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  Pathogenesis and Pathology of Trachoma

Pathogenesis and Pathology of Trachoma:

On palpabral conjunctiva, the procedure starts with diffuse hyperemia, infiltration leading to vascular papillae and lymphoid follicles. Both upper and lower lids might be included. Usually upper tarsal plate is included, later cicatricial tissues build up due to follicular necrosis. Diffuse infiltration or fibrosis also viewed. Structural modification in the lids develops due to retraction of cicatricial tissue.

This leads to enteropion and trichiasis leading to partial or net loss of vision. In cornea, infiltration and neo-vascularization of upper limbus take place that might extend downwards and reach pupillary region. Corneal conjunctiva might be affected. Follicles might develop at the upper limbus. Superficial keratitis might take place. Re-absorption of infiltration at the limbus might lead to formation of Herbert’s pits and corneal opacity might lead to ulceration. Follicles have been explained on urethral and cervical mucous membranes in extraocular situation.

Diagnosis:

In endemic regions the following signs are looked for: Upper tarsal follicles, Limbal follicles or Herbert’s pits, corneal infiltration and neo-vascularization. Conjunctival scars of characteristic configuration.

Laboratory diagnosis of Trachoma:

Specimens: Conjunctival or corneal scrapings are collected.

Direct demonstration: Organisms or inclusion bodies are explained employing any of the staining procedures: Gimenez stain, Giemsa stain, Macchiavello’s stain, Iodine stain or by Immunofluorescence

Isolation of agents: Growth of the organisms is challenged in Egg yolk and Tissue cultures in which inclusions are appeared for by staining or by IF. Type specific antibodies in serum and tears are explained.

 

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