撒哈拉地区婴儿群体中由沙眼衣原体引起的滤泡性结膜炎：分子与临床诊断
Follicular conjunctivitis caused by Chlamydia trachomatis in an infant Saharan population: molecular and clinical diagnosis.
作者信息
Javaloy J, Ferrer C, Vidal M T, Alió J L
机构信息
Instituto Oftalmológico de Alicante, Spain.
出版信息
Br J Ophthalmol. 2003 Feb;87(2):142-6. doi: 10.1136/bjo.87.2.142.
AIMS
To ascertain the prevalence of acute trachoma as a supposed endemic disease among infants in the Saharan refugee camps of Tindouf (Algeria) and to evaluate the efficacy of treatment with a single dose of azithromycin.
METHODS
527 children aged between 3 and 17 were evaluated in the camp schools in October 2001. All the children were clinically and microbiologically examined, including slit lamp checks of anterior segment and two conjunctival swabs, one for the detection of membrane lipopolysaccharide by quick immunoassay test Clearview Chlamydia MF and the other for the detection of specific DNA by chlamydia plasmid specific polymerase chain reaction (PCR) assay. After examination, a single dose of azithromycin was administered to each child. One month later samples from positive children and 12 random negative children by the first PCR were taken to perform a new PCR assay.
RESULTS
Chlamydia trachomatis was suspected in 2.47% of the children, papillary hypertrophy being the most frequently seen clinical sign. Scarring changes secondary to trachoma were detected in 11.7% of the children. Only four cases (0.8%) were positive to the immunoassay test and 12 cases (2.27%) were positive by PCR. After treatment a second PCR was performed on positive children and they were negative of chlamydia DNA amplification. However, one child who was negative and received the treatment was positive in the second PCR assay.
CONCLUSION
Acute trachoma prevalence is much lower than expected among infants in this Saharan population. The possible reasons could be the recent improvements in hygiene and health care. Cicatricial trachoma is more frequent. The Clearview immunoassay test has very low sensitivity in the detection of this disease. A single dose of azithromycin is sufficient to treat chlamydial conjunctivitis. However, a programme of improvement in hygiene and health care is necessary to prevent re-infection.
目的
确定在廷杜夫（阿尔及利亚）撒哈拉难民营中，急性沙眼作为一种疑似地方病在婴儿中的患病率，并评估单剂量阿奇霉素治疗的疗效。
方法
2001年10月，对难民营学校中527名年龄在3至17岁之间的儿童进行了评估。所有儿童均接受了临床和微生物学检查，包括眼前节裂隙灯检查和两次结膜拭子检查，一次用于通过快速免疫测定试验Clearview衣原体MF检测膜脂多糖，另一次用于通过衣原体质粒特异性聚合酶链反应（PCR）测定检测特异性DNA。检查后，给每个儿童服用单剂量阿奇霉素。一个月后，采集首次PCR检测为阳性儿童和12名随机抽取的阴性儿童的样本进行新的PCR检测。
结果
2.47%的儿童疑似沙眼衣原体感染，乳头肥大是最常见的临床体征。11.7%的儿童检测到沙眼继发的瘢痕改变。免疫测定试验仅4例（0.8%）呈阳性，PCR检测12例（2.27%）呈阳性。治疗后，对阳性儿童进行了第二次PCR检测，衣原体DNA扩增结果为阴性。然而，一名接受治疗且首次检测为阴性的儿童在第二次PCR检测中呈阳性。
结论
在这个撒哈拉人群的婴儿中，急性沙眼患病率远低于预期。可能的原因是近期卫生和医疗保健状况有所改善。瘢痕性沙眼更为常见。Clearview免疫测定试验在检测这种疾病时灵敏度非常低。单剂量阿奇霉素足以治疗衣原体性结膜炎。然而，有必要开展一项改善卫生和医疗保健的计划以预防再次感染。
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