Trachoma infections

Effective personal and environmental hygiene has been proven successful in combating trachoma. Encouraging the washing of children s faces, improved access to clean water supplies, and proper disposal of human and animal wastes have been shown to decrease the number of trachoma infections in many communities. 

A number of infections caused by Chlamydia trachomatis, such as trachoma, inclusion conjunctivitis, pneumonia, and urethritis, can be treated with topical or systemic sulfonamides, although tetracycline or erythromycin is preferred. 

Respiratory, skin, and soft-tissue infections UTIs pelvic inflammatory disease (PID) brucellosis trachoma Rocky Mountain spotted fever typhus Q fever lickettsia severe acne (Adoxa) smallpox psittacosis ornithosis granuloma inguinale lymphogranuloma venereum intestinal amebiasis (adjunctive treatment) prevention of rheumatic fever ... 

Mild, moderate, or severe prostate, urinary tract, and CNS infections (excluding meningitis)-, uncomplicated gonorrhea inflammatory acne Brucellosis skin granulomas cholera trachoma nocardiasis yaws and syphilis when penicillins are contraindicated PO... 

Treatment of corneal ulcers, conjunctivitis and other superficial infections of the eye, pro-phylaxis after injuries to the eye/removal of foreign bodies, adjunctive therapy for trachoma and inclusion conjunctivitis Ophthalmic Solution l-Sdropstolowerconjunc-tival sac q2-3h. Seborrheic dermatitis, seborrheic sicca (dandruff), secondary bacterial skin infections Topical Ointment Apply small amount in lower conjunctival sac 1 -4 times/day and at bedtime. 

Ophthalmic infections Due to susceptible strains of N. gonorrhoeae, staphylococci, H. influenzae and in the treatment of trachoma. 

Sodium sulfacetamide ophthalmic solution or ointment is effective in the treatment of bacterial conjunctivitis and as adjunctive therapy for trachoma. Another sulfonamide, mafenide acetate, is used topically but can be absorbed from burn sites. The drug and its primary metabolite inhibit carbonic anhydrase and can cause metabolic acidosis, a side effect that limits its usefulness. Silver sulfadiazine is a much less toxic topical sulfonamide and is preferred to mafenide for prevention of infection of burn wounds. 

Esrey, S. A., Potash, J. B., Roberts, L., Shift, C. (1991). Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bulletin of the World Health Organization, 69, 609-621. 

Trachoma is caused by an organism called Chlamydia trachomatis. Through the discharge from an infected person s eyes, trachoma is passed on by contact with hands or skin, on clothing, or by flies that land on the face. 

Health Organization (WHO) estimates that 6 million people worldwide are blind because of trachoma and more than 150 million people are infected and in need of medical treatment for the disease. 

In adnlts with chlamydial ocnlar infections such as inclusion conjnnctivitis or trachoma, treatment with oral doxycycline or tetracycline is a recommended strategy (seeTable 11-1). In commnnity-based programs to control trachoma, topical tetracycline ointment administered twice daily on an intermittent schedule (5 consecutive days each month for 6 months) can be useful. However, incomplete cnre and snbseqnent disease transmission can resnlt. In contrast, oral treatment with tetracycline or doxycycline cnres trachoma. 

Chlamydiae are obligate intracellular parasites that depend on the host cell to carry out metabolic biosynthe-sis.The genus includes two major species C. trachomatis, which causes disease in humans, and Chlamydia psittaci, which infects primarily nonhumans. The many different serotypes cause a wide spectrum of disease states, including inclusion conjunctivitis, trachoma, lymphogranuloma venereum, and cervicitis or urethritis. 

In its early stages trachoma presents as a chronic follicular conjunctivitis with a predilection for the superior tarsal and bulbar conjunctiva. Over time, the conjunctival reaction becomes papillary in nature and, with the inflammatory infiltration that occurs, the follicular character of the infection can become obscured. Patients experience symptoms of photophobia, tearing, and mucoid or mucopurulent discharge. Limbal edema and superior bulbar conjunctival hyperemia also may occur. Conjunctival follicles that form at the limbus are characteristic of severe trachoma. Primary corneal involvement often includes superior epithelial keratitis and superficial superior pannus formation. A wide variety of corneal infiltrates... 

Whitty CJ, Glasgow KW, Sadiq ST, Mabey DC, Bailey R. Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children. Pediatr Infect Dis J 1999 18(ll) 955-8. 

There are few absolute clinical indications for the use of sulphonamides. They have been used extensively in the past for urinary tract infections, though less now. They are used for certain respiratory infections, including that by Pneumocystis carnii, some sexually transmitted diseases (chlamidia. chancroid, trachoma), in drug-resistant malaria (with pyrimethamine), in inflammatory towel disease (sulfasalazine) and as silver sulfadiazine for topical application in infected burns. 

Jones RB, Batteiger BE. Chlamydia trachomatis (trachoma, perinatal infections, lymphogranuloma venereum, and other genital infections). In Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 5th ed. New York, Churchill-Livingstone, 2000 1989-2004. 

Bacterial infections are the other common neglected diseases. They comprise leprosy and trachoma, which are controlled by antibiotic treatments, Buruli ulcer, managed by surgery and antibiotics, cholera, caused by Vibrio cholerae living in contaminated drinking water, and for which antibacterials and isotonic fluid replacement therapy are recommended. 

Have a wide spectrum, but use as individual agents is limited by resistance. Common uses include nocardial infections (DOC), simple UT infections (sulfisoxazole), ulcerative colitis (sulfasalazine), trachoma (sulfacetamide, topical), burns (Ag sulfadiazine, topical), and toxoplasmosis (sulfadiazine + pyrimethamine). 

Sulfacetamide, a sulfonamide antibiotic (instill 1 to 2 drops of 10% solution into lower conjunctival sac), is used in inclusion conjunctivitis, corneal ulcers, trachoma, and prophylaxis for ocular infection. 

Sulhsoxazole is used in urinary tract and systemic infections in lymphogranuloma venereum (genital, inguinal, or anorectal infections) in uncomplicated urethral, endocervi-cal, or rectal infechons caused by C. trachomatis in con-junctivihs, corneal ulcer, superflcial ocular infechons and as an adjunct in systemic treatment of trachoma. 

Dawson, C. R., Schachter, J., Sallam, S., Sheta, A., Rubinstein, R. A., and Washton, H. (1997). A comparison of oral azithromycin with topical oxytetracycline/polymyxin for the treatment of trachoma in children. Clin. Infect Dis. 24, 363-368. 

Resistance to sulfonamides is now common for N. meningitidiSy as well as in cases of bacillary dysentery. Antibiotics have generally replaced the sulfonamides for these purposes. Sulfonamides, particulady sulfisoxazole and sulfadiazine, are of value in treatment of infections due to Nocardia species, and sulfonamides are effective for trachoma. Inclusion conjunctivitis is also treated with sulfacetamide ointment. Oral administration of a sulfonamide, eg, sulfisoxazole, has been successful for treatment of lymphogranuloma venereum and chancroid Dapsone and sulfonamides have also been used for treatment of the skin disorder dermatitis herpetiformis. Sulfonamides have been used for long term prophylaxis of rheumatic fever, but are being replaced by penicillin for this purpose, except in cases of hypersensitivity to penicillin (19). 

The least-controlled bacterial diseases in the world today are cholera, trachoma, leprosy, tuberculosis, brucellosis, urethritis, and the trepo-nematoses. Indonesia, North Africa, and (especially) the Indian subcontinent are the most severely afflicted with cholera, but thanks to the aeroplane, no part of the world is safe. Cholera is easily cured with tetracycline and intravenous saline. Cholera epidemics begin through poor hygiene, and spread explosively when the number of sufferers exceeds the nursing resources. Trachoma is an infection of the eyes by a minute, intracellular bacterium of the Chlamydia... 

At the present time, the largest use of sulfonamide antibacterials is as urinary antiseptics, e.g. those caused by E. coli and Proteus mirabilis. They are also used in treating nocardiosis (of lungs or foot), trachoma (eye), lymphogranuloma venereum, dermatitis herpatiformis, and valued for the prophylaxis of streptococcal infections in those prone to them, and in preventing recurrence of rheumatic fever. 

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