Trachoma: an update on prevention, diagnosis, and treatment

Abstract

Purpose of review: To review recent clinical and epidemiological studies regarding the prevention, diagnosis, and treatment of trachoma.

Recent findings: Newer studies propose novel diagnostic tests that appear sensitive for the detection of ocular chlamydial infection. For example, recent studies with ribosomal RNA-based nucleic acid amplification tests (NAATs) have demonstrated improved sensitivities compared to DNA-based NAATs; and the progression of scarring has now been characterized with confocal microscopy. Immunologic studies have further explored the etiology of clinical sequelae, suggesting that chronic inflammation can lead to progressive scarring even in the absence of Chlamydia. Mass oral azithromycin distributions remain a mainstay of treatment; studies have assessed the appropriate frequency and duration of treatment programs. Current studies have also explored ancillary effects of azithromycin distribution on mortality and bacterial infections.

Summary: Trachoma programs have had remarkable success at reducing chlamydial infection and clinical signs of trachoma. Recent work suggests improved methods to monitor infection and scarring, and better ways to distribute treatment. Whereas studies continue to demonstrate reduction in infection in hyperendemic areas, more work is necessary to achieve elimination of this blinding disease.

Figure 1

Clinical features of Trachoma Based on the WHO clinical grading scheme⁹ a) Follicular Trachoma (FT) with follicles > 0.5mm b) Active trachoma characterized by TF and intense trachoma c) Tarsal congunctival scarring (trachomatous scarring, TS) d) Corneal opacification (CO) over the pupil with trachomatous trichiasis