Materiały źródłowe

• #1 Trachoma – Eye Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/eye-disorders/conjunctival-and-scleral-disorders/trachoma

  Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis and is characterized by progressive exacerbations and remissions. […] Diagnosis is usually clinical. […] Diagnosis of trachoma is usually clinical because testing is rarely available in endemic areas. Lymphoid follicles on the tarsal plate or along the corneal limbus, linear conjunctival scarring, and corneal pannus are considered diagnostic in the appropriate clinical setting. […] C. trachomatis can be isolated in culture or identified by nucleic acid amplification tests (NAAT) and immunofluorescence techniques, and testing should be done when it is readily available to confirm diagnosis and prevent disease progression in cases of diagnostic uncertainty. […] Diagnosis is usually clinical, but standard methods to detect chlamydia can be done when available.

• #2 Trachoma – UpToDate

  https://www.uptodate.com/contents/trachoma/print

  Trachoma is the leading infectious cause of blindness worldwide. It is a chronic keratoconjunctivitis caused by recurrent infection with Chlamydia trachomatis (a small, gram-negative obligate intracellular bacterium); humans are the only hosts. Trachoma is caused almost exclusively by C. trachomatis serotypes A, B, Ba, and C; genital infection is caused by serotypes D through K. […] The prevalence of active disease (characterized by follicles and/or severe inflammation of the upper tarsal conjunctiva) is highest in young children and declines to low levels in adulthood. In endemic areas, it is common to be infected at least once (and often more than once) in childhood. […] Trachoma may be associated with ocular pain and loss of vision, leading to loss of economic productivity and quality of life. In 2023, an estimated 116 million people lived in districts in which the prevalence of active trachoma (trachomatous inflammation—follicular, TF) was ≥5 percent, and 1.5 million required surgery for trichiasis.

• #3 Trachoma – UpToDate

  https://www.uptodate.com/contents/trachoma

  Trachoma is the leading infectious cause of blindness worldwide. It is a chronic keratoconjunctivitis caused by recurrent infection with Chlamydia trachomatis (a small, gram-negative obligate intracellular bacterium); humans are the only hosts. Trachoma is caused almost exclusively by C. trachomatis serotypes A, B, Ba, and C; genital infection is caused by serotypes D through K. […] The prevalence of active disease (characterized by follicles and/or severe inflammation of the upper tarsal conjunctiva) is highest in young children and declines to low levels in adulthood. In endemic areas, it is common to be infected at least once (and often more than once) in childhood. […] A subgroup of children may have persistent, severe infection; these individuals are at risk for developing cicatricial (scarring) disease as older children and adults. […] In 2023, an estimated 116 million people lived in districts in which the prevalence of active trachoma (trachomatous inflammation—follicular, TF) was ≥5 percent, and 1.5 million required surgery for trichiasis.

• #4

  https://www.who.int/teams/control-of-neglected-tropical-diseases/trachoma/diagnosis

  In areas where trachoma is endemic, active (inflammatory) trachoma is common among preschool-aged children, with prevalence rates which can be as high as 60-90%. Infection becomes less frequent and shorter in duration with increasing age. […] Trachoma disease is usually clinically diagnosed. People are examined for clinical signs through the use of magnifiers (loupes). In most early stages, infection does not present visible signs of the disease. However, repeated infections cause scarring of the conjunctiva and it is during this phase that infected individuals get the feeling of irritation. […] The WHO grading system for trachoma classifies the disease in 5 grades: Trachomatous Inflammation Follicular (TF) – which mostly requires topical treatment. Trachomatous Inflammation Intense (TI) – during which topical and systemic treatments are considered. Trachomatous Scarring (TS) – when scars are visible as in the tarsal conjunctiva and which may obscure tarsal blood vessels. Trachomatous Trichiasis (TT) – when an individual is referred for eyelid surgery; and Corneal Opacity – a stage during which a person is irreversibly blind.

• #5 Trachoma | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-022-00359-5

  Trachoma is diagnosed through clinical examination. This requires a trained examiner, a calm examinee, magnification (generally 2.5 binocular magnifying loupes), and a means for the examiner to prevent iatrogenic transmission of infection from one examinee to the next (alcohol-based hand gel, disposable examination gloves, or soap and water). Diagnosis is often (but not always) done in the field. Illumination is also important; a torch is optimal when looking for TT, whereas bright sunlight is generally adequate for examining the conjunctiva. […] Most individuals with active trachoma have minimal or no symptoms. Some report eye irritation or a small amount of discharge. Individuals with TT often report a history of eye pain, blepharospasm (involuntary closure of both eyelids), light intolerance or reduced vision.

• #6 Trachoma | Doctor

  https://patient.info/doctor/trachoma.htm

  Laboratory tests are not used in endemic areas where the diagnosis is by clinical examination. […] Cell culture used to be the standard test but has been superseded by newer tests. […] In other areas, polymerase chain reaction (PCR) and ligase chain reaction (LCR) have high sensitivity and specificity. […] Another new test is direct fluorescein-labelled monoclonal antibody (DFA) and enzyme immunoassay (EIA) of conjunctival smears. […] Giemsa cytology (the finding of intracytoplasmic inclusions) is technically demanding, has a high specificity but low sensitivity.

• #7 Trachoma | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-022-00359-5

  A comprehensive trachoma examination routine is ideal but, in some contexts (in particular, routine surveys conducted by public health programmes to estimate prevalence), not all of its elements are required. The examination should be guided by its purpose and context. […] The comprehensive examination comprises several steps. Visual acuity is measured (for each eye separately) where possible. […] The upper eyelid is everted and the tarsal conjunctiva examined for central follicles, inflammatory thickening due to a papillary response, and scarring. […] Other causes of conjunctival inflammation, conjunctival scarring, trichiasis, entropion and corneal opacity can have clinical signs that resemble those produced by trachoma. […] The interpretation of clinical signs and their classification as being attributable (or not attributable) to trachoma can be influenced by a range of contextual impressions.

• #8 Trachoma Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/trachoma

  Trachoma is an infection of the eye caused by bacteria called chlamydia. […] Lab tests are needed to identify the bacteria and make an accurate diagnosis. […] The health care provider will do an eye exam to look for scarring on the inside of the upper eye lid, redness of the white part of the eyes, and new blood vessel growth into the cornea.

• #9

  https://www.who.int/teams/control-of-neglected-tropical-diseases/trachoma/diagnosis

  In areas where trachoma is endemic, active (inflammatory) trachoma is common among preschool-aged children, with prevalence rates which can be as high as 60-90%. Infection becomes less frequent and shorter in duration with increasing age. […] Trachoma disease is usually clinically diagnosed. People are examined for clinical signs through the use of magnifiers (loupes). In most early stages, infection does not present visible signs of the disease. However, repeated infections cause scarring of the conjunctiva and it is during this phase that infected individuals get the feeling of irritation. […] The WHO grading system for trachoma classifies the disease in 5 grades: Trachomatous Inflammation Follicular (TF) – which mostly requires topical treatment. Trachomatous Inflammation Intense (TI) – during which topical and systemic treatments are considered. Trachomatous Scarring (TS) – when scars are visible as in the tarsal conjunctiva and which may obscure tarsal blood vessels. Trachomatous Trichiasis (TT) – when an individual is referred for eyelid surgery; and Corneal Opacity – a stage during which a person is irreversibly blind.

• #10 Trachoma – WikEM

  https://wikem.org/wiki/Trachoma

  Most common cause of infectious blindness worldwide. […] Clinical diagnosis. […] Simplified grading system composed of 5 clinical signs of infection. […] Follicular trachomatous inflammation (TF). […] Intense trachomatous inflammation (TI). […] Trachomatous scarring (TS). […] Trachomatous trichiasis (TT). […] Corneal opacity.

• #11 Doyne Lecture: trachoma, is it history? | Eye

  https://www.nature.com/articles/eye2008432

  In 1966, a new WHO grading system was developed that used nine signs. This was revised some in 1981, and in 1987, the WHO simplified grading system with five signs was developed, particularly for use by field workers. […] A recent WHO recommendation is for field studies to collect data only for three signs, TF, TT, and CO: TF (trachomatous inflammation follicular) is used to assess the need for trachoma control programs and monitor results; TT (trachomatous trichiasis) indicates those who need surgery; and CO (corneal opacity) is used as an indicator of the burden of blindness and visual impairment due to trachoma. […] Authors have commented on the poor correlation between clinical examination and PCR, particularly in areas with low prevalence of trachoma. […] It is true that a large proportion of people with active trachoma (TF), including some of those with intense inflammation (TI), do not have demonstrable organism on spot testing. However, this reflects the pathogenesis of trachoma as an immune-mediated disease, rather than some new divergence from the germ theory.

• #12 Trachoma – Eye Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/eye-disorders/conjunctival-and-scleral-disorders/trachoma

  Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis and is characterized by progressive exacerbations and remissions. […] Diagnosis is usually clinical. […] Diagnosis of trachoma is usually clinical because testing is rarely available in endemic areas. Lymphoid follicles on the tarsal plate or along the corneal limbus, linear conjunctival scarring, and corneal pannus are considered diagnostic in the appropriate clinical setting. […] C. trachomatis can be isolated in culture or identified by nucleic acid amplification tests (NAAT) and immunofluorescence techniques, and testing should be done when it is readily available to confirm diagnosis and prevent disease progression in cases of diagnostic uncertainty. […] Diagnosis is usually clinical, but standard methods to detect chlamydia can be done when available.

• #13

  https://www.atsu.edu/faculty/chamberlain/website/lectures/tritzid/eyedis.htm

  Trachoma is the most serious of the eye diseases caused by Chlamydia trachomatis. There is no genital involvement in this disease; the disease is spread person-to-person via the common use of towels and washcloths. Both children and adults can be infected. This is the leading cause of blindness in the world. […] […] Clinical diagnosis of trachoma rests on the finding of characteristic follicles and scars in the conjunctiva, and vascularization and infiltration of the cornea. In the typical case, diagnosis is easy; in mild cases or after distortion of the anatomy of the external eye, the diagnosis of activity may be difficult. The World Health Organization lists these stages of the disease: […] 1. TR-D is the symbol applied to trachoma dubium, or suspect trachoma. The clinical signs suggest an early conjunctival reaction, but either there are no follicles or they are atypical. Corneal changes are either not visible or are atypical. Inclusions are not demonstrated and the agent cannot be isolated via inoculation of seven-day chick embryos with conjunctival scrapings.

• #14 Trachoma Workup: Laboratory Studies

  https://emedicine.medscape.com/article/1202088-workup

  In endemic areas, the diagnosis is almost always based on the clinical appearance. […] To confirm that the clinical diagnosis of active trachoma is the result of ocular C trachomatis infection, the best laboratory techniques are the nucleic acid amplification tests (NAATs), of which the polymerase chain reaction (PCR) is one example. […] The NAATs have high sensitivity and specificity but are too expensive and too technically complex to be widely available in most settings where trachoma is endemic. […] Other useful techniques are direct fluorescein-labeled monoclonal antibody (direct fluorescent antibody [DFA]) assay and enzyme immunoassay (EIA) of conjunctival smears. […] Newer diagnostic methods have superseded cell culture, which was the criterion standard for laboratory diagnosis. […] Giemsa cytology is microscopic examination of stained conjunctival scrapings for intracytoplasmic inclusions.

• #15 Trachoma | IntechOpen

  https://www.intechopen.com/chapters/82829

  Even though laboratory tests are not commonly used in the field of the diagnosis of C. trachoma, they are useful in non-endemic areas as well as in research laboratories. Frequently performed laboratory tests include the following: Polymerase chain reaction (PCR), specifically nucleic acid amplification tests (NAATs) are most sensitive. […] Direct fluorescent antibody assay. […] Enzyme immunoassay.

• #16 Trachoma Workup: Laboratory Studies

  https://emedicine.medscape.com/article/1202088-workup

  In endemic areas, the diagnosis is almost always based on the clinical appearance. […] To confirm that the clinical diagnosis of active trachoma is the result of ocular C trachomatis infection, the best laboratory techniques are the nucleic acid amplification tests (NAATs), of which the polymerase chain reaction (PCR) is one example. […] The NAATs have high sensitivity and specificity but are too expensive and too technically complex to be widely available in most settings where trachoma is endemic. […] Other useful techniques are direct fluorescein-labeled monoclonal antibody (direct fluorescent antibody [DFA]) assay and enzyme immunoassay (EIA) of conjunctival smears. […] Newer diagnostic methods have superseded cell culture, which was the criterion standard for laboratory diagnosis. […] Giemsa cytology is microscopic examination of stained conjunctival scrapings for intracytoplasmic inclusions.

• #17 Trachoma | Doctor

  https://patient.info/doctor/trachoma.htm

  Laboratory tests are not used in endemic areas where the diagnosis is by clinical examination. […] Cell culture used to be the standard test but has been superseded by newer tests. […] In other areas, polymerase chain reaction (PCR) and ligase chain reaction (LCR) have high sensitivity and specificity. […] Another new test is direct fluorescein-labelled monoclonal antibody (DFA) and enzyme immunoassay (EIA) of conjunctival smears. […] Giemsa cytology (the finding of intracytoplasmic inclusions) is technically demanding, has a high specificity but low sensitivity.

• #18 Diagnosis and Assessment of Trachoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC523557/

  Trachoma is caused by Chlamydia trachomatis. Clinical grading with the WHO simplified system can be highly repeatable provided graders are adequately trained and standardized. […] At the community level, rapid assessments are useful for confirming the absence of trachoma but do not determine the magnitude of the problem in communities where trachoma is present. New rapid assessment protocols incorporating techniques for obtaining representative population samples (without census preparation) may give better estimates of the prevalence of clinical trachoma. Clinical findings do not necessarily indicate the presence or absence of C. trachomatis infection, particularly as disease prevalence falls. The prevalence of ocular C. trachomatis infection (at the community level) is important because it is infection that is targeted when antibiotics are distributed in trachoma control campaigns. Methods to estimate infection prevalence are required.

• #19 Diagnosing trachoma for elimination – Somatosphere

  https://somatosphere.com/2018/diagnosing-trachoma-for-elimination.html/

  Trachoma is diagnosed using clinical signs, using what is known as the World Health Organization (WHO) simplified grading system. […] Trachomatous inflammation-follicular (TF), where there are characteristic off-white follicles of ≥0.5 mm, is the characteristic sign of active trachoma. […] However, the presence of clinical signs of active trachoma (TF and TI) is poorly correlated with detection of infection, especially after MDA where clinical signs tend to over-estimate prevalence relative to infection. […] Studies have shown that tests for infection, including lab-based nucleic acid amplification tests, can be cost-effective, especially when their use results in stopping or not initiating MDA. […] There therefore remains a need for a fit-for-purpose (“ASSURED”) diagnostic test that can be conducted in-country after minimal training, in order to provide community level prevalence estimates to guide elimination efforts.

• #20 The Relationship between Active Trachoma and Ocular Chlamydia trachomatis Infection before and after Mass Antibiotic Treatment | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005080

  Prior to MDA, TF is a good indicator of the community prevalence of C. trachomatis infection. […] Following MDA, the prevalence of TF tends to overestimate the underlying infection prevalence. […] In order to prevent unnecessary additional rounds of MDA and to accurately ascertain when elimination goals have been reached, a cost-effective test for C. trachomatis that can be administered in low-resource settings remains desirable. […] The most recent estimates from the World Health Organization (WHO) Alliance for the Global Elimination of Trachoma by 2020 (GET2020) estimates indicate that about 200 million people live in trachoma endemic areas in 42 countries, 2.2 million have visual impairment or blindness, and about 3.2 million have trichiasis. […] The antibiotic azithromycin is being used in community-wide mass drug administration (MDA); it is given as a single oral dose on an annual basis in endemic districts.

• #21 Correlation of Clinical Trachoma and Infection in Aboriginal Communities | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000986

  Trachoma is the leading infectious cause of blindness due to conjunctival infection with Chlamydia trachomatis. The presence of active trachoma and evidence of infection are poorly correlated and a strong immunologically-mediated inflammatory response means that clinical signs last much longer than infection. […] A consensus fine grading of trachoma, based on clinical assessment and photograding, was compared to PCR, a lipopolysacharide (LPS)-based point-of-care (POC) and a 16S RNA-based nucleic acid amplification test (NAAT). […] In low prevalence areas, the LPS-based POC test lacks the sensitivity to detect active ocular infection and nucleic acid amplification tests such as PCR or the 16S-RNA based NAAT performed better. […] The WHO simplified clinical grading scheme currently used for assessment of trachoma has a poor correlation with C. trachomatis genomic test findings, even though the detection of bacterial genome is strongly correlated with the prevalence and severity of active trachoma.

• #22 Doyne Lecture: trachoma, is it history? | Eye

  https://www.nature.com/articles/eye2008432

  In 1966, a new WHO grading system was developed that used nine signs. This was revised some in 1981, and in 1987, the WHO simplified grading system with five signs was developed, particularly for use by field workers. […] A recent WHO recommendation is for field studies to collect data only for three signs, TF, TT, and CO: TF (trachomatous inflammation follicular) is used to assess the need for trachoma control programs and monitor results; TT (trachomatous trichiasis) indicates those who need surgery; and CO (corneal opacity) is used as an indicator of the burden of blindness and visual impairment due to trachoma. […] Authors have commented on the poor correlation between clinical examination and PCR, particularly in areas with low prevalence of trachoma. […] It is true that a large proportion of people with active trachoma (TF), including some of those with intense inflammation (TI), do not have demonstrable organism on spot testing. However, this reflects the pathogenesis of trachoma as an immune-mediated disease, rather than some new divergence from the germ theory.

• #23 Diagnosis and Assessment of Trachoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC523557/

  While culture is a sensitive test for the presence of viable organisms and nucleic acid amplification tests are sensitive and specific tools for the presence of chlamydial nucleic acids, the commercial assays presently available are all too expensive, too complex, or too unreliable for use in national programs. There is an urgent need for a rapid, reliable test for C. trachomatis to assist in measuring progress towards the elimination of trachoma.

• #24 Target Product Profile: Trachoma Surveillance Diagnostic – Antigen Lateral Flow Test | PATH

  https://www.path.org/our-impact/resources/tpp-trachoma-antigen-lateral-flow-test/

  Trachoma is the leading cause of infectious blindness in the world. The infectious agent of trachoma is the bacteria Chlamydia trachomatis that spreads by contact with an infected persons hands or clothing. Infection leads to conjunctival inflammation that produces trachoma follicles visible on physical exam. Yet it is the repeated episodes of reinfection and inflammation that lead to scarring, distortion of the eyelid, and in-turning of the lid with the eyelashes touching the cornea, called trichiasis, that leads to blindness. […] In order to assess the impact of the community-wide antibiotic distribution, commonly known as mass drug administration (MDA), trachoma surveillance is performed with a physical exam of the eye. This method of diagnosis is acceptable for early control programs; however, as we move closer to elimination of trachoma, more sensitive and specific diagnostics are needed.

• #25 Correlation of Clinical Trachoma and Infection in Aboriginal Communities | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000986

  The fine grading of active trachoma strongly correlated with organism load and disease severity (rs=0.498, P=0.0004). […] A significant correlation was observed between PCR-positivity (Amplicor) and TFWHO (Wilcoxon rank sum tests P0.0001) and, between PCR-positivity and the fine grading scheme (Spearman Rho=0.98 and P=0.0004). […] Even though the detection of infection by PCR is a poor predictor of the presence of clinical disease and equally clinical disease was poorly correlated with infection, organism load was strongly correlated with the prevalence and severity of active trachoma as graded by the finer grading scheme. […] A rapid, simple and affordable POC test capable of accurate identification of active infection would nevertheless be a useful tool in trachoma control. […] The 16S-RNA test, a closed-system device based on visual detection of nucleic acid on a dipstick, offers several advantages and with its inherent sensitivity and thermostability and therefore has the potential to meet this need.

• #26 Rapid diagnostic device for trachoma eye infection delivers first promising result – Fraunhofer IZI

  https://www.izi.fraunhofer.de/en/press/press-releases/rapid-diagnostic-device-for-trachoma-eye-infection-delivers-first-promising-result.html

  A molecular biological, chip-based rapid test for the diagnosis of the eye infection trachoma developed at the Fraunhofer Institute for Cell Therapy and Immunology IZI has proven promising in first studies. […] The DjinniChip proved to be easy to handle and delivered fast results even in the field. […] With the DjinniChip, many cases of infection and non-infection with Chlamydia trachomatis were correctly diagnosed in the study. However, the test system did not yet show the expected high sensitivity, meaning to detect positive cases as positive.

• #27 Target Product Profile: Trachoma Surveillance Diagnostic – Antigen Lateral Flow Test | PATH

  https://www.path.org/our-impact/resources/tpp-trachoma-antigen-lateral-flow-test/

  This report proposes a target product profile (TPP) for the development of a new diagnostic technology that facilitates an accurate stopping decision phase for MDA. Each attribute has an acceptable standard that must be met and an ideal standard that, if met, would maximize the target products value. This TPP focuses on the development of a lateral flow rapid diagnostic test (RDT) that detects trachoma antigens.

• #28

  https://journals.lww.com/corneajrnl/fulltext/2025/05000/computer_vision_identification_of_trachomatous.11.aspx

  Trachoma surveys are used to estimate the prevalence of trachomatous inflammation-follicular (TF) to guide mass antibiotic distribution. […] This study describes the development and evaluation of machine learning models intended to reduce cost and improve reliability of these surveys. […] The classification model predicted a TF prevalence of 32%, which was not significantly different from the human consensus estimate (30%; 95% confidence interval of difference, 2 to +4%). […] Deep convolutional neural network models performed well at classifying TF and detecting the number of follicles evident in conjunctival photographs. […] Implementation of similar models may enable accurate, efficient, large-scale trachoma screening. […] The classification model’s estimate of the prevalence of TF in this population was not significantly different from the consensus of expert human image graders. […] Overall, these findings suggest similar deep learning models may have a role in guiding mass distribution of azithromycin to achieve elimination of trachoma.

• #29 Trachoma – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/958

  Trachoma is a keratoconjunctivitis caused by ocular infection with particular serovars of Chlamydia trachomatis. […] Prompt surgery must be offered to all patients who have trichiasis in order to prevent blindness. […] Key diagnostic factors include presence of risk factors, residence in or emigration from an endemic area, at-risk demographic, subtarsal conjunctival inflammation, subtarsal follicles, subtarsal conjunctival scarring, trichiasis, corneal opacification and visual loss, and Herbert’s pits. […] 1st investigations to order include clinical diagnosis. […] Investigations to consider include polymerase chain reaction (conjunctival swab). […] Emerging tests include novel molecular and serological tests.

• #30 Trachoma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/trachoma/symptoms-causes/syc-20378505

  Trachoma is a bacterial infection that affects your eyes. […] Early treatment may help prevent trachoma complications. […] Call your doctor if you or your child has itchy or irritated eyes or discharge from the eyes, especially if you live in or recently traveled to an area where trachoma is common. […] One episode of trachoma caused by Chlamydia trachomatis is easily treated with early detection and use of antibiotics. […] If you’ve been treated for trachoma with antibiotics or surgery, reinfection is always a concern. […] The WHO has developed a strategy to prevent trachoma, with the goal of eliminating it by 2020.

• #31 Trachoma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/958

  Trachoma is a keratoconjunctivitis caused by ocular infection with particular serovars of Chlamydia trachomatis. […] Prompt surgery must be offered to all patients who have trichiasis in order to prevent blindness. […] Key diagnostic factors include residence in or emigration from an endemic area, at-risk demographic, subtarsal conjunctival inflammation, subtarsal follicles, subtarsal conjunctival scarring, trichiasis, corneal opacification and visual loss, and Herbert pits. […] 1st tests to order include clinical diagnosis. […] Tests to consider include polymerase chain reaction (conjunctival swab). […] Emerging tests include novel molecular and serologic tests.

• #32 Trachoma: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/25148-trachoma

  Trachoma is an eye disease caused by a bacterium called Chlamydia trachomatis. The infection can cause irreversible blindness. […] An eye doctor will take a medical history and ask you questions. Theyll want to know if youve been in areas where trachoma is present. Your provider will do an eye exam. In addition, they may take a sample of any fluid by numbing your eye and swabbing it. They can send this to a lab to find out if the source of infection is Chlamydia trachomatis. […] In early stages, your provider can treat and cure trachoma by giving you antibiotics. The two drugs recommended for trachoma are azithromycin and an ointment made with tetracycline. […] If trachoma isnt treated, you wont be able to reverse the blindness that occurs.

• #33 DateLineHealthAfrica

  https://www.datelinehealthafrica.org/slideshowall/consumer/top-10-trachoma-questions-answered/296

  Trachoma is diagnosed via eye examination and laboratory tests. For eye examination, your doctor will examine your eye with the aid of a light and simple magnifier, to check for some of the signs and symptoms of trachoma. […] For the laboratory test, the doctor will numb your eye and swab the surface to take a sample. He will then go on to test if trachoma is the cause of the infection. […] Early diagnosis will allow the doctor to treat the disease on time and the patient must be counselled to take the right steps to prevent reinfection.

• #34

  https://www.aao.org/eye-health/diseases/what-is-trachoma

  Trachoma is an eye infection affecting both eyes. It is the worlds leading cause of infectious blindness. A bacterium called Chlamydia trachomatis causes trachoma. According to the World Health Organization (WHO), trachoma has caused the visual impairment of 1.8 million people. Of those people, 450,000 are irreversibly blind. […] Your ophthalmologist can diagnose most cases of conjunctivitis through an eye exam. They may take a sample (culture) if you visited a country where trachoma is common. To do this, they will numb your eye and swab the surface. The laboratory test will show if trachoma is the source of the eye infection. […] In more severe cases of trachoma, an eye exam will reveal: scarring on the inside of the upper eyelid, new blood vessel growth in the cornea, and eyelashes turned inward.

• #35

  https://www.aao.org/eye-health/diseases/what-is-trachoma

  Trachoma is an eye infection affecting both eyes. It is the worlds leading cause of infectious blindness. A bacterium called Chlamydia trachomatis causes trachoma. According to the World Health Organization (WHO), trachoma has caused the visual impairment of 1.8 million people. Of those people, 450,000 are irreversibly blind. […] Your ophthalmologist can diagnose most cases of conjunctivitis through an eye exam. They may take a sample (culture) if you visited a country where trachoma is common. To do this, they will numb your eye and swab the surface. The laboratory test will show if trachoma is the source of the eye infection. […] In more severe cases of trachoma, an eye exam will reveal: scarring on the inside of the upper eyelid, new blood vessel growth in the cornea, and eyelashes turned inward.

• #36 Trachoma – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/trachoma/trachoma+-+including+symptoms%2C+treatment+and+prevention

  Trachoma is a preventable disease of the eyes caused by infection with the bacteria Chlamydia trachomatis (different from the sexually transmitted form of this germ). It causes loss of vision and blindness in older people who have had severe active trachoma, usually since childhood. […] The diagnosis is made by qualified primary health care staff (Aboriginal health workers, nurses and doctors) taking a history and examining the eye. A swab of the eye may be used to help the diagnosis but is not routinely required.

• #37 Trachoma | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-022-00359-5

  Trachoma is diagnosed through clinical examination. This requires a trained examiner, a calm examinee, magnification (generally 2.5 binocular magnifying loupes), and a means for the examiner to prevent iatrogenic transmission of infection from one examinee to the next (alcohol-based hand gel, disposable examination gloves, or soap and water). Diagnosis is often (but not always) done in the field. Illumination is also important; a torch is optimal when looking for TT, whereas bright sunlight is generally adequate for examining the conjunctiva. […] Most individuals with active trachoma have minimal or no symptoms. Some report eye irritation or a small amount of discharge. Individuals with TT often report a history of eye pain, blepharospasm (involuntary closure of both eyelids), light intolerance or reduced vision.

• #38 Trachoma – EyeWiki

  https://eyewiki.org/Trachoma

  Trachoma is a clinical diagnosis based on high suspicion based on the above mentioned clinical findings. […] Some of the available diagnostic tools include: cytologic tests (Giemsa stain or direct fluorescent antibodies), different cell cultures and enzyme immunoassay methods. […] Currently, there is insufficient evidence to support the use of NAATs for national elimination programs. […] Histopathological studies of active inflammatory trachoma are characterized by diffuse mixed inflammatory cell infiltrate of the conjunctiva, mild to moderate epithelial hyperplasia and lymphoid follicles in the stroma; the latter being a clinical and pathological hallmark of trachoma. […] Most individuals are asymptomatic or have mild protean symptoms depending on the level of inflammation. Symptoms, if present, are similar to those seen in any chronic conjunctivitis and include chronic redness, discomfort, tearing, photophobia and mucopurulent discharge and visual loss in the late stages.

• #39 Trachoma – EyeWiki

  https://eyewiki.org/Trachoma

  Trachoma is a clinical diagnosis based on high suspicion based on the above mentioned clinical findings. […] Some of the available diagnostic tools include: cytologic tests (Giemsa stain or direct fluorescent antibodies), different cell cultures and enzyme immunoassay methods. […] Currently, there is insufficient evidence to support the use of NAATs for national elimination programs. […] Histopathological studies of active inflammatory trachoma are characterized by diffuse mixed inflammatory cell infiltrate of the conjunctiva, mild to moderate epithelial hyperplasia and lymphoid follicles in the stroma; the latter being a clinical and pathological hallmark of trachoma. […] Most individuals are asymptomatic or have mild protean symptoms depending on the level of inflammation. Symptoms, if present, are similar to those seen in any chronic conjunctivitis and include chronic redness, discomfort, tearing, photophobia and mucopurulent discharge and visual loss in the late stages.

• #40 Trachoma | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-022-00359-5

  A comprehensive trachoma examination routine is ideal but, in some contexts (in particular, routine surveys conducted by public health programmes to estimate prevalence), not all of its elements are required. The examination should be guided by its purpose and context. […] The comprehensive examination comprises several steps. Visual acuity is measured (for each eye separately) where possible. […] The upper eyelid is everted and the tarsal conjunctiva examined for central follicles, inflammatory thickening due to a papillary response, and scarring. […] Other causes of conjunctival inflammation, conjunctival scarring, trichiasis, entropion and corneal opacity can have clinical signs that resemble those produced by trachoma. […] The interpretation of clinical signs and their classification as being attributable (or not attributable) to trachoma can be influenced by a range of contextual impressions.

• #41 Doyne Lecture: trachoma, is it history? | Eye

  https://www.nature.com/articles/eye2008432

  Trachoma has two major phases: active or inflammatory trachoma with the variable presence of demonstrable infection and cicatricial or late trachoma with tarsal scarring entropion and trichiasis. In late trachoma, inflammation is variable, and Chlamydia is infrequently seen. […] In an endemic area, a well-established case of active trachoma can be very easy to diagnose. Difficulties occur with the differentiation of borderline cases from normal; or sometimes, distinguishing cases of severe inflammatory trachoma from acute bacterial or viral conjunctivitis. The detection of trichiasis only requires careful examination. However, the diagnosis of trachoma in areas of low endemicity can be much more difficult, although severe tarsal scarring, corneal pannus with Herbert’s pits, and upper lid trichiasis are pathonomonic in any setting.

• #42

  https://www.who.int/news-room/fact-sheets/detail/trachoma

  Women are blinded up to 4 times as often as men, probably due to their close contact with infected children and their resulting greater frequency of infection episodes. […] Elimination programmes in endemic countries are being implemented using the WHO-recommended SAFE strategy. […] Data reported to WHO by Member States for 2023 show that 130 746 people with trachomatous trichiasis were provided with corrective surgery in that year, and 32.9 million people in endemic communities were treated with antibiotics to eliminate trachoma. […] WHO adopted the SAFE strategy in 1993. […] The World Health Assembly adopted resolution WHA51.11 in 1998, targeting the global elimination of trachoma as a public health problem with 2020 as the target date.

• #43 What Is Trachoma Disease and How Does It Cause Blindness? | Orbis

  https://www.orbis.org/en/avoidable-blindness/trachoma-trichiasis

  Trachoma is an infectious eye disease and one of the leading causes of blindness globally. If left untreated it can develop into trichiasis – a painful condition where the eyelids turn inwards and the eyelashes rub against the surface of the eye leading to irreversible blindness. […] Trachoma can lead to trachomatous trichiasis in the later stages of the infection. Trachomatous trichiasis can occur when repeated infections of the inner part of the upper eyelid cause the upper eyelid to turn inwards so that eyelashes scrape on the eyeball – resulting in excruciating pain and permanent scarring of the front of the eye (the cornea). If left untreated trachomatous trichiasis will lead to blindness in most cases. […] The recommended global elimination strategy led by the World Health Organization is summarized by the acronym SAFE, which means Surgery for trachomatous trichiasis, Antibiotics to clear active chlamydia trachomatis infection, Facial cleanliness, and Environmental improvement to reduce transmission.

• #44 Trachoma | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/95555

  The prognosis of trachoma is influenced by various factors, including disease stages, comorbidities such as trichiasis and corneal opacities, access to healthcare, and the implementation of therapy and prevention strategies. […] Effective management of trichiasis and cicatricial entropion in trachoma is imperative to prevent visual disability. […] The SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement) recommended by WHO includes surgery for trichiasis, antibiotics, facial hygiene, and environmental improvement measures.

• #45

  https://www.who.int/news-room/fact-sheets/detail/trachoma

  Women are blinded up to 4 times as often as men, probably due to their close contact with infected children and their resulting greater frequency of infection episodes. […] Elimination programmes in endemic countries are being implemented using the WHO-recommended SAFE strategy. […] Data reported to WHO by Member States for 2023 show that 130 746 people with trachomatous trichiasis were provided with corrective surgery in that year, and 32.9 million people in endemic communities were treated with antibiotics to eliminate trachoma. […] WHO adopted the SAFE strategy in 1993. […] The World Health Assembly adopted resolution WHA51.11 in 1998, targeting the global elimination of trachoma as a public health problem with 2020 as the target date.

• #46 Trachoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/trachoma/diagnosis-treatment/drc-20378509

  Your doctor can diagnose trachoma through a physical examination or by sending a sample of bacteria from your eyes to a laboratory for testing. But lab tests aren’t always available in places where trachoma is common. […] The World Health Organization (WHO) recommends giving antibiotics to an entire community when more than 10% of children have been affected by trachoma. The goal of this guideline is to treat anyone who has been exposed to trachoma and reduce the spread of trachoma.

• #47 What Is Trachoma Disease and How Does It Cause Blindness? | Orbis

  https://www.orbis.org/en/avoidable-blindness/trachoma-trichiasis

  In the advanced stages of the disease where the eyelashes grow inward rubbing the cornea, surgery is required. This involves correcting the position of the eyelid to prevent the eyelashes turning inward causing further damage to the cornea and preventing vision loss. […] The antibiotic of choice for treating active trachoma is Azithromycin. For public health intervention in trachoma control and elimination, the dose of Azithromycin is based on measuring the height of patients. […] The World Health Organization recommends giving antibiotics to an entire community when more than 5% of children between 5 and 9 years of age have been affected by trachoma to reduce further spreading.

• #48 The Relationship between Active Trachoma and Ocular Chlamydia trachomatis Infection before and after Mass Antibiotic Treatment | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005080

  Prior to MDA, TF is a good indicator of the community prevalence of C. trachomatis infection. […] Following MDA, the prevalence of TF tends to overestimate the underlying infection prevalence. […] In order to prevent unnecessary additional rounds of MDA and to accurately ascertain when elimination goals have been reached, a cost-effective test for C. trachomatis that can be administered in low-resource settings remains desirable. […] The most recent estimates from the World Health Organization (WHO) Alliance for the Global Elimination of Trachoma by 2020 (GET2020) estimates indicate that about 200 million people live in trachoma endemic areas in 42 countries, 2.2 million have visual impairment or blindness, and about 3.2 million have trichiasis. […] The antibiotic azithromycin is being used in community-wide mass drug administration (MDA); it is given as a single oral dose on an annual basis in endemic districts.

• #49 TRACHOMA- DIAGNOSIS AND MANAGEMENT | PPT

  https://www.slideshare.net/slideshow/trachoma-159368401/159368401

  Trachoma, one of the oldest infectious eye diseases, is the worlds leading cause of preventable blindness. Repeated infections of the conjunctivae with Chlamydia trachomatis can lead to trichiasis, corneal opacity and blindness. An estimated 325 million people live in at-risk areas. Trachoma blinds one person every 15 minutes. […] The antibiotic of choice for treating active trachoma is Azithromycin. Children -20 mg/kg in a single dose. Adults – single dose of 1 g. Also available in eye drops and ointment form. Azithromycin can safely be used in all age groups and does not have the side effects associated with the earlier drug of choice tetracycline. […] Trachoma is an infectious eye disease caused by Chlamydia trachomatis. It is the world’s leading cause of preventable blindness. Repeated infections can cause scarring of the inner eyelid and other complications that can lead to vision loss. The WHO’s SAFE strategy aims to control trachoma through surgery, antibiotics, facial cleanliness, and environmental improvement to reduce transmission. Good hygiene practices like face washing and controlling flies are important for prevention.

• #50 What Is Trachoma Disease and How Does It Cause Blindness? | Orbis

  https://www.orbis.org/en/avoidable-blindness/trachoma-trichiasis

  In the advanced stages of the disease where the eyelashes grow inward rubbing the cornea, surgery is required. This involves correcting the position of the eyelid to prevent the eyelashes turning inward causing further damage to the cornea and preventing vision loss. […] The antibiotic of choice for treating active trachoma is Azithromycin. For public health intervention in trachoma control and elimination, the dose of Azithromycin is based on measuring the height of patients. […] The World Health Organization recommends giving antibiotics to an entire community when more than 5% of children between 5 and 9 years of age have been affected by trachoma to reduce further spreading.

• #51 Trachoma | About Neglected Tropical Diseases and Three Major Infectious Diseases | Eisai Co., Ltd.

  https://www.eisai.com/sustainability/atm/ntds/diseases/trachoma.html

  Trachomas symptoms are divided into two stages: […] Diagnosis and Treatment […] Treatment include drugs and/or surgical operation […] Drug cures include azithromycin and tetracycline eye ointment. […] Since trachoma is highly infectious, antibiotic drugs such as azithromycin are effective. […] Tetracycline eye ointment should be applied directly to the eye twice a day for six weeks. […] Eyelids that have risen up the eyeball can be easily treated with a simple surgical operation.

• #52 Trachoma Elimination: First Year of the Project in Brazil Conducts Surveys with Over 3 thousand People in DSEI Tocantins – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/news/6-5-2024-trachoma-elimination-first-year-project-brazil-conducts-surveys-over-3-thousand

  Sheila Rodovalho, PAHO/WHO Officer for Malaria and Neglected Infectious Diseases, explains that „were conducting surveys to provide a better understanding of the local situation, assessing household residents, especially children, to understand the transmission of the disease.” […] Maria de Ftima Costa Lopes, a technical consultant at the Department of Communicable Diseases of the Secretariat of Health Surveillance and Environment (SVSA), Brazilian Ministry of Health, highlights that the area was chosen because „it presented a history of trachoma cases, in addition to not having participated in the national trachoma prevalence survey for validation of trachoma elimination as a public health problem, conducted in 2018 in non-indigenous areas, and in 2021 in indigenous areas.” […] According to Maria de Ftima Costa Lopes, in addition to the diagnosis of trachoma, the surveys promoted „institutional exchange with intercultural and gender approaches.”

• #53 The Relationship between Active Trachoma and Ocular Chlamydia trachomatis Infection before and after Mass Antibiotic Treatment | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005080

  Decisions around when to initiate and stop MDA are guided by the prevalence of TF in children in endemic communities. […] Therefore, in view of the significance attached to TF for making programmatic decisions, it is important to understand the relationship between active disease and chlamydial infection in endemic communities. […] The relationship between the community-level prevalence of Active Trachoma and the proportion of people with TF who were infected with C. trachomatis (Positive Predictive Value, PPV) showed a positive correlation. […] The relationship between the community-level prevalence of Active Trachoma and the proportion of people without TF who were not infected with C. trachomatis (Negative Predictive Value, NPV) showed a strong negative correlation. […] After the introduction of MDA the relationship between the community prevalence of TF and chlamydial infection is less certain. […] Although the relationship between Active Trachoma and C. trachomatis infection appears to remain strong at the individual level, the population-level data suggests that post-MDA, Active Trachoma has a greater tendency to overestimate the underlying population prevalence of C. trachomatis infection.

• #54 LSHTM LSHTM Research Online

  https://researchonline.lshtm.ac.uk/id/eprint/333/

  BACKGROUND: The clinical signs of active trachoma are often present in the absence of ocular Chlamydia trachomatis infection in low prevalence and mass treated settings. […] We aimed to evaluate the diagnostic accuracy of a prototype point-of-care (POC) test, developed for field diagnosis of ocular C. trachomatis, in low prevalence settings of The Gambia and Senegal. […] The sensitivity of the prototype POC test ranged between 33.3-67.9%, the specificity between 92.4-99.0%, the positive predictive value between 4.3-21.0%, and the negative predictive value between 98.0-99.8%. […] In its present format, this prototype POC test is not suitable for field diagnosis of ocular C. trachomatis as its specificity decreases in hot and dry conditions: the environment in which trachoma is predominantly found. […] In the absence of a suitable test for infection, trachoma diagnosis remains dependent on clinical signs. Under current WHO recommendations, this is likely resulting in the continued mass treatment of non-infected communities.

• #55 Diagnosis and Assessment of Trachoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC523557/

  While culture is a sensitive test for the presence of viable organisms and nucleic acid amplification tests are sensitive and specific tools for the presence of chlamydial nucleic acids, the commercial assays presently available are all too expensive, too complex, or too unreliable for use in national programs. There is an urgent need for a rapid, reliable test for C. trachomatis to assist in measuring progress towards the elimination of trachoma.

• #56 The Relationship between Active Trachoma and Ocular Chlamydia trachomatis Infection before and after Mass Antibiotic Treatment | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005080

  Prior to MDA, TF is a good indicator of the community prevalence of C. trachomatis infection. […] Following MDA, the prevalence of TF tends to overestimate the underlying infection prevalence. […] In order to prevent unnecessary additional rounds of MDA and to accurately ascertain when elimination goals have been reached, a cost-effective test for C. trachomatis that can be administered in low-resource settings remains desirable. […] The most recent estimates from the World Health Organization (WHO) Alliance for the Global Elimination of Trachoma by 2020 (GET2020) estimates indicate that about 200 million people live in trachoma endemic areas in 42 countries, 2.2 million have visual impairment or blindness, and about 3.2 million have trichiasis. […] The antibiotic azithromycin is being used in community-wide mass drug administration (MDA); it is given as a single oral dose on an annual basis in endemic districts.

• #57 Diagnosing trachoma for elimination – Somatosphere

  https://somatosphere.com/2018/diagnosing-trachoma-for-elimination.html/

  Trachoma is diagnosed using clinical signs, using what is known as the World Health Organization (WHO) simplified grading system. […] Trachomatous inflammation-follicular (TF), where there are characteristic off-white follicles of ≥0.5 mm, is the characteristic sign of active trachoma. […] However, the presence of clinical signs of active trachoma (TF and TI) is poorly correlated with detection of infection, especially after MDA where clinical signs tend to over-estimate prevalence relative to infection. […] Studies have shown that tests for infection, including lab-based nucleic acid amplification tests, can be cost-effective, especially when their use results in stopping or not initiating MDA. […] There therefore remains a need for a fit-for-purpose (“ASSURED”) diagnostic test that can be conducted in-country after minimal training, in order to provide community level prevalence estimates to guide elimination efforts.

• #58 Trachoma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/trachoma/symptoms-causes/syc-20378505

  Trachoma is a bacterial infection that affects your eyes. […] Early treatment may help prevent trachoma complications. […] Call your doctor if you or your child has itchy or irritated eyes or discharge from the eyes, especially if you live in or recently traveled to an area where trachoma is common. […] One episode of trachoma caused by Chlamydia trachomatis is easily treated with early detection and use of antibiotics. […] If you’ve been treated for trachoma with antibiotics or surgery, reinfection is always a concern. […] The WHO has developed a strategy to prevent trachoma, with the goal of eliminating it by 2020.

• #59 Trachoma Eye Causes, Stages, Types, Transmission & Diagnosis

  https://www.medicinenet.com/trachoma/article.htm

  Trachoma is the leading infectious cause of blindness in the world. […] How do doctors diagnose trachoma? […] Although there are tests to identify the bacteria, doctors primarily diagnose trachoma by examining the eyes and eyelids of the patient. […] Community-based implementation of the SAFE strategy improved the prognosis for millions of at-risk individuals. If a doctor diagnoses trachoma and treats it early, before scarring of the eyelids and cornea, the prognosis for the preservation of vision is excellent.

• #60 Trachoma Eye Causes, Stages, Types, Transmission & Diagnosis

  https://www.medicinenet.com/trachoma/article.htm

  Trachoma is the leading infectious cause of blindness in the world. […] How do doctors diagnose trachoma? […] Although there are tests to identify the bacteria, doctors primarily diagnose trachoma by examining the eyes and eyelids of the patient. […] Community-based implementation of the SAFE strategy improved the prognosis for millions of at-risk individuals. If a doctor diagnoses trachoma and treats it early, before scarring of the eyelids and cornea, the prognosis for the preservation of vision is excellent.

• #61 Trachoma: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/25148-trachoma

  Trachoma is an eye disease caused by a bacterium called Chlamydia trachomatis. The infection can cause irreversible blindness. […] An eye doctor will take a medical history and ask you questions. Theyll want to know if youve been in areas where trachoma is present. Your provider will do an eye exam. In addition, they may take a sample of any fluid by numbing your eye and swabbing it. They can send this to a lab to find out if the source of infection is Chlamydia trachomatis. […] In early stages, your provider can treat and cure trachoma by giving you antibiotics. The two drugs recommended for trachoma are azithromycin and an ointment made with tetracycline. […] If trachoma isnt treated, you wont be able to reverse the blindness that occurs.

• #62 Diagnosis and Assessment of Trachoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC523557/

  Trachoma is caused by Chlamydia trachomatis. Clinical grading with the WHO simplified system can be highly repeatable provided graders are adequately trained and standardized. […] At the community level, rapid assessments are useful for confirming the absence of trachoma but do not determine the magnitude of the problem in communities where trachoma is present. New rapid assessment protocols incorporating techniques for obtaining representative population samples (without census preparation) may give better estimates of the prevalence of clinical trachoma. Clinical findings do not necessarily indicate the presence or absence of C. trachomatis infection, particularly as disease prevalence falls. The prevalence of ocular C. trachomatis infection (at the community level) is important because it is infection that is targeted when antibiotics are distributed in trachoma control campaigns. Methods to estimate infection prevalence are required.

• #63 The Relationship between Active Trachoma and Ocular Chlamydia trachomatis Infection before and after Mass Antibiotic Treatment | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005080

  Trachoma is a blinding disease, initiated in early childhood by repeated conjunctival infection with the obligate intracellular bacterium Chlamydia trachomatis. […] The population prevalence of the clinical signs of active trachoma; follicular conjunctivitis (TF) and/or intense papillary inflammation (TI), guide programmatic decisions regarding the initiation and cessation of mass drug administration (MDA). […] However, the persistence of TF following resolution of infection at both the individual and population level raises concerns over the suitability of this clinical sign as a marker for C. trachomatis infection. […] We systematically reviewed the literature for population-based studies and those including randomly selected individuals, which reported the prevalence of the clinical signs of active trachoma and ocular C. trachomatis infection by nucleic acid amplification test.

• #64 Diagnosis and Assessment of Trachoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC523557/

  Trachoma is caused by Chlamydia trachomatis. Clinical grading with the WHO simplified system can be highly repeatable provided graders are adequately trained and standardized. […] At the community level, rapid assessments are useful for confirming the absence of trachoma but do not determine the magnitude of the problem in communities where trachoma is present. New rapid assessment protocols incorporating techniques for obtaining representative population samples (without census preparation) may give better estimates of the prevalence of clinical trachoma. Clinical findings do not necessarily indicate the presence or absence of C. trachomatis infection, particularly as disease prevalence falls. The prevalence of ocular C. trachomatis infection (at the community level) is important because it is infection that is targeted when antibiotics are distributed in trachoma control campaigns. Methods to estimate infection prevalence are required.

• #65 Trachoma | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-022-00359-5

  To help maximize the objectivity of assessment, particularly for estimates of trachoma prevalence at the population level, WHO developed trachoma grading systems that have subsequently evolved over decades. […] The simplified WHO grading system includes acknowledged imperfections. […] Since 2012, standardization of grader training, grader certification and fieldwork procedures have further contributed to comparability and confidence in trachoma prevalence data generated by national programmes.

• #66 Diagnosis and Assessment of Trachoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC523557/

  Trachoma is caused by Chlamydia trachomatis. Clinical grading with the WHO simplified system can be highly repeatable provided graders are adequately trained and standardized. […] At the community level, rapid assessments are useful for confirming the absence of trachoma but do not determine the magnitude of the problem in communities where trachoma is present. New rapid assessment protocols incorporating techniques for obtaining representative population samples (without census preparation) may give better estimates of the prevalence of clinical trachoma. Clinical findings do not necessarily indicate the presence or absence of C. trachomatis infection, particularly as disease prevalence falls. The prevalence of ocular C. trachomatis infection (at the community level) is important because it is infection that is targeted when antibiotics are distributed in trachoma control campaigns. Methods to estimate infection prevalence are required.

• #67 Trachoma – UpToDate

  https://www.uptodate.com/contents/trachoma

  Trachoma is the leading infectious cause of blindness worldwide. It is a chronic keratoconjunctivitis caused by recurrent infection with Chlamydia trachomatis (a small, gram-negative obligate intracellular bacterium); humans are the only hosts. Trachoma is caused almost exclusively by C. trachomatis serotypes A, B, Ba, and C; genital infection is caused by serotypes D through K. […] The prevalence of active disease (characterized by follicles and/or severe inflammation of the upper tarsal conjunctiva) is highest in young children and declines to low levels in adulthood. In endemic areas, it is common to be infected at least once (and often more than once) in childhood. […] A subgroup of children may have persistent, severe infection; these individuals are at risk for developing cicatricial (scarring) disease as older children and adults. […] In 2023, an estimated 116 million people lived in districts in which the prevalence of active trachoma (trachomatous inflammation—follicular, TF) was ≥5 percent, and 1.5 million required surgery for trichiasis.

• #68

  https://www.who.int/news-room/fact-sheets/detail/trachoma

  Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis. […] Trachoma is the leading infectious cause of blindness worldwide. […] The infection is transmitted by direct or indirect transfer of eye and nose discharges of infected people, particularly young children who harbour the principal reservoir of infection. […] After years of repeated infection, the inside of the eyelid can become so severely scarred (trachomatous conjunctival scarring) that it turns inwards and causes the eyelashes to rub against the eyeball (trachomatous trichiasis), resulting in constant pain and light intolerance. […] Left untreated, this condition leads to the formation of irreversible opacities, with resulting visual impairment or blindness. […] The age at which this occurs depends on several factors including local transmission intensity.

• #69

  https://www.who.int/news-room/fact-sheets/detail/trachoma

  Women are blinded up to 4 times as often as men, probably due to their close contact with infected children and their resulting greater frequency of infection episodes. […] Elimination programmes in endemic countries are being implemented using the WHO-recommended SAFE strategy. […] Data reported to WHO by Member States for 2023 show that 130 746 people with trachomatous trichiasis were provided with corrective surgery in that year, and 32.9 million people in endemic communities were treated with antibiotics to eliminate trachoma. […] WHO adopted the SAFE strategy in 1993. […] The World Health Assembly adopted resolution WHA51.11 in 1998, targeting the global elimination of trachoma as a public health problem with 2020 as the target date.

• #70 Severity of Trachomatous Scarring among Adults in Trachoma-Endemic Amhara Region of Ethiopia in: The American Journal of Tropical Medicine and Hygiene Volume 111 Issue 3_Suppl (2024)

  https://www.ajtmh.org/view/journals/tpmd/111/3_Suppl/article-p121.xml

  Trachomatous scarring and its progression to trichiasis may prove a barrier to meeting WHO timelines for trachoma elimination and will necessitate ongoing surveillance and interventions after elimination thresholds have been met. […] The severity and baseline presence of scarring are strongly associated with the risk of trachomatous trichiasis (TT) development. […] A total of 421 (59.1%) of 712 individuals with a scarring grade had some degree of scarring (S1-S4). […] Scarring at every stage (S1-S4) was observed among even the youngest age group (15-19 years old). […] Among older adults (60 years and older), 70.5% (95% CI: 61.9, 78.1) had some stage of scarring. […] Individuals ages 60 years and older also experienced the greatest burden of severe scarring (S4 prevalence: 32.6%; 95% CI: 24.7, 41.3) compared with the lowest burden among individuals ages 15-19 years (6.2%; 95% CI: 2.0, 13.8).

• #71 Severity of Trachomatous Scarring among Adults in Trachoma-Endemic Amhara Region of Ethiopia in: The American Journal of Tropical Medicine and Hygiene Volume 111 Issue 3_Suppl (2024)

  https://www.ajtmh.org/view/journals/tpmd/111/3_Suppl/article-p121.xml

  Trachomatous scarring has been shown to progress regardless of active ocular Chlamydia trachomatis infection, indicating that scarring drivers may be unrelated to ongoing transmission. […] This study identified and assessed risk factors associated with scarring magnitude in a trachoma-endemic setting, utilizing a five-point photographic scale (S0S4). […] Among those with scarring, most cases (20.4%) were severe (S4, comprising more than 90% of the tarsal conjunctiva) compared with the prevalence of moderate S3-A/B (11.2%), S2 (8.3%), and mild S1 (19.2%). […] Older participants (60 years and older) experienced a greater burden of severe scarring (S4 prevalence: 32.6%) than their younger (15-19 years) counterparts (6.2%). […] Multivariate ordinal logistic regression models indicated female sex, increasing age, and district-level trachomatous follicular inflammation prevalence were significant predictors of scarring severity.

• #72 Severity of Trachomatous Scarring among Adults in Trachoma-Endemic Amhara Region of Ethiopia in: The American Journal of Tropical Medicine and Hygiene Volume 111 Issue 3_Suppl (2024)

  https://www.ajtmh.org/view/journals/tpmd/111/3_Suppl/article-p121.xml

  Trachomatous scarring and its progression to trichiasis may prove a barrier to meeting WHO timelines for trachoma elimination and will necessitate ongoing surveillance and interventions after elimination thresholds have been met. […] The severity and baseline presence of scarring are strongly associated with the risk of trachomatous trichiasis (TT) development. […] A total of 421 (59.1%) of 712 individuals with a scarring grade had some degree of scarring (S1-S4). […] Scarring at every stage (S1-S4) was observed among even the youngest age group (15-19 years old). […] Among older adults (60 years and older), 70.5% (95% CI: 61.9, 78.1) had some stage of scarring. […] Individuals ages 60 years and older also experienced the greatest burden of severe scarring (S4 prevalence: 32.6%; 95% CI: 24.7, 41.3) compared with the lowest burden among individuals ages 15-19 years (6.2%; 95% CI: 2.0, 13.8).

• #73 Severity of Trachomatous Scarring among Adults in Trachoma-Endemic Amhara Region of Ethiopia in: The American Journal of Tropical Medicine and Hygiene Volume 111 Issue 3_Suppl (2024)

  https://www.ajtmh.org/view/journals/tpmd/111/3_Suppl/article-p121.xml

  A strong association was observed between female sex and scarring severity, which remained after controlling for age and district-level TF prevalence. […] The results from this study demonstrate that these districts in Amhara have a considerable population at risk for TT incidence, particularly among women and older age groups.

• #74 Severity of Trachomatous Scarring among Adults in Trachoma-Endemic Amhara Region of Ethiopia in: The American Journal of Tropical Medicine and Hygiene Volume 111 Issue 3_Suppl (2024)

  https://www.ajtmh.org/view/journals/tpmd/111/3_Suppl/article-p121.xml

  A strong association was observed between female sex and scarring severity, which remained after controlling for age and district-level TF prevalence. […] The results from this study demonstrate that these districts in Amhara have a considerable population at risk for TT incidence, particularly among women and older age groups.

• #75 Trachoma – Eye Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/eye-disorders/conjunctival-and-scleral-disorders/trachoma

  Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis and is characterized by progressive exacerbations and remissions. […] Diagnosis is usually clinical. […] Diagnosis of trachoma is usually clinical because testing is rarely available in endemic areas. Lymphoid follicles on the tarsal plate or along the corneal limbus, linear conjunctival scarring, and corneal pannus are considered diagnostic in the appropriate clinical setting. […] C. trachomatis can be isolated in culture or identified by nucleic acid amplification tests (NAAT) and immunofluorescence techniques, and testing should be done when it is readily available to confirm diagnosis and prevent disease progression in cases of diagnostic uncertainty. […] Diagnosis is usually clinical, but standard methods to detect chlamydia can be done when available.

• #76

  https://www.who.int/teams/control-of-neglected-tropical-diseases/trachoma/diagnosis

  In areas where trachoma is endemic, active (inflammatory) trachoma is common among preschool-aged children, with prevalence rates which can be as high as 60-90%. Infection becomes less frequent and shorter in duration with increasing age. […] Trachoma disease is usually clinically diagnosed. People are examined for clinical signs through the use of magnifiers (loupes). In most early stages, infection does not present visible signs of the disease. However, repeated infections cause scarring of the conjunctiva and it is during this phase that infected individuals get the feeling of irritation. […] The WHO grading system for trachoma classifies the disease in 5 grades: Trachomatous Inflammation Follicular (TF) – which mostly requires topical treatment. Trachomatous Inflammation Intense (TI) – during which topical and systemic treatments are considered. Trachomatous Scarring (TS) – when scars are visible as in the tarsal conjunctiva and which may obscure tarsal blood vessels. Trachomatous Trichiasis (TT) – when an individual is referred for eyelid surgery; and Corneal Opacity – a stage during which a person is irreversibly blind.

• #77 The Relationship between Active Trachoma and Ocular Chlamydia trachomatis Infection before and after Mass Antibiotic Treatment | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005080

  Prior to MDA, TF is a good indicator of the community prevalence of C. trachomatis infection. […] Following MDA, the prevalence of TF tends to overestimate the underlying infection prevalence. […] In order to prevent unnecessary additional rounds of MDA and to accurately ascertain when elimination goals have been reached, a cost-effective test for C. trachomatis that can be administered in low-resource settings remains desirable. […] The most recent estimates from the World Health Organization (WHO) Alliance for the Global Elimination of Trachoma by 2020 (GET2020) estimates indicate that about 200 million people live in trachoma endemic areas in 42 countries, 2.2 million have visual impairment or blindness, and about 3.2 million have trichiasis. […] The antibiotic azithromycin is being used in community-wide mass drug administration (MDA); it is given as a single oral dose on an annual basis in endemic districts.

• #78 Diagnosing trachoma for elimination – Somatosphere

  https://somatosphere.com/2018/diagnosing-trachoma-for-elimination.html/

  Trachoma is diagnosed using clinical signs, using what is known as the World Health Organization (WHO) simplified grading system. […] Trachomatous inflammation-follicular (TF), where there are characteristic off-white follicles of ≥0.5 mm, is the characteristic sign of active trachoma. […] However, the presence of clinical signs of active trachoma (TF and TI) is poorly correlated with detection of infection, especially after MDA where clinical signs tend to over-estimate prevalence relative to infection. […] Studies have shown that tests for infection, including lab-based nucleic acid amplification tests, can be cost-effective, especially when their use results in stopping or not initiating MDA. […] There therefore remains a need for a fit-for-purpose (“ASSURED”) diagnostic test that can be conducted in-country after minimal training, in order to provide community level prevalence estimates to guide elimination efforts.

• #79 What Is Trachoma Disease and How Does It Cause Blindness? | Orbis

  https://www.orbis.org/en/avoidable-blindness/trachoma-trichiasis

  Trachoma is an infectious eye disease and one of the leading causes of blindness globally. If left untreated it can develop into trichiasis – a painful condition where the eyelids turn inwards and the eyelashes rub against the surface of the eye leading to irreversible blindness. […] Trachoma can lead to trachomatous trichiasis in the later stages of the infection. Trachomatous trichiasis can occur when repeated infections of the inner part of the upper eyelid cause the upper eyelid to turn inwards so that eyelashes scrape on the eyeball – resulting in excruciating pain and permanent scarring of the front of the eye (the cornea). If left untreated trachomatous trichiasis will lead to blindness in most cases. […] The recommended global elimination strategy led by the World Health Organization is summarized by the acronym SAFE, which means Surgery for trachomatous trichiasis, Antibiotics to clear active chlamydia trachomatis infection, Facial cleanliness, and Environmental improvement to reduce transmission.

• #80 Trachoma | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/95555

  The prognosis of trachoma is influenced by various factors, including disease stages, comorbidities such as trichiasis and corneal opacities, access to healthcare, and the implementation of therapy and prevention strategies. […] Effective management of trichiasis and cicatricial entropion in trachoma is imperative to prevent visual disability. […] The SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement) recommended by WHO includes surgery for trichiasis, antibiotics, facial hygiene, and environmental improvement measures.

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