Eradicating blinding trachoma: What is working?

Abstract

Trachoma remains the leading cause of preventable corneal blindness in developing countries. The disease is contracted in early childhood by repeated infection of the ocular surface by C. trachomatis. Initial clinical manifestation is a follicular conjunctivitis which if not treated on timely basis, may lead to conjunctival and eyelid scarring that may eventually result in corneal scarring and loss of vision. Over the past two decades, a remarkable reduction in the prevalence of active trachoma has occurred due to the World Health Organization's (WHOs) program GET 2020 for the elimination of trachoma with adoption of the SAFE strategy incorporating Surgery, Antibiotic treatment, Facial cleanliness and Environmental hygiene. However, patients who already had infection at young age may present with adnexal-related complications of trachomatous scarring that may cause corneal scarring and visual loss. These patients may present with evidence of trichiasis/entropion as well as eyelid retraction. Lacrimal complications may include nasolacrimal-duct obstruction, dacryocystitis and canaliculitis requiring intervention. In addition to the increased risk for corneal scarring, trichiasis/entropion may further increase the risks for microbial keratitis in patients who may have unrecognized dacryocystitis and canaliculitis. Female patients may have more trachomtous-related complications and may present at an early age. Available evidence indicates that SAFE strategy may be effective and on the right track towards achieving GET 2020 goal for the eradication of trachoma.

Tracoma: de lo básico a lo clínico

“…Se afecta la conjuntiva tarsal, más gravemente la superior; al examen físico se evidencia un engrosamiento folicular y papilar de las glándulas por la acumulación subepitelial de células linfoides y cuerpos elementales (32,34). Estas se observan como pequeños puntos blancos o amarillos, que una vez resueltos dejan depresiones patognomónicas conocidas como pozos de Hebert y, en algunas ocasiones, pannus corneal (7,29,35).…”

“…La segunda fase se caracteriza por manifestaciones cicatriciales debidas a la inflamación conjuntival a repetición; inicialmente aparecen como pequeñas cicatrices en forma de estrella, que se van desarrollando a lo largo del tiempo y que, al contraerse, son responsables de la triquiasis y el entropión; este fenómeno genera abrasiones corneales dolorosas, edema, úlceras, cicatrización y por último opacidad corneal (7,25,33,34).…”

“…La sequedad ocular es el resultado de la disminución en la población de células caliciformes y la destrucción de los conductos y glándulas lagrimales lo que lleva a una escasa producción de sustancias mucosas y acuosas lubricantes. Además, la infiltración de células linfoides y la cicatrización pueden afectar las glándulas lagrimales accesorias y sus respectivos conductos (9,34). El tracoma se puede estadificar según los hallazgos físicos de la siguiente manera (figura 2) (37):…”

Trachoma and Conjunctivitis

“…[12][13][14][15] According to some rough estimates, worldwide, trachoma infects 84 million people in 55 countries, blinding over 8 million. 16 According to the WHO estimates, if appropriate measures are not taken, over 75 million may become legally blind over the next twenty years. Trachoma is caused by the eye to eye transmission of infection with C. trachomatis.…”

“…Trachoma is endemic in parts of Africa, Asia, the Middle East, Latin America, the Pacific Islands, and aboriginal communities in Australia. 15,16,30,31 In endemic areas, most members of nearly all families may have active disease. Active trachoma may be seen in clusters in some families.…”