BACKGROUNDS: Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment. RESULTS: A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts. CONCLUSIONS Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.
Anti-Bacterial Agents/therapeutic use* ; Azithromycin/therapeutic use* ; Humans ; Infant ; Mass Drug Administration ; Prevalence ; Trachoma/epidemiology*

INTRODUCTION: This study aimed to determine the in vitro susceptibility of standard isolates of common pathogens causing bacterial conjunctivitis to non-fluoroquinolone antimicrobial ophthalmic medications. METHODS: This is a single-blind experimental study which compared the in vitro susceptibility of Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa and Staphylococcus epidermidis to locally available non-fluoroquinolone ophthalmic medications, specifically chloramphenicol, tobramycin, fusidic acid, gentamicin sulfate, sulfacetamide and polymyxin-neomycin. Utilizing the disk diffusion method, zones of inhibition in millimeters for each bacterial isolate was recorded and tabulated. Kruskal-Wallis test was used to determine statistical differences. RESULTS: Both Staphylococci were sensitive to all antibiotics except sulfacetamide. Only chloramphenicol showed activity against all four isolates. Tobramycin showed the largest zone of inhibition against Pseudomonas aeruginosa. There was statistically significant difference in the median zone of inhibition in each antimicrobial medication against Staphylococcus aureus (p = 0.002) and Staphylococcus epidermidis (p < 0.001) with the largest mean zone of inhibition by fusidic acid of 34 and 38 millimeters, respectively. Streptococcus pneumoniae was least susceptible to antibiotics tested; only chloramphenicol and fusidic acid showed activity. There were also significant differences in the median zones of inhibition across the isolates. CONCLUSION The standard isolates are susceptible to at least one non-fluoroquinolone ophthalmic medication. The antibiotics tested showed differences in activity against the four isolates. The findings of this study may be used as a basis to review local practice patterns or/and initiate revisions in the guidelines for prescribing initial treatment of bacterial conjunctivitis.
Conjunctivitis, Bacterial ; Anti-Bacterial Agents

PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.
Aged ; Aged, 80 and over ; Anterior Chamber ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Breast ; Conjunctivitis, Allergic ; Cornea ; Female ; Hematologic Tests ; Humans ; Hyperemia ; Inflammation ; Keratoconjunctivitis ; Lubricant Eye Drops ; Medicine, Traditional ; Milk, Human ; Ophthalmic Solutions ; Slit Lamp ; Steroids ; Tuberculosis ; Visual Acuity

Gonococcal conjunctivitis is rare in adults and, if not treated properly, can cause corneal perforation. Gonococcal conjunctivitis typically presents with a severe mucopurulent discharge, similar to that associated with viral conjunctivitis. Here, we describe a case of monocular gonococcal conjunctivitis, including its clinical characteristics and slit-lamp images, which was initially misdiagnosed as epidemic conjunctivitis. A 20-year-old man was referred to our hospital with no improvement in monocular infection and purulent ocular discharge after 2-wk treatment using antibiotic and 0.1% fluorometholone eye drops at the local ophthalmic clinic. Initially, 0.5% loteprednol eye drops were used since we suspected viral conjunctivitis. Following this treatment, conjunctival infection worsened and a yellow-white ocular discharge covered the conjunctiva and cornea surface. Additional history taking revealed that the patient had sexual contact with a prostitute 1 wk prior to symptom presentation and, after the encounter, he took antibiotics for genital discharge at the local urology clinic, but self-discontinued treatment. A Gram staining showed gram-negative diplococci and culture of collected ocular discharge from the palpebral conjunctiva revealed growth of Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. Following this, the patient was systemically treated with 3rd generation cephalosporin antibiotics. After 3-d treatment, conjunctival infection and purulent ocular discharge had significantly improved. When clinical symptoms are aggravated following steroid eye drop treatment for suspected monocular viral conjunctivitis, gonococcal conjunctivitis must be considered as a differential diagnosis
Adult* ; Anti-Bacterial Agents ; Cephalosporins ; Conjunctiva ; Conjunctivitis* ; Conjunctivitis, Viral ; Cornea ; Corneal Perforation ; Diagnosis, Differential ; Fluorometholone ; Humans ; Loteprednol Etabonate ; Male* ; Neisseria gonorrhoeae ; Ophthalmic Solutions ; Sex Workers ; Urology ; Young Adult

No abstract available.
Adult ; Anti-Bacterial Agents/*therapeutic use ; Chronic Disease ; Conjunctiva/*surgery ; Conjunctivitis/drug therapy/*surgery ; Female ; Follow-Up Studies ; Humans ; Ophthalmologic Surgical Procedures/*methods

PURPOSE: The purpose of this study was to investigate the etiology of acute pharygotonsillitis in pediatric patients. METHODS: Pharyngeal swabs from patients with acute pharyngotonsillitis were evaluated for viruses and bacterial organisms from March 2010 through March 2011. RESULTS: Of 615 patients, potentially pathogenic bacteria were isolated in 40 (6.5%), viruses were isolated in 310 (50.4%), and no pathogens were isolated in 267 patients (43.4%). Both viral and bacterial pathogens were found in 2 (0.3%). Of 40 patients with bacterial pathogens, group A streptococci were found in 31 (77.5%). Among 310 patients with virus infection, adenovirus was the most frequently recovered (203 patients; 65.5%), followed by rhinovirus (65 patients; 21.0%), enterovirus (43 patients; 13.9%) and coronavirus (18 patients; 5.8%). There were 25 patients who had been coinfected with 2 viruses. In viral pharyngotonsillitis, cough, rhinorrhea, conjunctivitis and diarrhea were prominent. On the other hand, pharyngeal injection and pharyngeal petechiae were prominent in bacterial pharyngotonsillitis. CONCLUSIONS: Virus infection was a big part of acute pharyngotonsillitis and there were differences in clinical manifestations among viral and bacterial infections. Therefore, we need to distinguish between virus infection and bacterial infection using clinical signs for preventing the abuse of antibiotics.
Adenoviridae Infections ; Anti-Bacterial Agents ; Bacteria* ; Bacterial Infections ; Child* ; Conjunctivitis ; Coronavirus ; Cough ; Diarrhea ; Enterovirus ; Hand ; Humans ; Purpura ; Rhinovirus

PURPOSE: To study the causative microorganism of neonatal bacterial conjunctivitis and its correlation with maternal factors. METHODS: We retrospectively reviewed the medical records of 55 neonates diagnosed with bacterial conjunctivitis and the records of mothers from January 2008 to July 2013. We investigated microbiologic culture of conjunctival discharge, time of occurrence, the mode of delivery, premature rupture of membrane (PROM), microbiologic culture of vaginal swab and the sensitivities to antibiotics. RESULTS: The most common organism was Staphylococcus epidermidis, isolated in 24 (36.4%) neonates, followed by other Coagulase-negative Staphylococcus (CNS) 10 (15.2%), E. cloacae 6 (9.1%), S. marsescens 6 (9.1%), and P. aeruginosa 5 (7.6%). Concerning the time of occurrence, 23 (41.8%) were founded with conjunctivitis within 1 week of life. By mode of delivery, 18 (32.7%) were delivered through vaginal route and 37 (67.3%) delivered by Cesarean section. The most common organism grown in conjunctival discharge of both group was S. epidermidis. Of these 55 neonates' mothers, 9 (16.4%) had history of PROM. Regardless of the presence of PROM, the most common organism was S. epidermidis. A total of 22 (40.0%) microbiologic culture of vaginal swab were examined and 6 (27.2%) of them had detected organisms. The results of vaginal swabs were in discord with results of conjunctival swabs of neonates. CONCLUSION: S. epidermidis was the most common infectious organism of neonatal bacterial conjunctivitis. We could not identify the correlation between neonatal bacterial conjunctivitis and maternal factors. Further comprehensive studies are needed to investigate the risk factors related to bacterial conjunctivitis of neonates.
Anti-Bacterial Agents ; Cesarean Section ; Cloaca ; Conjunctivitis ; Conjunctivitis, Bacterial* ; Female ; Humans ; Infant, Newborn ; Medical Records ; Membranes ; Mothers ; Pregnancy ; Retrospective Studies ; Risk Factors ; Rupture ; Staphylococcus ; Staphylococcus epidermidis

BACKGROUNDThis research aims at identifying relative interventions on trachoma and testing the effectiveness of control measures adopted by assessing its prevalence and related risk factors in Shandong province of China.

METHODSTrachoma rapid assessment (TRA) was conducted in 6 sub-districts selected from Shandong province based on primary high risk assessment. Active trachoma in children aged 1-9 years and environmental risk factors of trachoma (unclean faces, absence of running water, and absence of flush toilets) were assessed (TRA 1). Control measures were taken in endemic areas. A second TRA (TRA 2) was conducted after 12 months in the same 6 districts and findings of the two TRAs were compared.

RESULTSIn TRA 1, we found trachoma in 3 sub-districts and the detection rate was 4% (95% CI: 0.39%-11.12%), 6% (95% CI: 1.18%-14.17%), and 6% (95% CI: 1.18%-14.17%) respectively. We could not find trachoma cases in TRA 2. Research data supports that children living with environmental risk factors face an increased risk to active trachoma. However, we could not find statistical evidence for this association, which may be caused by the limited data on prevalence.

CONCLUSIONSThis research indicates that the TRA methodology is easy to assess trachoma and its related risk factors. Based on the results of this study, we have already achieved the goal of "elimination of trachoma" in Shandong province, as the detection rate of trachomatous inflamation follicular/trachomatous inflammation intense in 1-9-year-old children was less than 5%.

Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Male ; Prevalence ; Risk Factors ; Trachoma ; epidemiology

This essay examines the period between 1897 and 1910, when trachoma, a contagious eye disease, became an "Oriental" problem that justified exclusionary immigration policy against Asians entering the United States. It also investigates the ways in which the public fear and alleged threat of the eye disease destabilized and undermined the rights of Asian immigrants. Many scholars have explored the link between trachoma and southern and eastern European newcomers, in particular Jews, but they have not paid much attention to Chinese or Japanese immigrants, for whose exclusion trachoma played a significant role. This is primarily because the number of Asian immigrants was much smaller than that of their European counterparts and because the Chinese Exclusion Acts, which had already been in place, functioned as a stronger and more lasting deterrent to Asian immigration than exclusion or deportation through medical inspection. Moreover, into the 1910s, medical and scientific innovations for detecting parasitic diseases (e.g. hookworm) helped American authorities exclude Asians in larger numbers. Still, the analysis of the discourses surrounding trachoma and immigration from Asia, though short-lived, demonstrates the role of medical inspection in controlling and regulating Asian immigrants, in particular Chinese and Japanese, into the United States and in constructing their legal and political rights. In 1906, the fear of trachoma justified an order to segregate Japanese students from white children in San Francisco even at the cost of compromising their rights as citizens. Along with fierce criticisms against immigration officials by the American public, the 1910 investigation of the San Francisco Immigration Office problematized the admission of trachoma-afflicted Asian immigrants. Those critical of the Immigration Office and its implementation of American immigration policy called for exclusionary measures to limit the privileges of exempt classes and domiciled aliens and hinder the exertion of their rights to leave and reenter their adopted country. The two examples show that trachoma was a convenient excuse to condemn inefficient immigration policy and regulate allegedly diseased Asian bodies. In 1910, the federal government made a decision to relegate to steamship companies full responsibility for medical inspection at Asian ports. Since they had to pay a fine for every immigrant excluded at American borders for medical reasons, including trachoma, steamship companies carried out more rigorous examinations. With medical advancements and growing interest in parasitic diseases, trachoma soon lost its appeal to immigration authorities. However, the association of immigration, race, and disease has continued to provide a rationale for immigration control beyond American borders.
Emigrants and Immigrants/*history/legislation & jurisprudence ; Emigration and Immigration/*history/legislation & jurisprudence ; Far East/ethnology ; History, 19th Century ; History, 20th Century ; Humans ; Trachoma/ethnology/*history/prevention & control ; United States

Corynebacterium macginleyi is usually isolated from the eye surfaces and causes ocular infections such as conjunctivitis, keratitis, and endophthalmitis. However, cases that describe C. macginleyi as the causative agent for significant and life-threatening infections in immunocompromised patients are increasingly reported. Herein we report the first documented case of C. macginleyi pneumonia in a human immunodeficiency virus (HIV) patient. A 42-year-old homosexual man with HIV infection was hospitalized with a 1-month history of fever and dry cough. Chest radiograph revealed ill defined ground glass opacities in both lung fields. Methenamine silver stain of bronchoalveolar lavage fluid was negative. He showed clinical improvement after treatment with trimethoprim/sulfamethoxazole and prednisolone for three weeks, and was discharged. One month later, he presented with dyspnea and more progressive pulmonary infiltrations. Bronchial washing fluid culture yielded >100,000 colonies/mL of C. macginleyi, and he was given a 14-day course of antibiotic therapy with vancomycin, after which the patient fully recovered. This case suggest the importance of not overlooking the significance of positive cultures for C. macginleyi obtained from representative clinical samples in patients with signs and symptoms of bacterial infection.
Adult ; Bacterial Infections ; Bronchoalveolar Lavage Fluid ; Conjunctivitis ; Corynebacterium ; Cough ; Dyspnea ; Endophthalmitis ; Eye ; Eye Infections ; Fever ; Glass ; HIV ; HIV Infections ; Homosexuality ; Humans ; Immunocompromised Host ; Keratitis ; Lung ; Methenamine ; Pneumonia ; Prednisolone ; Thorax ; Vancomycin