Although a doctor practicing in the UK might rarely see a case of trachoma, and even then only in immigrants, it is the commonest cause of blindness in the world and, furthermore, the disease affects about 15% of the world's population. It is spread by direct contact and perpetuated by poverty and unhygienic conditions. Trachoma is caused by C. trachomatis serotypes A, B and C and affects underprivileged populations living in conditions of poor hygiene. The disease begins with conjunctivitis, which, instead of resolving, becomes persistent, especially under the upper lid where scarring and distortion of the lid can result. The inflammatory reaction spreads to infiltrate the cornea from above and ultimately the cornea itself can become scarred and opaque (Figure 6.3). At one time, trachoma was common in the UK, especially after the Napoleonic wars at the end of the eighteenth century. It had been eliminated by improved hygienic conditions long before the introduction of antibiotics.
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