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Trachoma

Disease Details

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Description: Trachoma is a bacterial infection caused by Chlamydia trachomatis that affects the eyes and can result in blindness if left untreated.
Type: Trachoma is an infectious eye disease caused by the bacterium Chlamydia trachomatis. It is not a genetic disorder and therefore does not have a type of genetic transmission. It is primarily spread through direct contact with eye discharge from an infected person or through contact with contaminated items such as towels or flies that have come into contact with the eyes or nose of an infected person.
Signs And Symptoms: The bacterium has an incubation period of 5 to 10 days, after which the affected individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye". Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva. Without reinfection, the inflammation gradually subsides.The conjunctival inflammation is called "active trachoma" and is usually seen in children, especially those in preschool. It is characterized by white lumps in the undersurface of the upper eyelid (conjunctival follicles or lymphoid germinal centres) and by nonspecific inflammation and thickening, often associated with papillae. Follicles may also appear at the junction of the cornea and the sclera (limbal follicles). Active trachoma can often be irritating and have a watery discharge. Bacterial secondary infection may occur and cause a discharge of pus.The later structural changes of trachoma are referred to as "cicatricial trachoma". These include scarring under the eyelid (tarsal conjunctiva) that leads to distortion of the eyelid with buckling of the lid (tarsus) so the lashes rub against the eye (trichiasis). This can lead to corneal opacities and scarring and then to blindness. Linear scars present in the sulcus subtarsalis are called Arlt's lines (named after Carl Ferdinand von Arlt). In addition, blood vessels and scar tissue can invade the upper cornea (pannus). Resolved limbal follicles may leave small gaps in the pannus (Herbert's pits).Most commonly, children with active trachoma do not present with symptoms, as the low-grade irritation and ocular discharge is just accepted as normal, but further symptoms may include:
Eye discharge
Swollen eyelids
Trichiasis (misaligned eyelashes)
Swelling of lymph nodes in front of the ears
Sensitivity to bright lights
Increased heart rate
Further ear, nose, and throat complications.The most important complication to look out for is a corneal ulcer, which is caused by intense rubbing of the affected eye, or trichiasis with a superimposed bacterial infection.
Prognosis: If not treated properly with oral antibiotics, the symptoms may escalate and cause blindness, which is the result of ulceration and consequent scarring of the cornea. Surgery may also be necessary to fix eyelid deformities.
Without intervention, trachoma keeps families in a cycle of poverty, as the disease and its long-term effects are passed from one generation to the next.
Onset: Trachoma typically has an onset of symptoms within 5 to 12 days after initial exposure to the causative bacterium, Chlamydia trachomatis. Early symptoms may include mild itching and irritation of the eyes and eyelids. If left untreated, the infection can lead to chronic conjunctivitis, scarring, and eventually blindness.
Prevalence: The global prevalence of trachoma has significantly decreased over the years due to public health interventions, but it remains a public health concern in certain regions. As of recent estimates, trachoma is still endemic in 44 countries, primarily in Africa, Asia, Central and South America, and the Middle East. Approximately 137 million people live in areas where trachoma is a public health problem, and around 1.9 million people are blind or visually impaired due to the disease.
Epidemiology: As of 2011, about 21 million people are actively affected by trachoma, with around 2.2 million people being permanently blind or have severe visual impairment from trachoma. An additional 7.3 million people are reported to have trichiasis. As of June 2022, 125 million individuals live in trachoma endemic areas and are at risk of trachoma-related blindness, and the disease is a public health problem in 42 countries. Of these, Africa is considered the worst affected area, with over 85% of all known active cases of trachoma. Within the continent, South Sudan and Ethiopia have the highest prevalence. In many of these communities, women are three times more likely than men to be blinded by the disease, likely due to their roles as caregivers in the family. Australia is the only developed country that has trachoma. In 2008, trachoma was found in half of Australia's very remote communities.
Intractability: Trachoma is not considered intractable. It is a preventable and treatable infectious eye disease caused by the bacterium Chlamydia trachomatis. Effective interventions include improved sanitation, access to clean water, facial cleanliness, and antibiotics to reduce infection. In advanced cases, surgery can be performed to correct eyelid deformities caused by the disease. Programs focusing on the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement) have been successful in reducing the prevalence of trachoma in many areas.
Disease Severity: Trachoma is a serious infectious disease that primarily affects the eyes and can lead to blindness if untreated. The severity ranges from mild inflammation of the conjunctiva to severe scarring and deformation of the eyelids, which can cause the eyelashes to turn inward and scrape the cornea. This condition is the leading infectious cause of blindness worldwide.
Healthcare Professionals: Disease Ontology ID - DOID:11265
Pathophysiology: Trachoma is a chronic infectious disease caused by the bacterium *Chlamydia trachomatis*. It is the leading infectious cause of blindness worldwide. The pathophysiology of trachoma involves several stages:

1. **Initial Infection:**
- *Chlamydia trachomatis* infects the conjunctival epithelium of the eye.
- The initial infection often presents as a mild, follicular conjunctivitis.

2. **Inflammation:**
- Recurrent infections or chronic inflammation cause a pronounced immune response.
- Follicles (small bumps) form on the conjunctiva, leading to follicular conjunctivitis.
- Inflammation can spread to the cornea (pannus formation), further damaging eye tissues.

3. **Scarring:**
- Persistent inflammation leads to scarring of the conjunctiva (cicatricial trachoma).
- Scarred conjunctiva can contract, causing distortion of the eyelids (entropion) and eyelashes turning inward (trichiasis).

4. **Corneal Damage and Blindness:**
- Inward-turned eyelashes scratch the cornea (corneal abrasion) leading to corneal opacity.
- Progressive corneal damage can significantly impair vision and eventually cause blindness.

Effective sanitation, facial cleanliness, and antibiotic treatment (such as azithromycin) are critical for preventing and controlling trachoma. In advanced cases, surgical interventions may be necessary to correct eyelid deformities and prevent further corneal damage.
Carrier Status: Trachoma is an infectious disease caused by the bacterium Chlamydia trachomatis. Carrier status typically refers to individuals who harbor the bacterium without showing symptoms, contributing to its spread. Trachoma is common in areas with poor sanitation and limited access to clean water. Individuals who carry the bacterium can still transmit it through direct contact with their eyes or nasal discharge, or indirectly through shared items like towels.

As for your query labeled "nan," if it refers to nutritional aspects, proper nutrition alone doesn't prevent trachoma, but general health and immune function can benefit from a balanced diet. Access to clean water and improved hygiene practices are critical for preventing the transmission of trachoma.
Mechanism: Trachoma is a bacterial eye infection caused by Chlamydia trachomatis.

**Mechanism:**
1. **Infection and Transmission**: The infection spreads through direct contact with eye, nose, or throat secretions from infected individuals, or indirectly via contaminated fomites like towels or flies serving as mechanical vectors.
2. **Initial Symptoms**: The infection typically begins in childhood with inflammation of the conjunctiva (conjunctivitis), leading to discomfort and eye discharge.
3. **Chronic Infection and Scarring**: Repeated infections result in chronic inflammation, which can cause scar tissue to form on the inner eyelids (entropion). Over time, the scar tissue leads to the eyelashes turning inward (trichiasis), scratching the cornea and potentially leading to vision loss or blindness.

**Molecular Mechanisms:**
1. **Bacterial Invasion**: Chlamydia trachomatis has a biphasic life cycle that includes an infectious elementary body (EB) and a replicative reticulate body (RB). The EBs attach and enter the conjunctival epithelial cells via receptor-mediated endocytosis.
2. **Intracellular Lifecycle**: Once inside the host cell, EBs convert to RBs, which replicate within a membrane-bound vacuole known as an inclusion. This process evades the host's immune response.
3. **Host Immune Response**: The repeated infection triggers an immune response involving the release of pro-inflammatory cytokines and infiltration of immune cells like neutrophils and macrophages, leading to chronic inflammation.
4. **Fibrosis and Scarring**: Persistent immune response and chronic inflammation stimulate fibroblast activation and extracellular matrix deposition, driving the scarring process in the conjunctiva.
5. **Aberrant Immune Signaling**: Molecular studies indicate that Chlamydia trachomatis may manipulate host cell signaling pathways, including the inhibition of apoptosis and modulation of antigen-presenting functions, to sustain its intracellular environment and promote chronic infection.

Understanding these mechanisms highlights the complexity of trachoma and the importance of targeting both the infection and the resulting immune pathology for effective treatment and prevention.
Treatment: Treatment for trachoma includes the SAFE strategy:
- **Surgery**: To correct advanced stages causing eyelid deformities.
- **Antibiotics**: Typically azithromycin to treat active infection.
- **Facial cleanliness**: To reduce transmission.
- **Environmental improvements**: To enhance sanitation and access to clean water.

Accessibility to proper hygiene and sanitation is also crucial in preventing the spread of the infection.
Compassionate Use Treatment: Compassionate use treatment for trachoma is generally not a standard practice since the disease is predominantly managed using established treatments. Trachoma is primarily addressed with azithromycin as part of the SAFE strategy (Surgery for trichiasis, Antibiotics, Facial cleanliness, and Environmental improvement) endorsed by the World Health Organization (WHO).

Regarding off-label or experimental treatments, these are not commonly employed for trachoma due to the effectiveness of the existing treatments. However, new research and clinical trials may investigate adjunct therapies or novel antibiotics, but these are not yet standard or widely recommended practices.
Lifestyle Recommendations: For trachoma, lifestyle recommendations to manage and prevent the disease include:

1. **Proper Hygiene**: Regular face washing with clean water to remove discharge from the eyes and nose. This helps reduce the spread of the bacteria.

2. **Sanitation Improvement**: Ensure access to clean water and improve sanitation facilities to reduce the risk of infection.

3. **Reduce Fly Contact**: Implementing measures to reduce fly populations, such as waste management and using insecticides, as flies can transmit the bacteria.

4. **Avoid Shared Towels**: Do not share facial towels or cloths, as the bacteria can be spread through contaminated materials.

5. **Educate the Community**: Raise awareness about the importance of facial cleanliness and environmental improvements.

6. **Prompt Treatment**: Seek prompt medical treatment if symptoms of eye infection appear. Antibiotics can treat early stages of trachoma effectively.

7. **Vaccination**: While there is no vaccine for trachoma, staying up-to-date with other vaccines and maintaining general health can help reduce the risk of infections.

Adopting these lifestyle changes can significantly reduce the incidence and impact of trachoma.
Medication: Trachoma, a bacterial eye infection caused by Chlamydia trachomatis, is primarily treated with antibiotics. The World Health Organization recommends azithromycin as the preferred treatment, often administered as a single oral dose. Alternatively, tetracycline eye ointment can be applied topically twice a day for six weeks. These treatments aim to eliminate the infection and prevent long-term complications such as blindness.
Repurposable Drugs: There are no specifically identified drugs currently repurposable for trachoma. Trachoma is primarily treated through the SAFE strategy endorsed by the World Health Organization (WHO), which includes Surgery for advanced cases, Antibiotics to clear infection (typically azithromycin), Facial cleanliness, and Environmental improvements to reduce disease transmission. If you have more specific inquiries or need detailed information, consulting specialized medical literature or a healthcare professional is recommended.
Metabolites: Trachoma is a bacterial infection caused by Chlamydia trachomatis, and specific metabolites directly linked to trachoma are not well-characterized in the literature. Therefore, no relevant information on metabolites is available for trachoma in typical clinical resources.
Nutraceuticals: There is limited evidence supporting the use of nutraceuticals in the treatment or prevention of trachoma. The primary strategy to combat trachoma involves a comprehensive public health approach known as the SAFE strategy: Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement to reduce transmission. Nutraceuticals are not a standard part of this approach.
Peptides: Trachoma is a bacterial infection caused by Chlamydia trachomatis, which affects the eyes and can lead to blindness if untreated. There is limited specific information linking peptides or nanotechnology directly to current standard treatments for trachoma. However, research in these areas is ongoing, and future therapies might involve innovative applications of peptides for antimicrobial purposes or nanotechnology for targeted drug delivery and improved diagnostics.