II. Epidemiology
- Trachoma is responsible for 15% of world blindness (most common cause of preventable blindness)
- Highest risk of Trachoma in first 3-6 years of life
- Children are the primary reservoir of the disease
- Trachoma is a disease of poverty
- Affects socioeconomically disadvantaged populations and developing nations
- Although rare in the U.S., native americans are most often affected
III. History
- Trachoma was first described in 16th Century B.C. Egypt
IV. Pathophysiology
- See Chlamydiaceae
- Organism: Chlamydia Trachomatis subtypes A-C
- Contrast with subtypes D to K (e.g. Cervicitis, Inclusion Conjunctivitis, Neonatal Pneumonia)
- Contrast with subtypes L1 to 3 (Lymphogranuloma venereum)
- Transmitted by hand to hand contact
- Typically transmitted between children by hand-to-hand contact of eye secretions
- Also transmitted when sharing contaminated clothing or towels
-
Conjunctival scarring (Cicatricial Trachoma)
- Chronic follicular Conjunctivitis
- Chronic inflammation from recurrent infection
- Scarring complete by young adulthood (develops slowly over 10-15 years)
V. Findings
- Conjunctival injection and inflammation leading to gradual Conjunctival scarring
-
Eyelid is is inverted inward due to scar traction
- Eyelashes chronically scrape the Conjunctiva and Corneal surface
- Chronic Corneal Abrasions lead to Bacterial Conjunctivitis and scarring
- Progressively Decreased Visual Acuity
- Blindness develops gradually over 10-15 years (typically by adulthood)
VI. Labs
- Intracytoplasmic Inclusion Bodies
- Historically used to identify Chlamydia Conjunctivitis (replaced by PCR)
- Responsible for the Chlamydial Conjunctivitis naming (Inclusion Conjunctivitis)
- However, Trachoma inclusion bodies are indistinguishable from those in Chlamydia Conjunctivitis
- Microscopy of cell scrapings from the palpebral Conjunctiva (inner Eyelid lining)
- Small Basophilic (deep purple) inclusion bodies seen within Conjunctival cells
- An inclusion body is a Chlamydia Initial Body (Chlamydia Reticulate Body)
- Historically used to identify Chlamydia Conjunctivitis (replaced by PCR)
VII. Management
- Azithromycin 20 mg/kg orally (up to 1 gram) for single dose (or Doxycycline 100 mg orally twice daily for 21 days) AND
- Topical Tetracycline or Erythromycin ointment twice daily for 28 days
VIII. References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Yanoff (1999) Ophthalmology, Mosby, p. 1.7
- Katusik (2003) Am J Ophthalmol 135(4): 447-51 [PubMed]
- Lietman (1999) Ophthalmol Clin North Am 12(1) [PubMed]
- Mabey (2005) Cochrane Database Syst Rev (2): CD001860 [PubMed]
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Related Studies
| Definition (MSH) | A chronic infection of the CONJUNCTIVA and CORNEA caused by CHLAMYDIA TRACHOMATIS. |
| Definition (MSHCZE) | Těžká infekční forma zánětu spojivek (konjunktivitidy) způsobená chlamydiemi. Vyskytuje se zejm. v Asii a Jižní Americe. Probíhá řadu měsíců a není-li léčen, vede ke ztrátě zraku. V rozvojových zemích je závažným zdravotním problémem a významnou příčinou slepoty. Včasná léčba antibiotiky je úspěšná. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (CSP) | chronic infection of the conjunctiva and cornea caused by chlamydia trachomatis. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D014141 |
| ICD9 | 076.9, 076 |
| ICD10 | A71 , A71.9 |
| SnomedCT | 186672003, 187379009, 154367007, 266200005, 2576002 |
| English | Trachomas, Trachoma, unspecified, Unspecified trachoma, [X]Trachoma, unspecified, trachoma, trachoma (diagnosis), Egyptian Ophthalmia, Ophthalmia, Egyptian, Trachoma, Trachoma [Disease/Finding], [X]Trachoma, unspecified (disorder), Unspecified trachoma (disorder), Trachoma (disorder), trachomatis; Chlamydia, Trachoma, NOS, Trachoma NOS |
| Dutch | trachoom niet-gespecificeerd, trachomatis; Chlamydia, Trachoom, niet gespecificeerd, trachoom, Trachoom |
| French | Trachome, non précisé, Conjonctivite granuleuse, Trachome, Ophtalmie d'Égypte, Ophtalmie égyptienne, Conjonctive égyptienne |
| German | Trachoma, unspezifisch, Trachom, nicht naeher bezeichnet, Trachoma, Trachom, Conjunctivitis granulosa trachomatosa, Conjunctivitis trachomatosa, Einschlußkonjunktivitis, trachomatöse, Körnerkrankheit |
| Italian | Tracoma, non specificato, Oftalmia egiziana, Tracoma |
| Portuguese | Tracoma NE, Oftalmia Egípcia, Conjuntivite Granulosa, Conjuntivite Granular, Conjuntivite Tracomatosa, Tracoma |
| Spanish | Tracoma no especificado, Oftalmía Egipcia, tracoma no especificado, tracoma no especificado (trastorno), [X]tracoma, no especificado (trastorno), [X]tracoma, no especificado, Conjuntivitis Granular, Conjuntivitis Tracomatosa, tracoma (trastorno), tracoma, Tracoma |
| Japanese | トラコーマ、詳細不明, ﾄﾗｺｰﾏｼｮｳｻｲﾌﾒｲ, ﾄﾗｺｰﾏ, トラコーマ, 顆粒結膜炎, トラホーム, 顆粒性結膜炎, 結膜炎-顆粒性 |
| Swedish | Trakom |
| Czech | trachom, Trachom, blíže neurčený, Trachom |
| Finnish | Trakooma |
| Russian | TRAKHOMA, ТРАХОМА |
| Korean | 트라코마, 상세불명의 트라코마 |
| Croatian | TRAHOM |
| Polish | Zapalenie spojówek ziarniste, Jaglica, Zapalenie oczu egipskie |
| Hungarian | trachoma, nem meghatározott, trachoma |
| Norwegian | Trakom |
Ontology: Trachoma inclusion conjunctivitis (C0856693)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 186671005 |
| English | Trachoma inclusion conjunctivitis |
| Dutch | trachoominclusie-conjunctivitis |
| French | Conjonctivite due à Chlamydia trachomatis |
| German | Trachomeinschlusskoerperchen-Konjunktivitis |
| Italian | Congiuntivite tracomatosa da inclusi |
| Portuguese | Conjuntivite de inclusões do tracoma |
| Spanish | Conjuntivitis de inclusión por tracoma |
| Japanese | トラコーマ性封入体結膜炎, ﾄﾗｺｰﾏｾｲﾌｳﾆｭｳﾀｲｹﾂﾏｸｴﾝ |
| Czech | Trachomová inkluzní konjunktivitida |
| Hungarian | Trachoma inclusiós conjunctivitis |
