TY - JOUR
T1 - The reliability of anterior segment lesions as indicators of onchocercal eye disease in Guatemala
AU - Winthrop, Kevin L.
AU - Proaño, Roberto
AU - Oliva, Orlando
AU - Arana, Byron
AU - Mendoza, Carlos
AU - Dominguez, Alfredo
AU - Amann, Josef
AU - Punkosdy, George
AU - Blanco, Carlos
AU - Klein, Robert
AU - Sauerbrey, Mauricio
AU - Richards, Frank
PY - 2006/12
Y1 - 2006/12
N2 - World Health Organization certification criteria for onchocerciasis elimination use anterior segment eye lesion prevalence as an indicator of mass ivermectin treatment program success. Lesions either contain visible microfilaria (noninflammatory punctate keratitis [PK] or microfilariae in anterior chamber [MFAC]), or microfilaria obscured by inflammation (inflammatory PK). To assess the utility of these disease indicators, two experienced ophthalmologists independently examined persons from endemic (N = 325) and nonendemic (N = 348) Guatemalan communities. Thirty-six (11.1%) and nine (2.6%) persons from endemic and nonendemic areas respectively had lesions found by either ophthalmologist (prevalence ratio = 4.3, 95% CI 2.1-8.8, P < 0.001). All lesions in nonendemic areas were inflammatory PK in whom no persons were seropositive for onchocerciasis. Overall, observer agreement was moderate (Kappa = 0.49), and most (61%) discordance occurred with inflammatory PK lesions. Our findings suggest that inflammatory punctate keratitis is neither a specific nor a reliable indicator of onchocercal eye disease. Future prevalence surveys should rely upon noninflammatory lesions as disease indicators.
AB - World Health Organization certification criteria for onchocerciasis elimination use anterior segment eye lesion prevalence as an indicator of mass ivermectin treatment program success. Lesions either contain visible microfilaria (noninflammatory punctate keratitis [PK] or microfilariae in anterior chamber [MFAC]), or microfilaria obscured by inflammation (inflammatory PK). To assess the utility of these disease indicators, two experienced ophthalmologists independently examined persons from endemic (N = 325) and nonendemic (N = 348) Guatemalan communities. Thirty-six (11.1%) and nine (2.6%) persons from endemic and nonendemic areas respectively had lesions found by either ophthalmologist (prevalence ratio = 4.3, 95% CI 2.1-8.8, P < 0.001). All lesions in nonendemic areas were inflammatory PK in whom no persons were seropositive for onchocerciasis. Overall, observer agreement was moderate (Kappa = 0.49), and most (61%) discordance occurred with inflammatory PK lesions. Our findings suggest that inflammatory punctate keratitis is neither a specific nor a reliable indicator of onchocercal eye disease. Future prevalence surveys should rely upon noninflammatory lesions as disease indicators.
UR - http://www.scopus.com/inward/record.url?scp=39049193442&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=39049193442&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.2006.75.1058
DO - 10.4269/ajtmh.2006.75.1058
M3 - Article
C2 - 17172365
AN - SCOPUS:39049193442
SN - 0002-9637
VL - 75
SP - 1058
EP - 1062
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 6
ER -