Pathogenesis of progressive scarring trachoma in Ethiopia and Tanzania and its implications for disease control: two cohort studies

Trachoma causes blindness through a conjunctival scarring process initiated by ocular Chlamydia trachomatis infection; however, the rates, drivers and pathophysiological determinants are poorly understood. We investigated progressive scarring and its relationship to conjunctival infection, inflammat...

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Published in:	PLoS neglected tropical diseases 2015-05, Vol.9 (5), p.e0003763-e0003763
Main Authors:	Burton, Matthew J, Rajak, Saul N, Hu, Victor H, Ramadhani, Athumani, Habtamu, Esmael, Massae, Patrick, Tadesse, Zerihun, Callahan, Kelly, Emerson, Paul M, Khaw, Peng T, Jeffries, David, Mabey, David C W, Bailey, Robin L, Weiss, Helen A, Holland, Martin J
Format:	Article
Language:	eng
Subjects:	Adult Biomedical research Blindness - microbiology Blindness - pathology Carcinoembryonic Antigen - genetics Carcinoembryonic Antigen - metabolism Care and treatment Chlamydia trachomatis - genetics Chlamydia trachomatis - pathogenicity Cicatrix - pathology Cohort Studies Conjunctiva - microbiology Conjunctiva - pathology Connective Tissue Growth Factor - genetics Connective Tissue Growth Factor - metabolism Cytokines Cytokines - genetics Cytokines - metabolism Development and progression Disease Progression Ethiopia - epidemiology Extracellular matrix Female Gene expression GPI-Linked Proteins - genetics GPI-Linked Proteins - metabolism Humans Infection control Infections Inflammation - pathology Interleukin-17 - metabolism Male Matrix Metalloproteinase 7 - genetics Matrix Metalloproteinase 7 - metabolism Methods Middle Aged Pathogenesis Polymerase Chain Reaction S100 Calcium Binding Protein A7 S100 Proteins - genetics S100 Proteins - metabolism Sexually transmitted diseases STD Studies Surgery Tanzania - epidemiology Trachoma Trachoma - epidemiology Trachoma - microbiology Trachoma - pathology Trichiasis - diagnosis Trichiasis - microbiology Trichiasis - pathology
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Summary:	Trachoma causes blindness through a conjunctival scarring process initiated by ocular Chlamydia trachomatis infection; however, the rates, drivers and pathophysiological determinants are poorly understood. We investigated progressive scarring and its relationship to conjunctival infection, inflammation and transcript levels of cytokines and fibrogenic factors. We recruited two cohorts, one each in Ethiopia and Tanzania, of individuals with established trachomatous conjunctival scarring. They were followed six-monthly for two years, with clinical examinations and conjunctival swab sample collection. Progressive scarring cases were identified by comparing baseline and two-year photographs, and compared to individuals without progression. Samples were tested for C. trachomatis by PCR and transcript levels of S100A7, IL1B, IL13, IL17A, CXCL5, CTGF, SPARCL1, CEACAM5, MMP7, MMP9 and CD83 were estimated by quantitative RT-PCR. Progressive scarring was found in 135/585 (23.1%) of Ethiopian participants and 173/577 (30.0%) of Tanzanian participants. There was a strong relationship between progressive scarring and increasing inflammatory episodes (Ethiopia: OR 5.93, 95%CI 3.31-10.6, p
ISSN:	1935-2735 1935-2727 1935-2735