Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross-sectional study

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Lynch, Kathleen D
Morotti, Wendy
Brian, Garry
Ketchup, Lenore
Kingston, Kozue
Starr, Mitchell
Ware, Robert S
Everill, Beth
Asgar, Nazihah
O'Keefe, Anne
Whop, Lisa J
Kaldor, John M
Lambert, Stephen B
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2022
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Abstract

Objectives: To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community. Design: Three cross-sectional screening surveys, 2019–2021, complemented by laboratory pathology testing. Setting: Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists. Participants: Children aged 1–14 years; opportunistic screening of people aged 15 years or more. Main outcome measures: Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein. Results: During the three surveys, 73 examinations of 58 children aged 1–4 years, 309 of 171 aged 5–9 years, and 142 of 105 aged 10–14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation–follicular were identified in 5–9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10–14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1–9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies. Conclusions: Despite the prevalence of clinical signs consistent with trachomatous inflammation–follicular among 5–9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.

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Medical Journal of Australia

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© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMP Co Pty Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Clinical sciences

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Life Sciences & Biomedicine

Medicine, General & Internal

General & Internal Medicine

Trachoma

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Lynch, KD; Morotti, W; Brian, G; Ketchup, L; Kingston, K; Starr, M; Ware, RS; Everill, B; Asgar, N; O'Keefe, A; Whop, LJ; Kaldor, JM; Lambert, SB, Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross-sectional study, Medical Journal of Australia, 2022

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