Conjunctival Scarring, Corneal Pannus, and Herbert’s Pits in Adolescent Children in Trachoma-endemic Populations of the Solomon Islands and Vanuatu

Butcher, Robert; Tagabasoe, Junely; Manemaka, Joseph; Bong, Annie; Garae, Mackline; Daniel, Lui; Handley, Becca L.; Hu, Victor; Harding-Esch, Emma; Bakhtiari, Ana; Willis, Rebecca; Müller, Andreas; Kaldor, John; Mesurier, Richard Le; Mabey, David; Cama, Anasaini; Sokana, Oliver; Taleo, Fasihah; Taylor, Hugh R.; Solomon, Anthony W.

doi:10.1093/cid/ciaa1151

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…In communities in Guinea Bissau and Taiwan in which trachoma is endemic, 60-80% of people with TF and 20-40% of those without active trachoma have Herbert's pits or pannus. 15,22,23 Finally, only one 5-9-year-old child had clinical signs consistent with TI. In communities where trachoma is endemic, TI is frequently encountered in young children; in the long term, it is the best predictor of trachomatous scarring in adults.…”

Section: Discussionmentioning

confidence: 98%

“…[9][10][11][12][13] As the predictive value of simple clinical assessment declines, other tools may be more useful for estimating trachoma prevalence, including assessment of conjunctival scarring and anti-Pgp3 seropositivity, each recognised as persistent markers of previous active trachoma and C. trachomatis infection. 14,15 We have previously reported that simplified grading caused overestimation of the prevalence of trachoma in a Torres Strait Island community. 9 We have therefore supplemented data from surveys in northwest Queensland recommended by the National Trachoma Surveillance and Control Reference Group by collecting additional information to determine whether community-wide treatment and further screening rounds are required.…”

mentioning

confidence: 99%

“…Findings from the Torres Strait Islands and across the Pacific suggest that simplified clinical grading can lead to overestimating infection prevalence 9‐13 . As the predictive value of simple clinical assessment declines, other tools may be more useful for estimating trachoma prevalence, including assessment of conjunctival scarring and anti‐Pgp3 seropositivity, each recognised as persistent markers of previous active trachoma and C. trachomatis infection 14,15 …”

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confidence: 99%

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Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross‐sectional study

Lynch

Morotti

Brian

et al. 2022

Medical Journal of Australia

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Objectives: To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community.Design: Three cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing.Setting: Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists. Participants:Children aged 1-14 years; opportunistic screening of people aged 15 years or more.Main outcome measures: Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein.Results: During the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies.Conclusions: Despite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-yearold children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.The known: Trachoma was formerly endemic in northwest Queensland.The new: Three annual surveys in a remote Queensland community in which trachoma had been endemic found clinical signs consistent with follicular trachoma in 7% of examinations of children aged 5-9 years, beyond the 5% threshold for which community-wide azithromycin treatment is recommended. However, additional clinical and laboratory assessments suggested that childhood ocular Chlamydia trachomatis infections were unlikely.The implications: Simplified clinical grading can overestimate the burden of trachoma in low prevalence settings, leading to unnecessary antibiotic treatment and further screening. Assessing progress to trachoma elimination in Australia and elsewhere should therefore incorporate laboratory testing.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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confidence: 99%

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Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross‐sectional study

Lynch

Morotti

Brian

et al. 2022

Medical Journal of Australia

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“…The retrospective nature of our work increases the risk of misclassification bias. Although the patients we included had features of cicatricial trachoma, including Herbert's pits, 21 and an absence of any other obvious cause for corneal scarring, trachoma cannot be proven to be the cause of their corneal opacification or their amyloidosis.…”

Section: Discussionmentioning

confidence: 99%

Atypical Corneal Phenotype in Patients With Trachoma and Secondary Amyloidosis

Gupta

Yadav

Solomon

et al. 2021

Cornea

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Purpose: To report clinical presentation, in vivo confocal microscopic features, and corneal phenotype in patients with trachomatous keratopathy (TK) and secondary amyloidosis.Methods: Histopathological records of all patients undergoing keratoplasty at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences over a 3-year period were scanned retrospectively for a diagnosis of TK and amyloidosis. Demographic profile and details of preoperative comprehensive ophthalmic assessment were extracted. The histopathology was freshly reviewed.Results: Fifteen patients (29 eyes) with TK and atypical corneal involvement due to amyloid deposition were identified. Herbert's pits and upper palpebral conjunctival scarring were present in all cases. Central or total diffuse corneal scarring was present involving the anterior stroma in 5 (31%) and the full thickness of the cornea in 11 (69%) of the eyes. Eight (73%) of 11 patients with deep stromal amyloid deposits revealed bilateral, discrete, blue-white opacities at the level of deep stroma and Descemet membrane (DM). Endothelial cells were atrophic and flattened with gutta formation. Confoscans revealed hyperreflective, needle-shaped crystalline deposits of extracellular amyloid at various depths of the corneal stroma up to DM. All host corneal buttons demonstrated Congo red-positive amyloid deposits on histopathological examination. Conclusions:We describe a distinct form of TK unlike the usual presentation of dense, leucomatous, vascularized corneal scarring in trachoma. We believe that amyloid deposits in DM and the corneal endothelium have not previously been reported in patients with trachoma.

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“…13 Vanuatu has recently become the fourteenth country to eliminate trachoma as a public health problem; 14 its case for validation relied in part on the TF found in children's eyelids not being associated with PCR evidence of C. trachomatis infection, high levels of anti-C. trachomatis antibodies in children, or much conjunctival scarring in adolescents. 15,16 As Lynch and colleagues advise for Australia, international guidance for trachoma programs should be re-assessed.…”

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confidence: 99%