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Swain J, Sharma PK, Mohanty L, Panigrahi PK. Ocular manifestations in HIV patients attending a tertiary care hospital in Eastern India and correlation of posterior segment lesions with CD4+ counts. Indian J Ophthalmol 2023; 71:3701-3706. [PMID: 37991307 PMCID: PMC10788747 DOI: 10.4103/ijo.ijo_942_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts. METHODS This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case. RESULTS A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30-39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001). CONCLUSION Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections.
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Affiliation(s)
- Jyotirmayee Swain
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Pramod Kumar Sharma
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Pg chowk, Burla, Odisha, India
| | - Loknath Mohanty
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Pradeep Kumar Panigrahi
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
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2
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Danjou W, Pradat P, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Trad S, Seve P. Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment. Br J Ophthalmol 2023; 107:500-504. [PMID: 34711577 DOI: 10.1136/bjophthalmol-2021-318868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
AIMS Few studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate the value of the QuantiFERON test in a large cohort of patients with uveitis for both the diagnosis of tubercular uveitis and antituberculosis treatment (ATT) response prediction. METHODS A single-centre retrospective study including consecutive adult patients with uveitis who were prescribed a QuantiFERON test between January 2003 and December 2019 was performed. Adjusted ORs (aORs) were calculated between patients with uveitis responding and not responding to ATT according to the Collaborative Ocular Tuberculosis Study (COTS) group diagnostic criteria. Sensitivity (SE), specificity (Sp), and positive and negative predictive values of the QuantiFERON test were calculated. RESULTS A total of 1075 patients were included in the study; 178 (16.5%) were found positive using the QuantiFERON test. Among the 178 positive patients, 62 (35%) had a diagnosis of tubercular uveitis according to the updated COTS classification; all received ATT for 6 months; and 44/62 (71%) responded to ATT. A QuantiFERON test value of >2 IU/mL was associated with a greater chance of responding to ATT (aOR=36.7, 95% CI 7.2 to 185.9, p<0.001). The optimal threshold to maximise both Sp and SE for diagnosis of TB uveitis was 4 IU/mL. CONCLUSION One-sixth of the patients diagnosed with uveitis had a positive QuantiFERON test. The QuantiFERON threshold with the optimal SE and Sp for the diagnosis of tubercular uveitis was 4 IU/mL. TRIAL REGISTRATION NUMBER NCT03863782.
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Affiliation(s)
- William Danjou
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre Pradat
- Centre de recherche clinique, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yvan Jamilloux
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Service d'ophtalmologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Salim Trad
- Service de médecine interne, Hôpital Ambroise Paré, Paris, France
| | - Pascal Seve
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Villeurbanne, France
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3
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Cifuentes-González C, Barraquer-López D, Mejía-Salgado G, Reyes-Guanes J, Rojas-Carabali W, Polanía-Tovar D, de-la-Torre A. Colombian ocular infectious epidemiology study (COIES): presumed ocular tuberculosis incidence and sociodemographic characterization, 2015-2020. Ophthalmic Epidemiol 2022:1-10. [PMID: 36196030 DOI: 10.1080/09286586.2022.2129076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
PURPOSE This study aims to describe the incidence and geographical distribution of presumed ocular tuberculosis (POTB) in Colombia between 2015 and 2020 based on the Colombian Ministry of Health and Social Protection data. METHODS We conducted a claims-based study using the Integrated Social Protection Information System database from the Colombian Ministry of Health. We used the specific code of the International Classification of Diseases for Ocular Tuberculosis (A18.5) and tuberculosis from 2015 to 2020 to estimate the incidence and the demographic status of the disease in Colombia. We used STROBE guidelines. RESULTS During the 6 years of study, the crude unadjusted incidence was 0.2 new cases of POTB in one million consulting patients and 55 new cases of POTB in 100,000 patients with TB showing a decreasing pattern of the disease. From the 28 new cases, the mean age of presentation was 41.4 years (SD ± 25.3) with a female predominance (60.7% of the cases). Distribution by age shows a higher proportion of cases in groups 15-19 (14%), 20-24 (11%), 55-59 (11%), and 60-64 (11%) years of age. The geographic analysis showed a higher number of cases in Andean region, followed by the Caribbean and Pacific regions. CONCLUSIONS This is the first study that determines the incidence of POTB in a developing country from Latin America. POTB incidence in Colombia is lower than the reported worldwide. It could be attributed to a low burden of Tuberculosis in Colombia, underdiagnosis, and a low rate of immigration from countries with a high burden of TB.
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Affiliation(s)
- Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), NeuroVitae Research Center, Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.,Ophthalmology Interest Group, Neuroscience Research Group (NEUROS). Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Doménico Barraquer-López
- Neuroscience Research Group (NEUROS), NeuroVitae Research Center, Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.,Ophthalmology Interest Group, Neuroscience Research Group (NEUROS). Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Germán Mejía-Salgado
- Neuroscience Research Group (NEUROS), NeuroVitae Research Center, Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.,Ophthalmology Interest Group, Neuroscience Research Group (NEUROS). Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Ophthalmology Interest Group, Neuroscience Research Group (NEUROS). Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.,Escuela Barraquer. Research Group. Escuela Superior de Oftalmología - Instituto Barraquer de América, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), NeuroVitae Research Center, Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.,Ophthalmology Interest Group, Neuroscience Research Group (NEUROS). Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Diego Polanía-Tovar
- Neuroscience Research Group (NEUROS), NeuroVitae Research Center, Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.,Ophthalmology Interest Group, Neuroscience Research Group (NEUROS). Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Research Center, Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.,Ophthalmology Interest Group, Neuroscience Research Group (NEUROS). Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
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Alli HD, Ally N, Mayet I, Joseph L, Omar SV, Madhi SA. Tubercular Uveitis in Uveitis Cases in a High TB and HIV Setting: A Prospective Cohort Study. Transl Vis Sci Technol 2022; 11:9. [PMID: 35006262 PMCID: PMC8762688 DOI: 10.1167/tvst.11.1.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose The diagnosis of tubercular uveitis (TBU) is difficult. The lack of a diagnostic gold standard has contributed to challenges in determining the true prevalence and clinical predictors of TBU. We aimed to determine the proportion of TBU cases in adults with uveitis and to examine clinical features associated with TBU. Methods A prospective cohort study of adult uveitis cases after exclusion of other specific etiologies. The diagnosis of TBU was based on a composite reference of: any clinical signs of uveitis; exclusion of other causes of uveitis; and positive QuantiFERON-Gold test, tuberculin skin test, and/or ocular TB polymerase chain reaction. Results Of 79 cases analyzed, 49 (62%) had TBU. Female sex (P = 0.001) and chronic uveitis (P = 0.006) cases were more common in the TBU group than the non-TBU group whereas diffuse choroiditis (P = 0.010) and HIV-positive (P = 0.001) cases were less common. Choroidal granulomas (P = 0.176) and serpiginous-like choroiditis (P = 0.292) were more common in TBU group, albeit not significantly. On univariate analysis, female sex (odds ratio, 5.1; P = 0.002), negative HIV status (odds ratio, 0.2; P = 0.001), and chronic uveitis (odds ratio, 4.1; P = 0.008) were associated with TBU. A negative HIV test was associated with TBU on multivariate analysis (P = 0.049). Conclusions A high proportion of cases had TBU. Our study did not significantly confirm some of the clinical features associated with TBU reported in other studies. Translational Relevance Our study highlights the difficulties in determining the proportion and clinical predictors of TBU, especially in the absence of a gold standard diagnostic test.
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Affiliation(s)
- Hassan D Alli
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naseer Ally
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ismail Mayet
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lavania Joseph
- Centre for Tuberculosis, National TB Reference Laboratory, WHO TB Supranational Laboratory Network, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Shaheed V Omar
- Centre for Tuberculosis, National TB Reference Laboratory, WHO TB Supranational Laboratory Network, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Molecular Medicine & Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (VIDA), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Babalola Y, Oluleye T, Ashaye A. Vitreoretinal manifestations of human immunodeficiency virus infection and acquired immunodeficiency syndrome in patients attending an antiretroviral therapy clinic in Nigeria: A cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Alli HD, Ally N, Mayet I, Dangor Z, Madhi SA. Global prevalence and clinical outcomes of tubercular uveitis: a systematic review and meta-analysis. Surv Ophthalmol 2021; 67:770-792. [PMID: 34626620 DOI: 10.1016/j.survophthal.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
Tubercular uveitis (TBU) is an inflammation/infection of the eye secondary to Mycobacterium tuberculosis infection. The difficulty in making the diagnosis has resulted in variable prevalence and clinical response rates. We aimed to determine the global prevalence of TBU in uveitis patients stratified by TB high-burden countries (HBCs) and non-HBCs and by geographic regions and the clinical response of TBU to antitubercular treatment We performed a systematic review and meta-analysis of TBU studies published in PubMed, Scopus and EMBASE, up to June 30, 2020. A random effects model was used for all meta-analyses. Of 5,018 articles identified, 70 prevalence studies (65,607 uveitis and 3,166 TBU cases) and 18 clinical outcome studies (1,570 TBU cases; 1,304 responded to anti-tubercular therapy [ATT]) were analyzed. The overall weighted prevalence of TBU was 4.0% (95% CI, 3-5); in TB HBCs it was 7.0% (95% CI, 5-11), non-HBCs 3.0% (95% CI, 2-4), and sub-Saharan Africa 11.0% (95% CI, 8-15). The overall weighted clinical response was 82.0% (95% CI, 75-89). Despite the difficulty in diagnosing TBU, the prevalence is expectantly higher in HBCs, and sub-Saharan Africa and the clinical outcome is poor. Standardization of diagnostic criteria and ATT is warranted in future cohort studies.
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Affiliation(s)
- Hassan D Alli
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Naseer Ally
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ismail Mayet
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ziyaad Dangor
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Shabir A Madhi
- Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (VIDA), Faculty of Health Sciences, University of the Witwatersrand, South Africa
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7
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Yakin M, Kesav N, Cheng SK, Caplash S, Gangaputra S, Sen HN. The Association between QuantiFERON-TB Gold Test and Clinical Manifestations of Uveitis in the United States. Am J Ophthalmol 2021; 230:181-187. [PMID: 33945821 DOI: 10.1016/j.ajo.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the prevalence of QuantiFERON-TB Gold (QFT-G) positivity among uveitis patients compared to general population and to evaluate the differences in clinical features of uveitis. DESIGN Retrospective cohort study. METHODS SETTING: Institutional. PATIENT POPULATION 418 consecutive new uveitis patients, regardless of clinical suspicion, were tested for QFT-G. OBSERVATION PROCEDURES Demographics, TB risk factors, clinical characteristics of uveitis were collected. MAIN OUTCOME MEASURES The frequency of QFT-G positivity among uveitis patients and characteristic clinical features among QFT-G positive patients. RESULTS QFT-G positivity was found in 60/418 patients with uveitis (14.4%, 95% CI: 11.18 - 18.14) higher than the general US population (5%, 95% CI: 4.2 - 5.8, p<.001). Age, gender and residence were similar between QFT-G positive and negative groups. Uveitis patients with positive QFT-G were more likely to be foreign born or have a recent travel history (OR:5.84; 95% CI: 2.83 - 12.05; p<.001). QFT-G positive patients were more likely to present with granulomatous uveitis (OR 2.90; 95%CI 1.36 - 6.21; p=.006). No significant association was found with specific clinical features such as choroiditis, retinal vasculitis, occlusive vasculitis, and serpiginoid choroiditis (p>.05 for each). Prevalence of TB-uveitis based on treatment response was 1.19%. CONCLUSIONS Our study demonstrates significantly higher prevalence of QFT-G positivity among uveitis patients compared to average US population. Characteristic signs of TB uveitis reported in endemic countries were not seen in this cohort. Implications of higher prevalence of QFT-G positivity among uveitis patients require further investigation.
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8
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Latif N, Janani MK, Sudharshan, Selvamuthu P, Dutta Majumder P. Triple trouble: A case of retinochoroiditis in a patient with syphilis, tuberculosis, and human immunodeficiency virus infection. Indian J Ophthalmol 2021; 68:1995-1997. [PMID: 32823455 PMCID: PMC7690511 DOI: 10.4103/ijo.ijo_2170_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A 31-year-old male patient presented with sudden onset loss of vision in the left eye. Ocular examination revealed significant vitritis with chorioretinitis lesion in the posterior pole. Subsequent investigations revealed positive human immunodeficiency virus (HIV) and syphilis serology; chest imaging revealed active pulmonary tuberculosis. Polymerase chain reaction from aqueous aspirate was positive for Mycobacterium tuberculosis. There was complete resolution of the lesions following antisyphilitic medications, antitubercular therapy along with highly active antiretroviral therapy. Syphilis and tuberculosis coinfection in a previously unknown HIV patient is rare but can occur. It is worthwhile to look for multiple coinfections in HIV patients.
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Affiliation(s)
- Neethu Latif
- Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - M K Janani
- Sankara Nethralaya Referral Laboratory, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sudharshan
- Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
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9
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Pradeep S, Thatikonda D, Nair N, Sudharshan S, Rao C, Biswas J. Tubercular panophthalmitis in a patient with human immunodeficiency virus infection: Proven clinicopathologically and by molecular diagnostic tests. Indian J Ophthalmol 2021; 68:2045-2047. [PMID: 32823475 PMCID: PMC7690524 DOI: 10.4103/ijo.ijo_1190_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ocular tuberculosis (OTB) in patients with human immunodeficiency virus (HIV) commonly presents as choroidal tubercles or granuloma. We report a rare presentation of OTB with hypopyon granulomatous uveitis in a patient with HIV on highly active antiretroviral therapy (HAART). Aqueous humor polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis (MTB). Antitubercular therapy (ATT) was initiated despite which it progressed to scleral abscess and panophthalmitis. Enucleation with ball implantation was done. Histopathology revealed caseating granuloma with numerous acid-fast bacilli (AFB) and real-time PCR showed increased copies of MTB genome. After a full course of ATT, he had stable ocular and systemic condition at final follow-up.
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Affiliation(s)
- Suchitra Pradeep
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Divya Thatikonda
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nivedita Nair
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - S Sudharshan
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Chetan Rao
- Department of Vitreo-retina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
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10
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Betzler BK, Gupta V, Agrawal R. Clinics of ocular tuberculosis: A review. Clin Exp Ophthalmol 2021; 49:146-160. [DOI: 10.1111/ceo.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Vishali Gupta
- Advanced Eye Centre Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
- National Healthcare Group Eye Institute Tan Tock Seng Hospital Singapore Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust London UK
- Singapore Eye Research Institute Singapore Singapore
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11
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Balamurugan S, Gurnani B, Kaur K. Commentry: Ocular coinfections in human immunodeficiency virus infection-What is so different? Indian J Ophthalmol 2020; 68:1997-1998. [PMID: 32823456 PMCID: PMC7690466 DOI: 10.4103/ijo.ijo_680_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- S Balamurugan
- Uvea Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Bharat Gurnani
- Cornea Consultant, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Kirandeep Kaur
- Pediatric Ophthalmology Fellow, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
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12
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Mehta S, Peters RP, Smit DP, Gupta V. Ocular Tuberculosis in HIV-infected Individuals. Ocul Immunol Inflamm 2020; 28:1251-1258. [PMID: 32809898 DOI: 10.1080/09273948.2020.1776882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aim: To review the current literature and publications to assess the clinical features, recommended investigations and treatment for ocular tuberculosis in HIV infected patients. Methods: Literature review. Results: The human immunodeficiency virus (HIV) epidemic affects as many as 37.9 million people. Mycobacterium tuberculosis infection is common in HIV infection and is a leading cause of death and morbidity. Common clinical presentations include anterior uveitis (granulomatous or otherwise), choroidal granulomas/tubercles, chorioretinitis, subretinal abscess, panophthalmitis, retinal detachment and vasculitis. The majority of clinical findings were in the posterior segment, appeared primarily infective (tubercles/chorioretinitis/abscess) and were largely seen in the context of pulmonary tuberculosis or disseminated disease. Current investigational patterns include corroborative tests such as tuberculin skin test or Interferon-γ release assay. Systemic testing includes Computed Tomography, MRI or PET/CT scans. Newer Molecular techniques such as GeneXpert MTB/RIF assay and Line Probe assays (LPA) are increasingly important. Apart from standard ocular anti-inflammatory protocols, anti-tubercular treatment as per the clinical staging (latent or active) needs to be initiated. Initiation of anti-retroviral therapy (ART) is important and can be started soon after ATT. Conclusions: Ocular manifestations within this group are distinct and unique investigational and therapeutic approaches are needed.
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Affiliation(s)
- Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Centre , Mumbai, India
| | - Remco Ph Peters
- Department of Medical Microbiology, University of Pretoria , Pretoria, South Africa.,Department of Medical Microbiology, Maastricht University Medical Centre , Maastricht, The Netherlands.,Foundation for Professional Development, Research Unit , East London, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute , Chandigarh, India
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13
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Antaki F, Javidi S, Touma S, Aubin MJ. Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series. Clin Ophthalmol 2020; 14:3075-3096. [PMID: 33116360 PMCID: PMC7548324 DOI: 10.2147/opth.s265521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To systematically review the characteristics of patients with endogenous tuberculous (TB) endophthalmitis and panophthalmitis in an effort to help clinicians with diagnosis and treatment. Patients and Methods We conducted a systematic literature search in MEDLINE/PubMed, EMBASE and Web of Science from inception to August 2020. References and abstracts were screened independently by two authors. Included studies were case reports and case series reporting endogenous TB endophthalmitis and panophthalmitis secondary to Mycobacterium tuberculosis complex (MTBC). Available-case analysis was employed to handle missing data. Results A total of 1343 articles were found using the search strategy. Following abstract screening, 51 articles were selected for full text-review, from which 26 were deemed eligible for inclusion in the study. Forty-four cases from 26 articles were included in the quantitative analysis. The median age of presentation was 29.5 (range: 1 to 81), and 11/44 patients (25.0%) were pediatric. Immunosuppression was seen in 9/36 cases (25.0%). Most patients (24/38, 63.2%) had no prior history of tuberculosis. Systemic symptoms were absent in half of the patients (16/32, 50.0%). Visual acuity was poor, with 23/27 cases (85.2%) being 20/200 or worse at presentation. Poor organ and visual outcomes were reported: 36/43 cases (83.7%) resulted in enucleation/evisceration or exenteration. Intraocular tumors were suspected in 5/34 cases (14.7%). Pulmonary tuberculosis was seen in 15/35 cases (42.8%), and miliary tuberculosis was seen in 7/35 cases (20.0%). The earliest source of TB diagnosis was through histopathologic specimen after eye removal in 32/44 cases (72.7%), vitreous specimen in 6/44 cases (13.6%) and aqueous specimen in 3/44 cases (6.8%). Conclusion TB endophthalmitis is a rare and sight-threatening manifestation of ocular tuberculosis. It can occur in apparently healthy individuals and can mimic intraocular tumors and other infectious etiologies. Diagnosis remains a significant challenge, which, often delayed, leads to profound visual loss. Early detection and treatment of intraocular tuberculosis may be associated with better ocular and systemic outcomes.
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Affiliation(s)
- Fares Antaki
- Centre Universitaire d'Ophtalmologie (CUO), Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-L'île-de-Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Simon Javidi
- Centre Universitaire d'Ophtalmologie (CUO), Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-L'île-de-Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Samir Touma
- Centre Universitaire d'Ophtalmologie (CUO), Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-L'île-de-Montréal, Montreal, Quebec, Canada
| | - Marie-Josée Aubin
- Centre Universitaire d'Ophtalmologie (CUO), Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-L'île-de-Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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14
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Sudharshan S, Nair N, Curi A, Banker A, Kempen JH. Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy - An update. Indian J Ophthalmol 2020; 68:1787-1798. [PMID: 32823395 PMCID: PMC7690468 DOI: 10.4103/ijo.ijo_1248_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.
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Affiliation(s)
| | - Nivedita Nair
- Department of Uveitis, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Andre Curi
- André Luiz Land Curi, National Institute of Infectious Diseases - INI/ Fiocruz, Brazil
- Clinical Research Laboratory of Infectious, Diseases in Ophthalmology - INI / Fiocruz, Brazil
| | - Alay Banker
- Banker's Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, Ethiopia
- Schepens Eye Research Institute, Boston, Massachusetts, USA
- MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
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15
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"There is more than what meets the eye" - Extensive spinal tuberculosis presenting as ocular tuberculosis. Indian J Tuberc 2020; 67:404-406. [PMID: 32825880 DOI: 10.1016/j.ijtb.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/11/2019] [Accepted: 11/03/2019] [Indexed: 11/24/2022]
Abstract
Ocular tuberculosis (OTB) is a rare form of extrapulmonary Tuberculosis (EPTB) and a rare presenting feature of tuberculosis (TB) in children. We report such a case in a 3-year-old boy who presented with a painless swelling over left upper eyelid. Mycobacterium tuberculosis bacilli were isolated from the swelling by a Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis. Investigating him for the extent of disease, we found him to have intracranial extension to involve the ethmoid sinus on contrast enhance Computed Tomography and Pott's disease causing a compression fracture of L3 with bilateral paravertebral collection, epidural extension and a left psoas abscess on Magnetic Resonance Imaging. After starting antitubercular therapy, the child is doing well and on regular follow up. We are presenting this case to highlight the fact that extensive spinal tuberculosis can present without any neurological deficit and may even present only as a benign looking orbital swelling.
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16
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Testi I, Betzler B, Gupta V, Kon OM, Agrawal R, Pavesio C. Current clinical management of ocular tuberculosis. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1736044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Bjorn Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vishali Gupta
- Advance Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Onn Min Kon
- Chest and Allergy Clinic, St. Mary’s Hospital, Imperial College Healthcare National Health Service Trust, London, UK
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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17
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Jain S, Bajgai P, Kaur S, Dogra M, Sharma A, Sharma K, Katoch D, Dogra MR, Gupta V, Singh R. Ocular Tuberculosis in Human Immunodeficiency Virus and Systemic Tuberculosis Co-infected Patients. Ocul Immunol Inflamm 2020; 29:1002-1006. [PMID: 32083986 DOI: 10.1080/09273948.2020.1714059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the prevalence and clinical findings of ocular tuberculosis (TB) in Human immunodeficiency virus (HIV) and systemic TB co-infected patients.Methods: In this prospective, observational, non-comparative case series, we included HIV and systemic TB co-infected patients, who underwent a detailed ophthalmic and systemic evaluation.Results: Of 85 patients, ocular tuberculosis was seen in eleven patients and their 16 eyes (12.9%). Without the benefit of eye exam, the diagnosis of disseminated TB was missed in 5/52 (9.6%) and 2/25 (8%) of patients clinically assumed to have pulmonary and Extrapulmonary TB, respectively.Conclusion: HIV patients with the disseminated TB have higher risk for ocular TB. As ocular symptoms are rare, still all of them need a detailed ocular examination to look for active ocular TB which will reclassify isolated pulmonary/extrapulmonary to disseminated TB warranting a detailed systemic examination.
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Affiliation(s)
- Sahil Jain
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Bajgai
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Tsirouki T, Steffen J, Dastiridou A, Praidou A, Androudi S. Endophthalmitis in HIV Infection. Ocul Immunol Inflamm 2020; 28:1060-1065. [PMID: 31944150 DOI: 10.1080/09273948.2019.1699580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The role of HIV infection in exogenous and endogenous endophthalmitis has not been clarified. We aim to assess the potential role of HIV as a risk factor or a poor prognostic feature in this sight-threatening condition. Methods: Literature review. Review of evidence: Evidence for endophthalmitis in HIV patients is based on scarce retrospective case series and case reports. Infrequency of literature on this topic is owed to the diversity of the different types of endophthalmitis as well as the rarity of the coexistence of the two conditions. Conclusions: Endophthalmitis in HIV patients are a rare but potentially devastating condition. Many forms of endophthalmitis tend to occur in severely immunosuppressed HIV patients with low CD4 counts. Therefore, the early introduction of cART with full immune reconstitution is an essential part of the prevention of endophthalmitis in the HIV population.
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Affiliation(s)
- Theodora Tsirouki
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Jonel Steffen
- Division of Ophthalmology, University of Cape Town , Cape Town, South Africa
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Anna Praidou
- Department of Ophthalmology, Agios Dimitrios Hospital , Thessaloniki, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
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19
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Bisht D, Pande R. Study of ocular manifestations in tuberculosis and its association with HIV AIDS in a tertiary care hospital. Indian J Tuberc 2019; 67:320-326. [PMID: 32825858 DOI: 10.1016/j.ijtb.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess and understand the prevalence and clinical presentation of ocular morbidity in patients suffering from tuberculosis and compare it with ocular involvement in patients coinfected with tuberculosis and HIV AIDS. MATERIALS AND METHODS This was a non-comparative, observational, cross sectional study done on 580 patients, who were diagnosed cases of tuberculosis, pulmonary or extrapulmonary, on or off treatment, visiting the Ophthalmology OPD, Tuberculosis OPD and ART Centre of the institute in the period from March 2015 to March 2018, screened for ocular morbidity. RESULTS Out of 580, 408 patients had only tuberculosis and 172 had tuberculosis with HIV AIDS. 108 patients were found to have ocular involvement (18.6%) out of which 63 were males and 45 were females. The prevalence of ocular morbidity in patients with only tuberculosis was found to be 16.4% and in those having both tuberculosis and HIV AIDS was found to be 23.8%. CONCLUSION Our study concludes that posterior uveitis, pan uveitis, periphlebitis and vitritis are the most common ocular manifestations in tuberculosis. In patients with both tuberculosis and HIV most common ocular findings included vitritis and herpes zoster ophthalmicus. Our study also concludes that lower CD4 counts (less than 200) in HIV AIDS patient is significantly associated with ocular involvement.
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Affiliation(s)
- Divya Bisht
- Department of Ophthalmology, BJ Government Medical College, Pune, Maharashtra, India.
| | - Ranjana Pande
- Department of Ophthalmology, BJ Government Medical College, Pune, Maharashtra, India
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20
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Ganesh SK, Abraham S, Sudharshan S. Paradoxical reactions in ocular tuberculosis. J Ophthalmic Inflamm Infect 2019; 9:19. [PMID: 31493128 PMCID: PMC6730739 DOI: 10.1186/s12348-019-0183-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/09/2019] [Indexed: 12/18/2022] Open
Abstract
Paradoxical reactions following initiation of anti-tubercular therapy have been documented most often in extrapulmonary tuberculosis. A combination of factors such as delayed hypersensitivity, decreased suppressor mechanisms, and an increased response to mycobacterial antigens mediated by the host’s immune system have been implicated in the development of these reactions. Similar worsening in patients with ocular tuberculosis while on treatment has been described. It is therefore important for the clinician to be aware of this occurrence, as prompt recognition and timely institution of corticosteroids and immunosuppressants can lead to restoration of vision. In these patients, an alteration or discontinuation of anti-tubercular therapy may not be indicated.
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Affiliation(s)
- Sudha K Ganesh
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600 006, India.
| | - Sharanya Abraham
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600 006, India
| | - Sridharan Sudharshan
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600 006, India
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21
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Agrawal R, Gunasekeran DV, Raje D, Agarwal A, Nguyen QD, Kon OM, Pavesio C, Gupta V. Global Variations and Challenges With Tubercular Uveitis in the Collaborative Ocular Tuberculosis Study. Invest Ophthalmol Vis Sci 2019; 59:4162-4171. [PMID: 30120485 DOI: 10.1167/iovs.18-24102] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to examine regional variation management practices and outcomes for tubercular uveitis (TBU). Methods In this retrospective multinational cohort study, patients from 25 international eye care centers diagnosed with TBU with a minimum follow-up of 1 year were included. The geographic variation in treatment outcomes on survival analysis in patients with TBU were analyzed. Treatment failure is defined as a persistence or recurrence of inflammation within 6 months of completing antitubercular therapy, the inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. Results Records of 945 patients (1485 eyes) with TBU were analyzed. The mean age was 41.3 ± 15.0 years (range, 4-90 years), with more males (52.9%, n = 500/945) and predominant Asian ethnicity (74.4%, n = 690/927). Most patients had no symptoms (92.0%, n = 655/712) or history (76.7%, n = 604/787) suggestive of pulmonary tuberculosis (TB). Some patients had evidence of inactive pulmonary TB on chest X-rays (26.9%, n = 189/702) or chest computed tomography (68.6%, n = 109/159). Patients with western geographic origin (log-rank = 6.47, P = 0.010), African or Hispanic ethnicity (log-rank = 19.9, P < 0.001), and positive immigrant status (log-rank = 4.89, P = 0.027) had poorer survival outcomes. Conclusions This is a first-ever multinational analysis of TBU that highlights regional differences in treatment outcomes for this elusive form of extrapulmonary TB. Our findings will help in the design of future collaborative studies together with internists to develop best practice guidelines for this early opportunity to address TB infection and strategies to target at-risk groups such as immigrants.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom.,Singapore Eye Research Institute, Singapore
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom.,School of Medicine, National University of Singapore, Singapore
| | | | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Onn Min Kon
- Chest and Allergy Clinic, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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22
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Korotkih SA, Sabadash EV, Medvinskiy ID, Skornyakov SN, Chernenko MA, Demin AP, Novikov BI. [Diagnostics of early signs of ocular pathology in patients with HIV/tuberculosis co-infection]. Vestn Oftalmol 2019; 135:61-69. [PMID: 31714514 DOI: 10.17116/oftalma201913505161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The current epidemic situation in Russia is characterized by increasing rate of co-infection (HIV/tuberculosis). Damage to the organ of vision is more common among patients with this pathology, presenting significant difficulties in diagnosis of the ophthalmic manifestations. High-tech imaging method - optical coherence tomography (OCT) allows exploration of the eye tissues with high accuracy and depth, as well as evaluation of the structure of the choroid and microcirculation parameters of the anterior and posterior eye segments.
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Affiliation(s)
- S A Korotkih
- Partsyezda St., Ekaterinburg, Russian Federation, 620039 ,Ural State Medical University, 3 Repina St., Ekaterinburg, Russian Federation, 620028
| | - E V Sabadash
- Ural Research Institute of Phthisiopulmonology of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, 50, 22; Partsyezda St., Ekaterinburg, Russian Federation, 620039 ,Ural State Medical University, 3 Repina St., Ekaterinburg, Russian Federation, 620028
| | - I D Medvinskiy
- Ural Research Institute of Phthisiopulmonology of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, 50, 22; Partsyezda St., Ekaterinburg, Russian Federation, 620039 ,Ural State Medical University, 3 Repina St., Ekaterinburg, Russian Federation, 620028
| | - S N Skornyakov
- Ural Research Institute of Phthisiopulmonology of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, 50, 22; Partsyezda St., Ekaterinburg, Russian Federation, 620039 ,Ural State Medical University, 3 Repina St., Ekaterinburg, Russian Federation, 620028
| | - M A Chernenko
- Ural Research Institute of Phthisiopulmonology of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, 50, 22; Partsyezda St., Ekaterinburg, Russian Federation, 620039 ,Ural State Medical University, 3 Repina St., Ekaterinburg, Russian Federation, 620028
| | - A P Demin
- Ural Research Institute of Phthisiopulmonology of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, 50, 22
| | - B I Novikov
- Ural Research Institute of Phthisiopulmonology of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, 50, 22
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23
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Gupta SB, Verma D, Singh DP. Case Study. Ophthalmology 2018. [DOI: 10.4018/978-1-5225-5195-9.ch008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In the developing countries, incidence of systemic tuberculosis is very high, with over 8 million new cases each year. The incidence of tuberculous uveitis is also rising correspondingly. It is difficult to diagnose ocular tuberculosis because of the lack of specific ocular findings and specific confirmatory laboratory tests. However, in a developing country like India, where the prevalence of latent tuberculosis is high, uveitis of unexplained cause not fitting into known uveitis entities, in presence of Monteux positivity, is more likely to be tubercular in origin. Hence, early diagnosis and prompt treatment with antitubercular treatment may result in dramatic drop in recurrence and improve individual patient outcomes.
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Affiliation(s)
| | - Divya Verma
- Department of Ophthalmology, L.N. Medical College, Bhopal, India
| | - D. P. Singh
- Department of Ophthalmology, L.N. Medical College, Bhopal, India
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24
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Agrawal R, Gunasekeran DV, Grant R, Agarwal A, Kon OM, Nguyen QD, Pavesio C, Gupta V. Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)-1. JAMA Ophthalmol 2017; 135:1318-1327. [PMID: 29075752 PMCID: PMC6583556 DOI: 10.1001/jamaophthalmol.2017.4485] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/11/2017] [Indexed: 12/25/2022]
Abstract
Importance Eradication of systemic tuberculosis (TB) has been limited by neglected populations and the HIV pandemic. Whereas ocular TB often presents as uveitis without any prior evidence of systemic TB, the existing uncertainty in the diagnosis of TB uveitis may perpetuate missed opportunities to address systemic TB. Objective To examine the clinical features of TB uveitis and the associations with response to antitubercular therapy (ATT). Design, Setting, and Participants This retrospective multinational cohort study included patients from 25 ophthalmology referral centers diagnosed with TB uveitis and treated with ATT from January 1, 2004, through December 31, 2014, with a minimum follow-up of 1 year. Main Outcomes and Measures Treatment failure, defined as a persistence or recurrence of inflammation within 6 months of completing ATT, inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. Results A total of 801 patients (1272 eyes) were studied (mean [SD] age, 40.5 [14.8] years; 413 [51.6%] male and 388 [48.4%] female; 577 [73.6%] Asian). Most patients had no known history (498 of 661 [75.3%]) of systemic TB. Most patients had bilateral involvement (471 of 801 [58.8%]). Common clinical signs reported include vitreous haze (523 of 1153 [45.4%]), retinal vasculitis (374 of 874 [42.8%]), and choroidal involvement (419 of 651 [64.4%]). Treatment failure developed in 102 of the 801 patients (12.7%). On univariate regression analysis, the hazard ratios (HRs) associated with intermediate uveitis (HR, 2.21; 95% CI, 1.07-4.55; P = .03), anterior uveitis (HR, 2.68; 95% CI, 1.32-2.35; P = .006), and panuveitis (HR, 3.28; 95% CI, 1.89-5.67; P < .001) were significantly higher compared with posterior distribution. The presence of vitreous haze had a statistically significant association (HR, 1.95; 95% CI, 1.26-3.02; P = .003) compared with absence of vitreous haze. Bilaterality had an associated HR of 1.50 (95% CI, 0.96-2.35) compared with unilaterality (HR, 1 [reference]), although this finding was not statistically significant (P = .07). On multivariate Cox proportional hazards regression analysis, the presence of vitreous haze had an adjusted HR of 2.98 (95% CI, 1.50-5.94; P = .002), presence of snow banking had an adjusted HR of 3.71 (95% CI, 1.18-11.62; P = .02), and presence of choroidal involvement had an adjusted HR of 2.88 (95% CI, 1.22-6.78; P = .02). Conclusions and Relevance A low treatment failure rate occurred in patients with TB uveitis treated with ATT. Phenotypes and test results are studied whereby patients with panuveitis having vitreous and choroidal involvement had a higher risk of treatment failure. These findings are limited by retrospective methods. A prospectively derived composite clinical risk score might address this diagnostic uncertainty through holistic and standardized assessment of the combinations of clinical features and investigation results that may warrant diagnosis of TB uveitis and treatment with ATT.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
- Singapore Eye Research Institute, Singapore
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
- School of Medicine, National University of Singapore, Singapore
| | - Robert Grant
- Faculty of Health, Social Care, and Education, Kingston University and St George’s, University of London, London, England
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare, National Health Service Trust, London, England
| | | | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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25
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Darian-Smith E, Lin ML, Lim LL, McCluskey P, Hall AJ. The Incidence of Ocular Tuberculosis in Australia Over the Past 10 Years (2006-2015). Ophthalmic Epidemiol 2017; 24:406-412. [PMID: 28901810 DOI: 10.1080/09286586.2017.1336562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the incidence and clinical phenotype of ocular tuberculosis in Australia based on the mandatory jurisdictional health notification records for TB. METHODS A whole population retrospective case series (Australia). Patients diagnosed with ocular tuberculosis were identified over the past 10 years (1 January 2006 to 31 December 2015) as recorded by individual Health Department jurisdictions per mandatory health notifications. The incidence rates were calculated based on the available Australian census data. Incidence rates were age and sex standardized. RESULTS A total of 162 cases of ocular tuberculosis were identified across Australia over a 10-year time period. Of these, 156 participants were overseas born. The 10-year Australian incidence of ocular tuberculosis was 0.77 per 100,000 people. While there has been a downward trend in overall TB annual incidence rates from 2010 to 2015, over the same period the annual incidence of ocular TB has increased compared to the 4 previous years. Descriptive clinical data regarding the ocular manifestations of TB was available in 73/157 patients. In these 73 patients the commonest manifestations of ocular TB were unspecified uveitis (50.1%), focal, multifocal or serpiginous choroiditis or chorioretinitis (12.3%) and retinal vasculitis (11.0%). Of patients with ocular TB, 4/162 (2.47%) had associated pulmonary TB and 8/162 (4.94%) had associated systemic (non-pulmonary) TB. Systemic anti-TB therapy was administered to 161 patients. CONCLUSIONS The annual Australian incidence of ocular tuberculosis was 0.077 per 100,000 people. Increasing notifications in the past 6 years may demonstrate increased awareness and changing diagnostic criteria of the disease in the Australian population.
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Affiliation(s)
- Erica Darian-Smith
- a Department of Ophthalmology , Alfred Hospital , Melbourne , Victoria , Australia.,b School of Medicine, University of Tasmania , Hobart , Tasmania
| | - Ming-Lee Lin
- a Department of Ophthalmology , Alfred Hospital , Melbourne , Victoria , Australia.,d Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Lyndell L Lim
- d Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.,f Centre for Eye Research Australia , University of Melbourne, Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Peter McCluskey
- e Save Sight Institute Discipline of Ophthalmology , Sydney Medical School, University of Sydney , Camperdown , New South Wales , Australia
| | - Anthony J Hall
- a Department of Ophthalmology , Alfred Hospital , Melbourne , Victoria , Australia.,c Department of Surgery , Monash University , Clayton , Victoria , Australia
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Abstract
Ocular tuberculosis is an extrapulmonary mycobacterial infection with variable manifestations. The reported incidence of ocular involvement varies considerably, depending on the criteria used for diagnosis and the population sampled. However, tuberculosis is thought to affect the lungs in 80% of patients, with the remaining 20% being affected in other organs, such as the eye. It is imperative for physicians to consider this diagnosis in their differential, as ocular tuberculosis can present in a fashion similar to that of more common conditions causing ocular inflammation. In addition, prompt recognition of the clinical signs and symptoms leads to quicker initiation of antituberculosis therapy.
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Kalogeropoulos D, Kitsos G, Konstantinidis A, Gartzonika C, Svarna E, Malamos K, Katsanevakis E, Kalogeropoulos C. Tuberculous Posterior Sclero-Uveitis with Features of Vogt-Koyanagi-Harada Uveitis: An Unusual Case. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:367-374. [PMID: 28389634 PMCID: PMC5391803 DOI: 10.12659/ajcr.903304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient: Male, 32 Final Diagnosis: Ocular tuberculosis (tuberculous posterior sclero-uveitis with features of Vogt-Koyanagi-Harada uveitis) Symptoms: Pain and progressive visual impairment of his left eye Medication: Systemic anti-tuberculosis treatment (6-month course) Clinical Procedure: Thorough ophthalmological and systemic exploration Specialty: Ophthalmology
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - George Kitsos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Athanasios Konstantinidis
- Department of Pulmonology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Ioannina, Greece
| | - Constantina Gartzonika
- Laboratory of Microbiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Evgenia Svarna
- Department of Radiology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Emmanouil Katsanevakis
- School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Paez Soria E, Magnano P, Schlaen A, Luvini P, Arevalo Calderon G, Martinez Cartier M, Chiaradía P, Couto C. Tuberculous Subretinal Abscess in a Non-HIV Patient with Miliary Tuberculosis. Case Rep Ophthalmol 2016; 7:292-300. [PMID: 28101049 PMCID: PMC5216240 DOI: 10.1159/000453447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022] Open
Abstract
This case report describes the features of a tuberculous subretinal abscess in a non-HIV patient. It includes the characterization of the lesion with spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence examination. SD-OCT and autofluorescence imaging showed external retinal involvement during development of the tuberculous subretinal abscess. Patients with tuberculous lesions need a multidisciplinary approach, since the disease may involve any part of the body. In this case in particular, incidental findings at computed tomography scan led to the detection of this rare ocular manifestation of tuberculous disease.
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Affiliation(s)
- Eugenia Paez Soria
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Paula Magnano
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Ariel Schlaen
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
- *Dr. Ariel Schlaen, Department of Ophthalmology, University of Buenos Aires, Arenales 981 2do Piso, Buenos Aires C1061AAE (Argentina), E-Mail
| | - Paula Luvini
- Department of Internal Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Pablo Chiaradía
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Cristóbal Couto
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
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Smit D, Meyer D. Classification of Intraocular Tuberculosis: A South African Perspective. Ocul Immunol Inflamm 2016; 26:827-829. [PMID: 27925838 DOI: 10.1080/09273948.2016.1254248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Derrick Smit
- a Division of Ophthalmology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - David Meyer
- a Division of Ophthalmology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Jain S, Bajgai P, Tigari B, Sharma K, Sharma A, Gupta V, Singh R. Bevacizumab for paradoxical worsening treatment adjunct in HIV patient with choroidal tuberculoma. J Ophthalmic Inflamm Infect 2016; 6:42. [PMID: 27822744 PMCID: PMC5099299 DOI: 10.1186/s12348-016-0112-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/28/2016] [Indexed: 12/05/2022] Open
Abstract
The use of anti-tubercular therapy (ATT) along with anti-retroviral therapy (ART) in human immunodeficiency virus-tuberculosis (HIV-TB) co-infected individuals could at times lead to paradoxical worsening due to an increase in the inflammatory activity due to immune reconstitution inflammatory syndrome (IRIS) in the eye. This is characterized by anterior and posterior segment inflammatory reactions which may occur in the form of serous retinal detachment. We describe a case where the use of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agent led to resolution of the serous retinal detachment, which had failed to respond to other common modalities of treatment. An HIV-TB co-infected 18-year-old, male patient, who was started on ART and ATT developed IRIS in the form of worsening of serous retinal detachment around a pre-existent asymptomatic tuberculoma. The patient was initially treated with oral and topical steroids without a satisfactory response. Intravitreal bevacizumab was then tried for this patient. Serial fundus photos and optical coherence tomography (OCT) taken before and after treatment showed complete resolution of the serous retinal detachment with two doses of intravitreal bevacizumab. Intravitreal anti-VEGF agents may have a role in the reversal of serous retinal detachment, which occurs as a part of IRIS in HIV-tuberculosis co-infected individuals who have been started on anti-tubercular and anti-retroviral therapies.
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Affiliation(s)
- Sahil Jain
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Priya Bajgai
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Basavaraj Tigari
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kusum Sharma
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Aman Sharma
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
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Gupta P, Singh R, Gupta S, Kumar A, Kakkar N. Tuberculosis presenting as posttraumatic panophthalmitis. Oman J Ophthalmol 2016; 9:52-4. [PMID: 27013830 PMCID: PMC4785710 DOI: 10.4103/0974-620x.176102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Panophthalmitis is one of rare manifestations of tuberculosis described in atypical situations such as children, immune compromised patients, or drug abuse. The present report describes the first case of tubercular panophthalmitis developing after trauma in an otherwise healthy adult patient. A 46-year-old female patient presented with corneal infiltrate and endophthalmitis that developed after an injury to right eye with wooden object. Corneal scrapings and vitreous tap were sterile. The patient did not improve with antibiotics and developed panophthalmitis. On evisceration of the painful blind eye, histopathology showed the presence of granulomatous inflammation and acid-fast bacilli. The patient had no other systemic focus of tubercular infection. The patient was managed with anti-tubercular therapy for 6 months. Atypical presentations of tuberculosis like panophthalmitis pose a difficult problem in diagnosis as well as treatment. Direct inoculation of bacilli during trauma is a rare source of infection. This case report presents unusual development of tubercular panophthalmitis following direct inoculation of bacilli during trauma. Ocular tuberculosis should be considered in differential diagnosis of posttraumatic endophthalmitis and panophthalmitis, especially in endemic regions like India.
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Affiliation(s)
- Pankaj Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suruchi Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhiraj Kumar
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Tuberculous Panophthalmitis with Lymphadenitis and Central Nervous System Tuberculoma. Case Rep Infect Dis 2016; 2016:6785382. [PMID: 27051539 PMCID: PMC4804051 DOI: 10.1155/2016/6785382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis (TB) is a serious infectious disease that spreads globally. The ocular manifestations of TB are uncommon and diverse. TB panophthalmitis has been rarely reported. Here, we described a 38-year-old Thai man presenting with panophthalmitis of the right eye. Further investigation showed that he had concurrent TB lymphadenitis and central nervous system (CNS) tuberculoma, as well as HIV infection, with a CD4 cell count of 153 cells/mm3. Despite the initial response to antituberculous agents, the disease had subsequently progressed and enucleation was required. The pathological examination revealed acute suppurative granulomatous panophthalmitis with retinal detachment. Further staining demonstrated acid-fast bacilli in the tissue. Colonies of Mycobacterium tuberculosis were obtained from tissue culture. He was treated with antiretroviral agents for HIV infection and 12 months of antituberculous agents. Clinicians should be aware of the possibility of TB in the differential diagnosis of endophthalmitis and panophthalmitis, especially in regions where TB is endemic.
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Gupta B, Agrawal R, Swampillai AJ, Lim RHF, Kee A, Gunasekaran D, Pavesio C. Ocular manifestations of tuberculosis: an update. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1152887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Heiden D, Saranchuk P, Keenan JD, Ford N, Lowinger A, Yen M, McCune J, Rao NA. Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS. THE LANCET. INFECTIOUS DISEASES 2016; 16:493-9. [PMID: 26907735 DOI: 10.1016/s1473-3099(15)00269-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/29/2015] [Accepted: 08/10/2015] [Indexed: 02/04/2023]
Abstract
Choroidal tuberculosis is present in 5-20% of patients with disseminated tuberculosis, and point-of-care dilated binocular indirect ophthalmoscopy eye examination can provide immediate diagnosis. In geographical areas of high tuberculosis prevalence and in susceptible patients (CD4 counts less than 200 cells per μL) detection of choroidal granulomas should be accepted as evidence of disseminated tuberculosis. With training and proper support, eye screening can be done by HIV/AIDS clinicians, allowing early tuberculosis treatment. In regions with a high burden of tuberculosis, we recommend that eye screening be a standard part of the initial assessment of susceptible patients, including at a minimum all patients with HIV/AIDS with CD4 less than 100 cells per μL with or without eye symptoms, and with or without suspicion of disseminated tuberculosis.
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Affiliation(s)
| | - Peter Saranchuk
- Southern Africa Medical Unit, Operational Centre Brussels, Médecins Sans Frontières, Cape Town, South Africa
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Alan Lowinger
- Tufts University School of Medicine, Boston, MA, USA
| | - Michael Yen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph McCune
- Division of Experimental Medicine, University of California, San Francisco, CA, USA
| | - Narsing A Rao
- Ophthalmic Pathology Laboratory and Uveitis Service, USC Eye Institute, Keck School of Medicine, University of Southern California, CA, USA
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Agrawal R, Gupta B, González-López JJ, Cardoso J, Triantafullopoulou I, Grant R, Addison PKF, Westcott M, Pavesio CE. Spectrum of Choroidal Involvement in Presumed Ocular Tuberculosis: Report from a Population with Low Endemic Setting for Tuberculosis. Ocul Immunol Inflamm 2016; 25:97-104. [DOI: 10.3109/09273948.2015.1087577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Bhaskar Gupta
- Royal Devon and Exeter NHS Trust, Barrack Road, Exeter, UK
| | - Julio J. González-López
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, UK
| | - João Cardoso
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | - Robert Grant
- St. George’s, University of London & Kingston University, London, UK
| | | | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Carlos E. Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
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Dalvin LA, Smith WM. Orbital and external ocular manifestations of Mycobacterium tuberculosis: A review of the literature. J Clin Tuberc Other Mycobact Dis 2015; 4:50-57. [PMID: 31723688 PMCID: PMC6850259 DOI: 10.1016/j.jctube.2015.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/07/2015] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis that most commonly affects the lungs. However, extrapulmonary manifestations of TB can affect the eye and surrounding orbital tissues. TB can affect nearly any tissue in the eye, and a high index of suspicion is required for accurate diagnosis. Systemic anti-tuberculosis treatment is required in cases of ocular TB, and steroids are sometimes necessary to prevent tissue damage secondary to inflammation. Delays in diagnosis are common and can result in morbidities such as loss of an affected eye. It is important for ophthalmologists and infectious disease specialists to work together to accurately diagnose and treat ocular TB in order to prevent vision loss. This article reports the various known presentations of orbital and external ocular TB and reviews important elements of diagnosis and treatment.
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Affiliation(s)
- Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Wendy M Smith
- Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Rangel CM, Prada AM, Varon C, Merayo-Lloves J. Immune recovery uveitis in a patient with previously undiagnosed cytomegalovirus retinitis. BMJ Case Rep 2015; 2015:bcr-2015-212095. [PMID: 26531739 DOI: 10.1136/bcr-2015-212095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A 40-year-old man presented to the emergency service of the Department of Ophthalmology, Fundación Oftalmológica de Santander, Floridablanca, Colombia, with blurred vision in his right eye. Anamnesis revealed that he also had newly diagnosed stage C HIV. He had recently started highly active antiretroviral therapy (HAART). Examination disclosed intraocular inflammation, along with plain white peripheral non-exudative lesions with sparse haemorrhaging. The differential diagnosis included cytomegalovirus (CMV) retinitis and immune recovery uveitis (IRU). On follow-up, the patient's left eye presented with decreased visual acuity and increased vitreous haze. A vitrectomy with vitreous tap was performed for microbiological studies. PCR for CMV in the vitreous sample was negative. The patient was discharged with the final diagnosis of IRU. In HIV patients with uveitis, the knowledge of characteristic signs and symptoms of particular entities such as opportunistic infections and IRU will enable the clinician to give the appropriate treatment.
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Affiliation(s)
| | - Angélica M Prada
- Department of Ophthalmology, Fundación Oftalmológica de Santander (FOSCAL)/Universidad Autónoma de Bucaramanga, Floridablanca, Santander, Colombia
| | - Clara Varon
- Department of Ophthalmology, Fundación Oftalmologica de Santander, Floridablanca, Santander, Colombia
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Spectral domain optical coherence tomography imaging of tubercular chorioretinitis and intraretinal granuloma. Intraretinal tuberculosis: a case report. Int Ophthalmol 2015; 35:445-50. [DOI: 10.1007/s10792-015-0061-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
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Gupta V, Shoughy SS, Mahajan S, Khairallah M, Rosenbaum JT, Curi A, Tabbara KF. Clinics of Ocular Tuberculosis. Ocul Immunol Inflamm 2015; 23:14-24. [DOI: 10.3109/09273948.2014.986582] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gupta A, Sharma A, Bansal R, Sharma K. Classification of Intraocular Tuberculosis. Ocul Immunol Inflamm 2014; 23:7-13. [DOI: 10.3109/09273948.2014.967358] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Mehta S, Mansoor H, Khan S, Saranchuk P, Isaakidis P. Ocular inflammatory disease and ocular tuberculosis in a cohort of patients co-infected with HIV and multidrug-resistant tuberculosis in Mumbai, India: a cross-sectional study. BMC Infect Dis 2013; 13:225. [PMID: 23687908 PMCID: PMC3661345 DOI: 10.1186/1471-2334-13-225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 05/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART). METHODS Lilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation of HIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations. RESULTS Between February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158-361). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of seven patients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). 'These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%). Patients with extrapulmonary TB and patients<39 years old were at significantly higher risk of having ocular TB [Risk Ratio: 13.65 (95% CI: 2.4-78.5) and 6.38 (95% CI: 1.05-38.8) respectively]. CONCLUSIONS Ocular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai, India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.
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Affiliation(s)
- Salil Mehta
- Ophthalmology Department, Lilavati Hospital and Research Centre, Mumbai, India
| | | | | | - Peter Saranchuk
- South African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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Sudharshan S, Kaleemunnisha S, Banu AA, Shrikrishna S, George AE, Babu BR, Devaleenal B, Kumarasamy N, Biswas J. Ocular lesions in 1,000 consecutive HIV-positive patients in India: a long-term study. J Ophthalmic Inflamm Infect 2013; 3:2. [PMID: 23514612 PMCID: PMC3589206 DOI: 10.1186/1869-5760-3-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 11/16/2022] Open
Abstract
Background Ocular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern. Although they have been described in the Western population, there are not many such studies in the HAART era from India. This study aims to present the clinical profile, systemic correlation, and visual outcome in HIV-positive patients in relation to HAART in comparison with pre-HAART Indian studies and current Western data. Ocular findings and systemic correlation in 1,000 consecutive patients with HIV seen at a tertiary eye care center were analyzed. This study uses a prospective observational case series design. Results Age range of the patients was 1.5 to 75 years. Ocular lesions were seen in 68.5% of the patients (cytomegalovirus (CMV) retinitis was the commonest). The commonest systemic disease was pulmonary TB. Mean interval between HIV diagnosis and onset of ocular lesions was 2.43 years. CD4 counts range from 2 to 1,110 cells/mm3. Immune recovery uveitis (IRU) was seen in 17.4%. Interval between HAART initiation and IRU was 4 months to 2.5 years. Recurrence of ocular infection was seen in 2.53% (post-HAART) and > 20% (pre-HAART). Overall visual outcome showed improvement in about 14.3% and was maintained in 71.6% of the patients. Conclusions CMV retinitis is the commonest ocular opportunistic infection in India, even in the HAART era. Newer manifestations of known diseases and newer ocular lesions are being seen. In contrast to Western studies, in our patients on HAART, ocular lesions do not always behave as in immunocompetent individuals. Ocular TB needs to be kept in mind in India, as well as other neuro-ophthalmic manifestations related to cryptococci, especially in gravely ill patients. Occurrence and frequency of various ocular opportunistic infections in developing nations such as India have significant variations from those reported in Western literature and need to be managed accordingly.
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Affiliation(s)
- Sridharan Sudharshan
- Medical Research Foundation, 18, College Road, Sankara Nethralaya, Chennai, 600006, India.
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Abstract
ABSTRACT
Intraocular tuberculosis remains a major diagnostic challenge and it is extremely important to establish the diagnosis as the specific treatment helps in reducing the recurrences, thus reducing ocular morbidity. The present review aims to describe the global epidemiology and pathogenesis of intraocular tuberculosis with clinical spectrum and different presentations. The challenges in establishing the diagnosis with role of conventional tests like PPD skin test as well as current diagnostic tests including interferon gamma release assay and molecular diagnostic tests are discussed. The treatment requires anti-tuberculosis therapy with the use of concomitant corticosteroids and carries good prognosis provided the treatment is started in the early stage.
How to cite this article
Parchand S, Gupta V, Gupta A, Sharma A. Intraocular Tuberculosis. J Postgrad Med Edu Res 2013;47(4):193-201.
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An unusual cause of visual impairment in tuberculous meningitis. J Neurol Sci 2012; 318:174-7. [PMID: 22541255 DOI: 10.1016/j.jns.2012.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/29/2012] [Accepted: 04/02/2012] [Indexed: 11/21/2022]
Abstract
Impairment of vision is a devastating complication of tuberculous meningitis which may occur as a result of increased intracranial pressure, compression over the visual pathways or vasculitis. We herein present occurrence of neuroretinitis in a 35-year-old lady presenting with low grade fever and headache for one month, and associated with diminution of vision from 3 weeks. She was diagnosed as a case of definite tuberculous meningitis and initiated on anti-tuberculous treatment as per WHO guidelines with supplemental corticosteroids. Marked improvement in vision was observed and at 3 months of follow-up the patient was asymptomatic. Direct ophthalmoscopy, visual field analysis, fluorescein angiography, optical coherence tomography and magnetic resonance imaging of the brain were done to document the ophthalmological findings. Neuroretinitis, being an unusual cause of visual impairment in tuberculous meningitis, must be considered in patients without any evidence of raised intracranial pressure or compression, and with normal fluorescein angiography. We suggest that neuroretinitis may be added to list of causes of visual impairment in patients with tuberculous meningitis.
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Papineni P, Saunders J, Papageorgiou K, Westcott M, Noble H. Tuberculous choroidal granuloma in an HIV-positive patient. Int J STD AIDS 2012; 23:379-80. [PMID: 22648901 DOI: 10.1258/ijsa.2009.009148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of a 34-year-old HIV-positive patient undergoing treatment for pulmonary and lymph node Mycobacterium tuberculosis infection, who developed loss of vision secondary to a tuberculous choroidal granuloma.
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