Trachoma – the world’s problemTrachoma – the world’s problem

TrachomaTrachoma Affected more than 21 million people 2.2 million are visually impaired 1.2 million are blind Around 180 million people worldwide live in areas with high risk of trachoma Appears in young adulthood and in middle-aged persons Adult women are at much greater risk than adult men

It was once endemic in most countries

Now is presents for more than 3% of the world’s blindness in poor rural areas of Africa, Asia, Central and South America , Australia and the Middle East

More Statistics (I)More Statistics (I)

Around Around 285 million285 million people are visually people are visually impaired worldwide impaired worldwide

39 million39 million are blind, are blind, 246246 have low vision have low vision

80% of all visual impairment is avoidable (can 80% of all visual impairment is avoidable (can be prevented or cured)be prevented or cured)

Globally Globally 153 million153 million people over 5 years of age people over 5 years of age are visually impaired as a result of uncorrected are visually impaired as a result of uncorrected refractive errorsrefractive errors

More Statistics (II)More Statistics (II)

About About 65%65% of all people who are visually of all people who are visually impaired are agedimpaired are aged 50 50 and older, while this age and older, while this age group comprises about group comprises about 20% of the world’s 20% of the world’s populationpopulation..

An estimated An estimated 19 million children19 million children are visually are visually impaired. Of these, impaired. Of these, 12 million children12 million children are are visually impaired due to refractive errors; 1.4 visually impaired due to refractive errors; 1.4 million are blind. million are blind.

(October 2011, WHO)(October 2011, WHO)

caused by the caused by the Chlamydia trachomatisChlamydia trachomatis bacterium bacterium

Chlamydia trachomatisChlamydia trachomatis obligate intracellular humanobligate intracellular human pathogen, is one of threepathogen, is one of three bacterial species in the bacterial species in the genusgenus   ChlamydiaChlamydia

gram-negative, coccoid bacterium that typically gram-negative, coccoid bacterium that typically infects columnar epithelial cellsinfects columnar epithelial cells

It exhibits a characteristic two-stage It exhibits a characteristic two-stage developmental lifecycle consisting of spore-like developmental lifecycle consisting of spore-like

Life cycleLife cycle

Vectors - several Vectors - several synanthropic synanthropic muscid flysmuscid flys

Three types of TrachomaThree types of Trachoma

Acute trachomaAcute trachoma Recurring trachomaRecurring trachoma Chronic TrachomaChronic Trachoma

Acute trachomaAcute trachoma

It is frequently found in children who are It is frequently found in children who are dirty, dusty and unhealthy. It usually affects dirty, dusty and unhealthy. It usually affects one eye and gradually spreads to both the one eye and gradually spreads to both the eyes.eyes.

Recurring trachomaRecurring trachoma If poor hygiene persists the person gets If poor hygiene persists the person gets

affected again and againaffected again and again

Chronic TrachomaChronic Trachoma

It causes inward turning of the eyelid such It causes inward turning of the eyelid such that the eye lashes rub against the cornea .that the eye lashes rub against the cornea .

• Leads to blindness between the age of 30 to 40 Leads to blindness between the age of 30 to 40 years if left untreated. If it does not lead to years if left untreated. If it does not lead to blindness, it leads to scarring of the of the cornea blindness, it leads to scarring of the of the cornea of the eye.of the eye.

General SymptomsGeneral Symptoms painful eyespainful eyes swollen eyelidsswollen eyelids slimy discharge from the eyesslimy discharge from the eyes inward protraction of the eyelashesinward protraction of the eyelashes itching of the eyes and earitching of the eyes and ear nose and throat infection nose and throat infection

DetectionDetection An An rRNA-basedrRNA-based assay and assay and PCRPCR were were

performed on swab specimens taken from the performed on swab specimens taken from the right upper tarsal conjunctiva of 240 children right upper tarsal conjunctiva of 240 children aged 1 to 5 years living among 16 endemic aged 1 to 5 years living among 16 endemic villages in the Gurage Zone, Ethiopia.villages in the Gurage Zone, Ethiopia.

The The rRNA-basedrRNA-based test detected ocular C. test detected ocular C. trachomatis infection in 142 (59%) subjects trachomatis infection in 142 (59%) subjects compared with 67 (28%) detected by compared with 67 (28%) detected by PCRPCR

Conclusion:Conclusion:

The The rRNA-basedrRNA-based test appears to have test appears to have significantly greater sensitivity than PCR for significantly greater sensitivity than PCR for the detection of ocular C. trachomatis the detection of ocular C. trachomatis infection in children in trachoma-endemic infection in children in trachoma-endemic villages.villages.

PreventionPrevention

Maintaining good hygiene and sanitation are Maintaining good hygiene and sanitation are essential to prevent this disease of the essential to prevent this disease of the developing countries which has been developing countries which has been eradicated from the developed countries.eradicated from the developed countries.

Some steps:Some steps: 1)1) Avoid physical contact with a person suffering from Avoid physical contact with a person suffering from

trachomatrachoma

2)2) Personal cleanliness (especially face and hands) Personal cleanliness (especially face and hands)

3)3) Washing hands and face frequently in children who are Washing hands and face frequently in children who are already infected to prevent re-infectionalready infected to prevent re-infection

4)4) Keep separate towels, handkerchiefs and linens for Keep separate towels, handkerchiefs and linens for each member of the family.each member of the family.

5)5) Keep the food covered and use latrines and toilets for Keep the food covered and use latrines and toilets for defecation to prevent breeding of flies.defecation to prevent breeding of flies.

Treatment - antibioticsTreatment - antibiotics

There is There is no vaccine availableno vaccine available

Antibiotics can prevent long-term Antibiotics can prevent long-term complications if used early in the infection. complications if used early in the infection. Antibiotics include Antibiotics include erythromycin and erythromycin and doxycyclinedoxycycline. .

AlsoAlso Other medications are a Other medications are a tetracyclinetetracycline eye eye

ointmentointment and an and an oral azithromycinoral azithromycin known as known as ZithromaxZithromax. .

Although the oral azithromycin has been Although the oral azithromycin has been

found to be more effective, one of the biggest found to be more effective, one of the biggest issues is that it is more expensive than the issues is that it is more expensive than the ointment.ointment.

SurgerySurgery - given to those who are - given to those who are experiencing the more severe symptoms of experiencing the more severe symptoms of trachoma. trachoma.

One surgery is One surgery is eyelid rotation surgeryeyelid rotation surgery, where , where the doctor moves the eyelids away from the the doctor moves the eyelids away from the corneas. This surgery is done in order to corneas. This surgery is done in order to prevent scarring of the eyelid, and it generally prevent scarring of the eyelid, and it generally is done on an outpatient basis.is done on an outpatient basis.

Treatment-surgeryTreatment-surgery

AlsoAlso Also Also cornea grafting cornea grafting can be performed, which can be performed, which

is when the corneas are replaced in the eyes is when the corneas are replaced in the eyes from donor. from donor.

• Cornea grafting is an expensive procedure Cornea grafting is an expensive procedure that is often not available to those who need that is often not available to those who need it. One of the biggest problems with this it. One of the biggest problems with this procedure is there is always a chance that procedure is there is always a chance that corneas will be rejected.corneas will be rejected.