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Follicular conjunctivitis caused by Chlamydia trachomatis in an infant Saharan population: molecular and clinical
Insights
Acute trachoma is less common in Saharan refugee infants than expected, with scarring more prevalent. A single azithromycin dose effectively treats chlamydial conjunctivitis, but improved hygiene is crucial for prevention.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Public Health
Background:
- Trachoma is a leading cause of preventable blindness globally.
- Infant trachoma prevalence in Saharan refugee camps was previously considered high.
- Assessing current prevalence and treatment efficacy is vital for targeted interventions.
Purpose of the Study:
- To determine the prevalence of acute trachoma in infants in Tindouf refugee camps.
- To evaluate the effectiveness of a single azithromycin dose for treating chlamydial conjunctivitis.
Main Methods:
- Clinical and microbiological examination of 527 children (3-17 years).
- Conjunctival swabs analyzed using immunoassay and PCR for Chlamydia trachomatis.
- Azithromycin administered as a single dose, followed by repeat PCR testing.
Main Results:
- Acute trachoma prevalence was low (2.27% by PCR).
- Scarring trachoma was more frequent (11.7%).
- Single-dose azithromycin effectively cleared chlamydial DNA in most treated children.
Conclusions:
- Acute trachoma prevalence is lower than anticipated, possibly due to improved hygiene.
- Cicatricial (scarring) trachoma is more common.
- Azithromycin is effective, but ongoing hygiene and healthcare programs are essential for preventing reinfection.
Aims:
To ascertain the prevalence of acute trachoma as a supposed endemic disease among infants in the Saharan refugee camps of Tindouf (Algeria) and to evaluate the efficacy of treatment with a single dose of azithromycin.
Methods:
527 children aged between 3 and 17 were evaluated in the camp schools in October 2001. All the children were clinically and microbiologically examined, including slit lamp checks of anterior segment and two conjunctival swabs, one for the detection of membrane lipopolysaccharide by quick immunoassay test Clearview Chlamydia MF and the other for the detection of specific DNA by chlamydia plasmid specific polymerase chain reaction (PCR) assay. After examination, a single dose of azithromycin was administered to each child. One month later samples from positive children and 12 random negative children by the first PCR were taken to perform a new PCR assay.
Results:
Chlamydia trachomatis was suspected in 2.47% of the children, papillary hypertrophy being the most frequently seen clinical sign. Scarring changes secondary to trachoma were detected in 11.7% of the children. Only four cases (0.8%) were positive to the immunoassay test and 12 cases (2.27%) were positive by PCR. After treatment a second PCR was performed on positive children and they were negative of chlamydia DNA amplification. However, one child who was negative and received the treatment was positive in the second PCR assay.
Conclusion:
Acute trachoma prevalence is much lower than expected among infants in this Saharan population. The possible reasons could be the recent improvements in hygiene and health care. Cicatricial trachoma is more frequent. The Clearview immunoassay test has very low sensitivity in the detection of this disease. A single dose of azithromycin is sufficient to treat chlamydial conjunctivitis. However, a programme of improvement in hygiene and health care is necessary to prevent re-infection.