basis
    • Face washing – regular face washing to keep the eyes and face clear
    of discharge, health education
    • Environmental change–provide adequate water supply, improve
    community sanitation (building and using VIP latrines and proper
    waste disposal); exclude cows and goat from the home

    27

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