Progression of scarring trachoma in Tanzanian children: A four-year cohort study
Progression of scarring trachoma in Tanzanian children: A four-year cohort study
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DOI：
10.1371/journal.pntd.0007638
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发表时间：
2019-08-01
影响因子：
3.8
通讯作者：
Burton, Matthew J.
中科院分区：
文献类型：
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作者：
Ramadhani, Athumani M.;Derrick, Tamsyn;Burton, Matthew J.
背景沙眼是一种进行性致盲性疾病，由沙眼衣原体感染结膜引起。反复感染被认为会引起慢性炎症，从而导致疤痕形成，导致眼睑内翻。由于缺乏频繁随访的感染数据的纵向研究，沙眼衣原体、临床炎症和疤痕形成之间的关系尚未完全了解。方法和结果这项纵向队列研究在坦桑尼亚北部进行。基线年龄为 6-10 岁的儿童有资格纳入。四年来，每三个月对参与者进行一次拜访。在每个时间点收集临床体征和结膜拭子，通过 qPCR 检测沙眼衣原体。对基线和最终时间点的结膜照片进行分级并并排比较，以确定疤痕形成的发生率和进展。在参与该研究的 666 名儿童中，获得了 448 名儿童的结果数据。103/448 (23%) 名儿童检测到疤痕进展；其中 48 例 (11%) 曾出现疤痕，55 例 (12%) 已有疤痕进展。疤痕形成与沙眼乳头状炎症（TP）发作密切相关。在未经调整的模型中，发现沙眼衣原体感染和滤泡性沙眼 (TF) 发作与疤痕进展之间的相关性较弱，而在调整炎症后的多变量分析中不存在这种关联（多变量结果：沙眼衣原体 p = 0.44，TF p = 0.25，TP p =
BackgroundTrachoma is a progressive blinding disease initiated by infection of the conjunctiva with Chlamydia trachomatis. Repeated infections are thought to cause chronic inflammation, which drives scarring, leading to in-turning of the eyelids. The relationship between C. trachomatis, clinical inflammation and scarring development in children is not fully understood due to a paucity of longitudinal studies with infection data at frequent follow-up.Methods and findingsThis longitudinal cohort study took place in northern Tanzania. Children aged 6-10 years at baseline were eligible for inclusion. Participants were visited every three months for four years. Clinical signs and conjunctival swabs for C. trachomatis detection by qPCR were collected at each time-point. Conjunctival photographs from baseline and final time-points were graded and compared side-by-side to determine scarring incidence and progression.Of the 666 children enrolled in the study, outcome data were obtained for 448. Scarring progression was detected in 103/448 (23%) children; 48 (11%) of which had incident scarring and 55 (12%) had progression of existing scarring. Scarring was strongly associated with increasing episodes of trachomatous papillary inflammation (TP). Weaker associations were found between episodes of C. trachomatis infection and follicular trachoma (TF) with scarring progression in unadjusted models, which were absent in multivariable analysis after adjusting for inflammation (multivariable results: C. trachomatis p = 0.44, TF p = 0.25, TP p =