Infection is associated with inflammatory changes in the conjunctiva known as “active trachoma”. An individual’s immune system can clear a single episode of infection, but in endemic communities, re-acquisition of the organism occurs frequently.
After years of repeated episodes of active trachoma, 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; this and other alterations of the eye can lead to scarring of the cornea. 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. In very highly endemic communities, it can occur in childhood, though onset of visual impairment between the ages of 30 and 40 years is more typical.
Women are blinded up to four times as often as men, probably due to more frequent contact with infected children.
Individuals living in the poorest and most remote communities of Africa, Asia, Australia, the Middle East, Central and South America and the Pacific Islands are at risk.
Trachoma
Trachoma is a disease of the eye and the leading infectious cause of blindness worldwide. It is caused by an obligate intracellular bacterium called Chlamydia trachomatis. Infection is transmitted among people by direct or indirect transfer of ocular and nasal discharges of infected people; indirect transfer includes carriage on the body of particular species of flies. Preschool-age children harbour the principal reservoir of infection. Models suggest that an individual requires more than 150 lifetime infections to develop the blinding complications of trachoma.
Trachoma is endemic to some of the world’s poorest and most rural areas. Africa is the most effected continent, but it also has the most effective control efforts. The disease is also found in Central and South America, Asia, Australia, and the Middle East. As of 2 January 2020, 13 countries had reported achieving elimination goals. In 2018 alone, 146 112 people received surgical treatment for advanced trachoma and 89.1 million were treated with antibiotics. Despite these successes, the disease remains a serious public health concern. It is estimated that trachoma and trichiasis cause up to US$ 8 billion annually due to lost productivity from blindness and visual impairment.
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