ppt

1. Dr. Meseret

2. Introduction
 Ocular infection with Chlamydia Trachomatis
serovars A, B, Ba and C
 Leading cause of infectious blindness
worldwide
 Second leading cause of blindness worldwide
 Disappearance in Europe and America predated
antibiotics

3. Pathogenesis of trachoma blindness
 Normal conjunctiva Trachoma
infectn and re-infectn 2ry bact infctn
Scarring Trichiasis Corneal
opacity Blindness

4. Magnitude of the problem
 590 million people at risk from blinding trachoma
 150 million people have active trachoma
 10.6 million people have trichiasis
 5.9 million people blind from trachoma
 15% of global blindness: 2nd cause of blindness
 “a forgotten disease of forgotten
people”

5. Distribution of disease
 Trachoma is concentrated in hot, dusty, dry parts of the
world. Proxy for poverty
 Within endemic countries, trachoma is found in areas that
are:
 Rural
 Economically underdeveloped
 Without good water supplies
 Without basic sanitation
 Since it is an infectious disease, trachoma clusters at
neighbourhood and household level

7. Clincal features
 Over all similar to any type of conjunctivitis
 Clinical features range from mild symptoms to
sever disease
 Usually bilateral, but can be assymetrical
 In sever cases- eyelid edema and photophobia
may be presnt

8. Clincal features…
 1. Active disease
 A. follicles
 Are enlarged nodules of
lymphoid tissue under
the conj epithelium
 B. papillae- raised areas
on the surface of the
epith caused by blood
vessels and infl cells
growing in the sub conj
tissue

9. Clincal features…
 Follicles at the upper
limbus may resolve
leaving a row of shallow
depressions called
Herbert’s pits
 Supeiror epith keratitits
amd pannus formation

10. Clincal features…
 2. Chronic disease
 Conjunctival scars
 Can be mild (linear ) or
 Borad (arlt lines)

11. Complications of trachoma
 Trichiasis
 Distichiasis
 Corneal vascularization
 Cicatrical entropion
 Dry eye

12. Grading
 1. Trachoma
inflammation -
follicular (TF)
 -Five or more
folliclees
(>0.5mm) on the
supeior tarsal
conjunctiva

13. Clincal features…
 Trachoma
inflammation –intense
 (TI)
 Trachomatous
inflammation diffusely
involving the tarseal
conj. obscuring 50% or
more of deep tarsal
vessels

14. Clincal features…
 Trachomatous
scarring (TS)
 The presence of
scarring in the tarsal
conjunctiva

15.  Trachomatous
trichiasis (TT)
 At least one lash
touching the globe

16. Clincal features…
 Corneal opacity
(CO)
 Corneal opacity over
the pupil sufficient
to blurr the iris
details

17. Intervention: SAFE strategy
 Surgery for trichiasis
 Antibiotics for TF/TI
 Facial cleanliness to prevent transmission
of C. trachomatis
 Environmental change to prevent
transmission of C. trachomatis

18. Transmission of Infection
 Transmission of chlamydia from ocular and nasal
secretion of children
 Direct spread during play/sharing a bed
 Conveyance on fingers
 Indirect spread on fomites
 Eye-seeking flies
 Coughing/sneezing

19. Disruption of Infection cycle
 Antibiotics
 Faces, Fingers, Fomites and Flies: Hygiene
 Environmental changes:
 water provision and use
 Overcrowded housing
 Domestic waste management
 Animal proximity to household

20. Which antibiotic?
Tetracycline ointment bid. for 6 weeks
Cures 60-80% of cases of TF/TI if full course is
administered; compliance is a problem

21. Which antibiotic...?
Oral Azithromycin
More effective than tetracycline especially for
mass distribution
1gm po stat, or 20mg/kg stat (for children)

22. Mass treatment protocol