Trachoma: An update on prevention, diagnosis, and treatment

F. I Proctor Foundation and Department of Ophthalmology, University of California-San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA.
Current opinion in ophthalmology (Impact Factor: 2.5). 05/2012; 23(4):288-95. DOI: 10.1097/ICU.0b013e32835438fc
Source: PubMed


To review recent clinical and epidemiological studies regarding the prevention, diagnosis, and treatment of trachoma.
Newer studies propose novel diagnostic tests that appear sensitive for the detection of ocular chlamydial infection. For example, recent studies with ribosomal RNA-based nucleic acid amplification tests (NAATs) have demonstrated improved sensitivities compared to DNA-based NAATs; and the progression of scarring has now been characterized with confocal microscopy. Immunologic studies have further explored the etiology of clinical sequelae, suggesting that chronic inflammation can lead to progressive scarring even in the absence of Chlamydia. Mass oral azithromycin distributions remain a mainstay of treatment; studies have assessed the appropriate frequency and duration of treatment programs. Current studies have also explored ancillary effects of azithromycin distribution on mortality and bacterial infections.
Trachoma programs have had remarkable success at reducing chlamydial infection and clinical signs of trachoma. Recent work suggests improved methods to monitor infection and scarring, and better ways to distribute treatment. Whereas studies continue to demonstrate reduction in infection in hyperendemic areas, more work is necessary to achieve elimination of this blinding disease.

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    • "Rövidítések HAART = highly active antiretroviral therapy; IUSTI = International Union against Sexually Transmitted Infections; kART = kombinált antiretrovirális terápia; LGV = lymphogranuloma venereum; MSM = men who have sex with men; NAAT = nucleic acid amplifi cation test; OEK = Országos Epidemiológiai Központ; PCR = polymerase chain reaction; STD = sexually transmitted diseases A Chlamydia trachomatis obligát intracelluláris baktérium , amelyet a felszíni membránfehérjék alapján különböző szerovariánscsoportokba oszthatunk. Ezek igen eltérő klinikai tüneteket okoznak, az " A–C " csoport kiváltotta trachoma felelős a legnagyobb számban a fertőzéses eredetű vakságért világszerte [1]. A " D–K " szerotípus a húgyutak, a méhnyak, méh és a petevezeték hámsejtjeinek gyulladását okozza sokszor jelentősebb panasz nélkül, számos esetben meddőséghez vezetve, emellett pedig a conjunctiva zárványtestes megbetegedése mögött is ez a csoport áll. "
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    ABSTRACT: Lymphogranuloma venereum is a sexually transmitted infection caused by the Chlamydia trachomatis serovars L1-3. It has been found to be endemic in tropical countries. In the last decades several cases have been reported in Western Europe, particularly in men who have sex with men population infected with human immunodeficiency virus. The authors present three cases of lymphogranuloma venereum infections, observed at their department in 2013 and 2014. The three human immunodeficiency virus infected patients who belonged to men who have sex with men population had casual sexual contacts in Western Europe. The symptoms included urethral discharge, discomfort and inguinal lymphadenomegaly in two patients, and rectal pain, discharge and perianal ulceration in one patient. The diagnosis was confirmed by nucleic acid amplification test performed in samples obtained from urethral discharge and exudate of perianal ulcer; lymphogranuloma venereum 2b serovars were demonstrated in two patients and serovar 2 in one patient. Doxycyclin (daily dose of two times 100 mg for 21 days) resolved the symptoms in all cases. The authors conclude that lymphogranuloma venereum is a diagnostic challenge in Hungary, too. It is important to be aware of the altered clinical features of this disease to prevent complications and spreading. Orv. Hetil., 2015, 156(1), 36-40.
    Full-text · Article · Jan 2015 · Orvosi Hetilap
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    • "A review [126] of recent research in the prevention, diagnosis, and treatment of trachoma concluded that the SAFE strategy's mass treatment with antibiotics is the mainstay of trachoma treatment and is why community-targeted strategies are key to program success. Future research could focus on optimizing mass treatment by investigating integrated monitoring and treatment strategies at a community level. "
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    ABSTRACT: Since the inception of (the Global Elimination of Blinding Trachoma) GET 2020 in 1997 and the implementation of the SAFE strategy a year later, much progress has been made toward lowering the prevalence of trachoma worldwide with elimination of the disease in some countries. However, high recurrence of trichiasis after surgery, difficulty in controlling the reemergence of infection after mass distribution of azithromycin in some communities, the incomplete understanding of environment in relation to the disease, and the difficulty in establishing the prevalence of the disease in low endemic areas are some of the issues still facing completion of the GET 2020 goals. In this narrative review, literature was searched from 1998 to January 2013 in PubMed for original studies and reviews. Reasons for these ongoing problems are discussed, and several suggestions are made as avenues for exploration in relation to improving the SAFE strategy with emphasis on improving surgical quality and management of the mass treatment with antibiotics. In addition, more research needs to be done to better understand the approach to improve sanitation, hygiene, and environment. The main conclusion of this review is that scale-up is needed for all SAFE components, and more research should be generated from communities outside of Africa and Asia.
    Full-text · Article · May 2013 · The Scientific World Journal
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    • "Acanthamoeba keratitis is less well understood, although there is an important role for Acanthamoeba lectins, proteases and possibly intracellular bacteria [10] [11]. As there are recent reviews on river blindness [4], trachoma [12], fungal keratitis [13] Acanthamoeba keratitis [10] [11] and HSV keratitis, the current review will focus on the mechanisms of innate immunity that underlie corneal inflammation and bacterial keratitis, primarily Pseudomonas aeruginosa keratitis. This review will also examine how P. aeruginosa virulence factors impair the host response and mediate bacterial replication in the cornea. "
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    ABSTRACT: Microbial infections of the cornea frequently cause painful, blinding and debilitating disease that is often difficult to treat and may require corneal transplantation. In addition, sterile corneal infiltrates that are associated with contact lens wear cause pain, visual impairment and photophobia. In this article, we review the role of Toll-Like Receptors (TLR) in bacterial keratitis and sterile corneal infiltrates, and describe the role of MD-2 regulation in LPS responsiveness by corneal epithelial cells. We conclude that both live bacteria and bacterial products activate Toll-Like Receptors in the cornea, which leads to chemokine production and neutrophil recruitment to the corneal stroma. While neutrophils are essential for bacterial killing, they also cause tissue damage that results in loss of corneal clarity. These disparate outcomes, therefore, represent a spectrum of disease severity based on this pathway, and further indicate that targeting the TLR pathway is a feasible approach to treating inflammation caused by live bacteria and microbial products. Further, as the P. aeruginosa type III secretion system (T3SS) also plays a critical role in disease pathogenesis by inducing neutrophil apoptosis and facilitating bacterial growth in the cornea, T3SS exotoxins are additional targets for therapy for P. aeruginosa keratitis.
    Full-text · Article · Feb 2013 · International Reviews Of Immunology
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