II. Epidemiology
- Trachoma responsible for 15% of world blindness
III. History
- Trachoma first described in 16th Century B.C. Egypt
IV. Characteristics
- Trachoma
- Highest risk of Trachoma in first 3-6 years of life
- Associated with Chlamydia subtypes A-C
- Conjunctival scarring (Cicatricial Trachoma)
- Chronic follicular Conjunctivitis
- Chronic inflammation from recurrent infection
- Scarring complete by young adulthood
- Adult Inclusion Conjunctivitis (AIC)
- Affects <2% with genital tract Chlamydia
- Transmission
- Sexually Transmitted Infection (oculogenital)
- Historical: Non-chlorinated swimming pools (1900)
- Acute follicular Conjunctivitis >5 days post-exposure
- Neonatal Inclusion Conjunctivitis (NIC)
- Transmission during Vaginal Delivery
- Conjunctivitis onset 5-14 days after birth
- Associated with development of Chlamydia Pneumonia
- Initial watery discharge becomes copious and purulent
V. Signs
- May present as subacute case (>4 weeks)
- Unilateral Conjunctivitis with hyperemia and mucopurulent discharge (stringy mucous discharge)
-
Lymphoid follicle formation (also seen in some Viral Conjunctivitis)
- Tiny, rice grain size, gelatinous pale bumps on the Conjunctiva at fornix
VI. Labs
-
Chlamydia trachomatis testing
- Nasal Swab for Chlamydia Direct Fluorescence Antibody (low Test Sensitivity) OR
- Chlamydia DNA Probe or NAAT (better Test Sensitivity)
VII. Causes
- Chlamydia trachomatis
- Less common Chlamydia Conjunctivitis causes
VIII. Differential Diagnosis
IX. Management
- Trachoma
- Azithromycin 20 mg/kg orally (up to 1 gram) for single dose (or Doxycycline 100 mg orally bid x21 days) AND
- Topical Tetracycline or Erythromycin ointment twice daily for 28 days
- Adult Inclusion Conjunctivitis (AIC)
- Azithromycin 1 g for 1 dose (or Doxycycline 100 mg twice daily for 7 days) AND
- Topical Erythromycin ointment to eye twice daily for 21 days
- Neonatal Inclusion Conjunctivitis (NIC)
- Erythromycin base or EES 50 mg/kg/day divided four times daily for 14 days
X. Prevention
-
Erythromycin or Tetracycline ophthalmic ointment
- Applied to newborns eyes within 1 hour of delivery
- Sexually Transmitted Disease Prevention
- Sexually Transmitted Disease surveillance in Pregnancy
XI. 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 (MSHCZE) | Zánět spojivek (konjunktivitida) charakterizovaný nálezem inkluzí (tzv. iniciálních tělísek) ve stěrech ze spojivky. Bývá způsoben chlamydiemi. Projevuje se hnisavou sekrecí. Vyskytuje se u novorozenců (inkluzní blenorea) nebo dospělých (tzv. konjunktivitida z plaveckého bazénu). Léčí se antibiotiky, dospělým lze podávat tetracyklin, novorozencům např. erythromycin. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (MSH) | An infection of the eyes characterized by the presence in conjunctival epithelial cells of inclusion bodies indistinguishable from those of trachoma. It is acquired by infants during birth and by adults from swimming pools. The etiological agent is CHLAMYDIA TRACHOMATIS whose natural habitat appears to be the genito-urinary tract. Inclusion conjunctivitis is a less severe disease than trachoma and usually clears up spontaneously. |
| Definition (CSP) | infection of the eyes characterized by the presence in conjunctival epithelial cells of inclusion bodies indistinguishable from those of trachoma; it is acquired by infants during birth and by adults from swimming pools; the etiological agent is Chlamydia trachomatis whose natural habitat appears to be the genito-urinary tract. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D003235 |
| ICD9 | 077.0 |
| ICD10 | A74.0 |
| SnomedCT | 111840005, 186674002, 186733005, 154370006, 266202002, 56009001, 266109000, 231861005 |
| English | Blennorrhea, Inclusion, Blennorrheas, Inclusion, Conjunctivitides, Inclusion, Conjunctivitis, Inclusion, Inclusion Blennorrheas, Inclusion Conjunctivitides, Inclusion Blennorrhea, Inclusion Conjunctivitis, inclusion blenorrhea, paratrachoma, paratrachoma (diagnosis), inclusion conjunctivitis, inclusion conjunctivitis (diagnosis), Conjunctivitis chlamydial, Conjunctivitis, Inclusion [Disease/Finding], conjunctivitis inclusion, chlamydial conjunctivitis, conjunctivitis chlamydia, Conjunctivitis;chlamydia, Trachoma inc. conjunctivitis, Inclusion blenorrhoea, Chlamydia conjunctivitis, Inclusion blennorrhea, Paratrachoma, Chronic conjunctivitis due to Chlamydia trachomatis, Inclusion conjunctivitis due to Chlamydia trachomatis, Chlamydial conjunctivitis, Chlamydial conjunctivitis (disorder), Inclusion blennorrhoea, Inclusion conjunctivitis (disorder), Inclusion blenorrhea, Inclusion conjunctivitis, chlamydia conjunctivitis |
| Italian | Congiuntivite da Chlamydia, Congiuntivite da inclusione, Blenorragia da inclusione, Blenorrea da inclusioni, Congiuntivite da inclusioni |
| Dutch | inclusie-blennorroe, Conjunctivitis door Chlamydia, Chlamydia-conjunctivitis, inclusie-conjunctivitis, Blenorroe, inclusie-, Conjunctivitis, inclusion-, Inclusion-conjunctivitis |
| French | Blennorrhée à inclusions, Conjonctivite à Chlamydia, Conjonctivite à inclusion, Conjonctivite à inclusions |
| German | Einschlussblenorrhoe, Chlamydienkonjunktivitis, Einschlusskonjunktivitis, Konjunktivitis durch Chlamydien, Bindehautentzündung, Einschluß-, Blennorrhoe, Einschluß-, Einschlußblennorrhoe, Konjunktivitis, Einschluß- |
| Portuguese | Blenorreia de inclusão, Blenorreia de Inclusão, Conjuntivite a clamídia, Conjuntivite por inclusão, Conjuntivite de Inclusão |
| Spanish | Blenorrea de inclusión, Blenorrea por inclusión, conjuntivitis por inclusión, blenorrea por inclusión, conjuntivitis por inclusión (trastorno), blenorrea de inclusión, conjuntivitis clamidial, conjuntivitis crónica por Chlamydia trachomatis, conjuntivitis de inclusión (trastorno), conjuntivitis de inclusión por Chlamydia trachomatis, conjuntivitis de inclusión, conjuntivitis por clamidia (trastorno), conjuntivitis por clamidia, conjuntivitis por inclusión (concepto no activo), paratracoma, Conjuntivitis por clamidia, Conjuntivitis de inclusión, Blenorrea de Inclusión, Conjuntivitis de Inclusión |
| Japanese | クラミジア性結膜炎, ﾌｳﾆｭｳﾀｲｾｲﾉｳﾛｳ, ｸﾗﾐｼﾞｱｾｲｹﾂﾏｸｴﾝ, ﾌｳﾆｭｳﾀｲｹﾂﾏｸｴﾝ, 結膜炎-封入体, 封入体性結膜炎, 封入体性膿漏, 封入体結膜炎, 結膜炎-封入体性, 膿漏-封入体性 |
| Swedish | Konjunktivit, inklusion |
| Czech | konjunktivitida inkluzní, Paratrachom, Chlamydiová konjunktivitida, Inkluzní blenorea, Inkluzní konjunktivitida, paratrachom, konjunktivitida inkluzorní |
| Finnish | Inkluusiokonjunktiviitti |
| Russian | KON"IUNKTIVIT S VKLIUCHENIIAMI, BLENNOREIA S VKLIUCHENIIAMI, БЛЕННОРЕЯ С ВКЛЮЧЕНИЯМИ, КОНЪЮНКТИВИТ С ВКЛЮЧЕНИЯМИ |
| Korean | 클라미디아 결막염 |
| Polish | Zapalenie spojówek wtrętowe |
| Hungarian | inclusiós conjunctivitis, Inclusiós blenorrhoea, chlamydiás conjunctivitis, Zárványtestes blenorrhoea |
| Norwegian | Konjunktivitt, inklusjons-, Inklusjonskonjunktivitt |
Ontology: Trachoma (C0040592)
| 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 |
