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Helal RS, Attia S, Al-Baker ZM, Al-Shweiki S, Abu Sbeit R, Abukhattab M, Abdulla N, Khairallah M. The Spectrum of Presumed Tubercular Uveitis in a Referral Eye Clinic in Qatar. Ocul Immunol Inflamm 2024:1-8. [PMID: 38981050 DOI: 10.1080/09273948.2024.2368668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE To analyze the clinical spectrum of patients with presumed tubercular uveitis in a referral eye clinic in Qatar. METHODS We retrospectively reviewed the clinical records of 50 patients (80 eyes) diagnosed with presumed ocular tuberculosis who presented to the uveitis clinic, department of Ophthalmology Hamad Medical Corporation, Qatar, from January 2014 till December 2019. RESULTS Mean age at presentation was 34.5 ± 9.3 years. Forty one patients were males (82%) and 30 patients had bilateral involvement (60%). Forty eyes (50%) had posterior uveitis, 21 eyes (26.3%) intermediate uveitis, 11 eyes (13.7%) panuveitis, and 8 eyes (10%) anterior uveitis. Ocular findings included vitritis in 82.5% of eyes, retinal vasculitis in 46.3% (92% of which were occlusive in nature), multifocal choroiditis in 18.8%, serpiginous-like choroiditis in 11.3%, Most common complications at presentation or during follow-up included macular edema in 32 eyes (40%), preretinal or optic disc neovascularization in 29 eyes (36.3%) and vitreous hemorrhage in 17 eyes (21.3%). Anti-tubercular treatment was provided to 46 patients (92%). Systemic corticosteroids and corticosteroid sparing agents were associated, respectively, in 39 patients (78%) and 14 patients (28%). After 1 year of follow up, inflammation was controlled, with a significant improvement in visual acuity (p < 0.0001). CONCLUSIONS In Qatar, tubercular uveitis has a broad spectrum of ocular features, with posterior and intermediate uveitis being the most common anatomic forms. Vitritis, multifocal choroiditis without or with a serpiginous-like pattern, and occlusive retinal vasculitis are the most common ocular findings. Main sight-threatening ocular complications are macular edema, posterior segment neovascularization, and vitreous hemorrhage.
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Affiliation(s)
| | - Sonia Attia
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | | | | | - Rami Abu Sbeit
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar
| | | | - Nabeel Abdulla
- Department of Rheumatology, Hamad Medical Corporation, Doha, Qatar
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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2
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Tsui JK, Poon SHL, Fung NSK. Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series. Trop Dis Travel Med Vaccines 2023; 9:20. [PMID: 37964356 PMCID: PMC10648364 DOI: 10.1186/s40794-023-00205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Ocular tuberculosis (TB) affects 1-2% of patients with TB, with TB uveitis being the most common. This series aims to look at different manifestations of tuberculosis associated uveitis and the different tests used to make a presumptive or definitive diagnosis. METHODS Patients diagnosed with TB related uveitis in Hong Kong SAR between 2017 and 2020 were reviewed. Demographics, clinical features, investigations and treatments of patients were collected. RESULTS Fifteen eyes in 10 patients with a mean age 57.30 ± 10.17 years were included. The ocular manifestations on presentation included anterior uveitis (50%), posterior uveitis (40%) and panuveitis (10%), where 70% of them were unilateral and 30% were bilaterally infected; on subsequent visits the manifestations further developed into posterior uveitis (40%), panuveitis (40%) and anterior uveitis (20%), where 50% of them were unilateral and 50% bilateral infected. Tuberculosis tests were positive in 5 out of 7 Mantoux tests, 4 out of 4 T-SPOT TB tests, 3 out of 4 QuantiFERON-TB gold tests, 1 out of 1 lymph node biopsy, 0 out of 9 chest x-rays, and no aqueous fluid polymerase chain reaction (PCR) was tested. Vision impairing complications were seen in 6 patients where retinal vasculitis was most commonly seen. With anti-TB treatment prescribed in 9 patients, side effects occurred in 5 patients, including ocular hypertension, disc swelling, and hepatitis. CONCLUSIONS Ocular TB infections may manifest in various forms, and can involve different parts of the eye. Bilateral involvement of TB is commonly presented, and both eyes should be evaluated at every follow up. When TB is suspected in a patient, diagnostic confirmation requires multimodal investigations where a negative chest x-ray is not useful in ruling out ocular TB infections, especially in an endemic region like Hong Kong. In these patients, it is crucial to have a high index of suspicion for TB, even when they do not demonstrate classical respiratory signs and symptoms of TB.
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Affiliation(s)
- Jennifer Ks Tsui
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR, China
| | - Stephanie Hiu Ling Poon
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR, China
| | - Nicholas Siu Kay Fung
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR, China.
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3
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Putera I, Schrijver B, Ten Berge JCEM, Gupta V, La Distia Nora R, Agrawal R, van Hagen PM, Rombach SM, Dik WA. The immune response in tubercular uveitis and its implications for treatment: From anti-tubercular treatment to host-directed therapies. Prog Retin Eye Res 2023:101189. [PMID: 37236420 DOI: 10.1016/j.preteyeres.2023.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023]
Abstract
Tubercular uveitis (TB-uveitis) remains a conundrum in the uveitis field, which is mainly related to the diverse clinical phenotypes of TB-uveitis. Moreover, it remains difficult to differentiate whether Mycobacterium tuberculosis (Mtb) is present in the ocular tissues, elicits a heightened immune response without Mtb invasion in ocular tissues, or even induces an anti-retinal autoimmune response. Gaps in the immuno-pathological knowledge of TB-uveitis likely delay timely diagnosis and appropriate management. In the last decade, the immunopathophysiology of TB-uveitis and its clinical management, including experts' consensus to treat or not to treat certain conditions with anti-tubercular treatment (ATT), have been extensively investigated. In the meantime, research on TB treatment, in general, is shifting more toward host-directed therapies (HDT). Given the complexities of the host-Mtb interaction, enhancement of the host immune response is expected to boost the effectiveness of ATT and help overcome the rising burden of drug-resistant Mtb strains in the population. This review will summarize the current knowledge on the immunopathophysiology of TB-uveitis and recent advances in treatment modalities and outcomes of TB-uveitis, capturing results gathered from high- and low-burden TB countries with ATT as the mainstay of treatment. Moreover, we outline the recent progress of HDT development in the pulmonary TB field and discuss the possibility of its applicability to TB-uveitis. The concept of HDT might help direct future development of efficacious therapy for TB-uveitis, although more in-depth research on the immunoregulation of this disease is still necessary.
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Affiliation(s)
- Ikhwanuliman Putera
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Benjamin Schrijver
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Vishali Gupta
- Retina and Uvea Services, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rina La Distia Nora
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke NUS University, Singapore; Singapore Eye Research Institute, Singapore; Moorfields Eye Hospital, London, United Kingdom
| | - P Martin van Hagen
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S M Rombach
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Willem A Dik
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
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4
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Betzler BK, Putera I, Testi I, La Distia Nora R, Kempen J, Kon OM, Pavesio C, Gupta V, Agrawal R. Anti-tubercular therapy in the treatment of tubercular uveitis: A systematic review and meta-analysis. Surv Ophthalmol 2023; 68:241-256. [PMID: 36272559 DOI: 10.1016/j.survophthal.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
We quantitatively evaluated the efficacy of antitubercular therapy (ATT) in tubercular uveitis (TBU) patients. Main outcome measures include inflammation recurrence, inflammation reduction, complete resolution of inflammation, improved visual acuity (VA), ability to taper corticosteroids to < 10 mg/day without inflammatory progression, and use of adjunctive immunosuppressants while on ATT. This review is prospectively registered in PROSPERO (CRD42020206845). Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI:0.19-0.60) for TBU patients treated with ATT±corticosteroid versus no ATT. For TBU patients treated with ATT±corticosteroid, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation, and visual acuity improvement were 13% (n=310/2,216; 95%CI:9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI:51-78), respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI:78-99) of patients, 9% (n=121/1,376; 95%CI:6-13) of whom were administered concomitant immunosuppressive agents alongside ATT. We conclude that treatment of TBU with ATT±corticosteroid is associated with a high level of control or improvement of inflammation. More prospective studies with detailed reporting of ATT regimens, patient subgroups, and outcomes are required to better evaluate ATT effectiveness.
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Affiliation(s)
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Indonesia; Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Indonesia; Erasmus Medical Center, Rotterdam, The Netherlands
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, United States; Myungsung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and Myungsung Medical School, Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, England
| | | | - 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; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, Singapore.
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5
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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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6
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Alli HD, Ally N, Mayet I, Joseph L, Omar S, Madhi S. Treatment Outcome of Tubercular Uveitis in a High TB and HIV Setting: A Prospective Cohort Study. Clin Ophthalmol 2022; 15:4839-4846. [PMID: 35002219 PMCID: PMC8722693 DOI: 10.2147/opth.s342268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the time to resolution of inflammation in tubercular uveitis (TBU) cases on standard anti-tubercular treatment. Sub-analysis of time to resolution according to HIV status was also performed. Patients and Methods A prospective cohort study of presumed idiopathic uveitis cases >18 years underwent the tuberculin skin test, QuantiFERON-TB Gold test, and ocular tuberculosis (TB) polymerase chain reaction test. Adult TBU cases were treated with standard anti-tubercular therapy (and corticosteroids) for 9 months. Cases were followed-up for resolution of inflammation at 1.5, 3, 6, 9, 12 and 15 months post-diagnosis. Outcome measure was resolution of inflammation on ≤10 mg oral prednisone per day. Results Seventy-nine presumed idiopathic uveitis cases were enrolled in the study, 49 (62%) were diagnosed with TBU. The mean (SD) age of TBU cases at diagnosis was 41.8 (13.4) years. Using a multilevel mixed effects model, resolution was achieved at 6 months in the TBU cases (OR = 1.21; 95% CI, 1.03-1.41; P = 0.017). Using generalized estimating equations, resolution was also achieved at 6 months in the TBU cases (OR = 1.21; 95% CI, 1.05-1.39; P = 0.008). The HIV-positive cases (OR = 1.62; 95% CI, 1.13-2.31; P = 0.008) and the HIV-negative cases (OR = 1.25; 95% CI, 1.06-1.48; P = 0.009) achieved resolution at 9 months. Conclusion Resolution of inflammation in TBU cases on anti-tubercular treatment with corticosteroids was achieved at 6 months and maintained throughout the study. Our study suggests a minimum of 6 months treatment is required for significant resolution. Resolution of inflammation in HIV-positive and HIV-negative TBU cases needs to be further explored.
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Affiliation(s)
- Hassan Dawood Alli
- Department of Neurosciences, Division of Ophthalmology, St John Eye Hospital, Faculty of Health Sciences, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Naseer Ally
- Department of Neurosciences, Division of Ophthalmology, St John Eye Hospital, Faculty of Health Sciences, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Ismail Mayet
- Department of Neurosciences, Division of Ophthalmology, St John Eye Hospital, Faculty of Health Sciences, University of the Witwatersrand, Soweto, Gauteng, 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 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 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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7
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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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8
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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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9
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Bartimote C, Fraser-Bell S, Dunn H. Asymptomatic occlusive retinal vasculitis in newly diagnosed active tuberculosis. Respir Med Case Rep 2021; 33:101456. [PMID: 34401294 PMCID: PMC8349080 DOI: 10.1016/j.rmcr.2021.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Worldwide, tuberculosis is the leading cause of death from an infectious disease. Ocular involvement can cause significant and permanent vision loss. Ocular manifestations of tuberculosis often present with visual symptoms. Asymptomatic ocular tuberculosis is uncommon and yet can have serious consequences if missed. Case report An immunocompetent 26-year-old Filipino man living in regional Australia who was diagnosed with active pulmonary tuberculosis and started on antitubercular therapy. He was referred to an ophthalmologist for baseline ethambutol screening to exclude pre-existing optic neuropathy. Despite having no visual symptoms, when examined, the patient had vision threatening occlusive retinal vasculitis. He was initially commenced on localised therapy via bevacizumab intravitreal injections and retinal photocoagulation. Following completion of antitubercular therapy, high dose prednisone was commenced and slowly tapered. Conclusions We present the case of an asymptomatic sight threatening occlusive vasculitis that was discovered on pre-treatment ophthalmology review. This case emphasises the need for referral for full ophthalmic screening in newly diagnosed tuberculosis to exclude vision-threatening complications.
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Affiliation(s)
- Christopher Bartimote
- Ophthalmology, Royal North Shore Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Samantha Fraser-Bell
- Ophthalmology, Royal North Shore Hospital, Sydney, Australia.,Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Hamish Dunn
- Port Macquarie Eye Centre, Port Macquarie, Australia.,The University of Sydney, Sydney, Australia
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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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An Isolated Presentation of Ischemic Retinal Vasculitis by the Great Masquerader. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Agrawal R, Testi I, Bodaghi B, Barisani-Asenbauer T, McCluskey P, Agarwal A, Kempen JH, Gupta A, Smith JR, de Smet MD, Yuen YS, Mahajan S, Kon OM, Nguyen QD, Pavesio C, Gupta V. Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis-Report 2: Guidelines for Initiating Antitubercular Therapy in Anterior Uveitis, Intermediate Uveitis, Panuveitis, and Retinal Vasculitis. Ophthalmology 2020; 128:277-287. [PMID: 32603726 DOI: 10.1016/j.ophtha.2020.06.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022] Open
Abstract
TOPIC The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular Immunological Society, set up an international, expert-led consensus project to develop evidence- and experience-based guidelines for the management of tubercular uveitis (TBU). CLINICAL RELEVANCE The absence of international agreement on the use of antitubercular therapy (ATT) in patients with TBU contributes to a significant heterogeneity in the approach to the management of this condition. METHODS Consensus statements for the initiation of ATT in TBU were generated using a 2-step modified Delphi technique. In Delphi step 1, a smart web-based survey based on background evidence from published literature was prepared to collect the opinion of 81 international experts on the use of ATT in different clinical scenarios. The survey included 324 questions related to tubercular anterior uveitis (TAU), tubercular intermediate uveitis (TIU), tubercular panuveitis (TPU), and tubercular retinal vasculitis (TRV) administered by the experts, after which the COTS group met in November 2019 for a systematic and critical discussion of the statements in accordance with the second round of the modified Delphi process. RESULTS Forty-four consensus statements on the initiation of ATT in TAU, TIU, TPU, and TRV were obtained, based on ocular phenotypes suggestive of TBU and corroborative evidence of tuberculosis, provided by several combinations of immunologic and radiologic test results. Experts agreed on initiating ATT in recurrent TAU, TIU, TPU, and active TRV depending on the TB endemicity. In the presence of positive results for any 1 of the immunologic tests along with radiologic features suggestive of past evidence of tuberculosis infection. In patients with a first episode of TAU, consensus to initiate ATT was reached only if both immunologic and radiologic test results were positive. DISCUSSION The COTS consensus guidelines were generated based on the evidence from published literature, specialists' opinions, and logic construction to address the initiation of ATT in TBU. The guidelines also should inform public policy by adding specific types of TBU to the list of conditions that should be treated as tuberculosis.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom; Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Baharam Bodaghi
- Department of Ophthalmology, Sorbonne University, Paris, France
| | - Talin Barisani-Asenbauer
- OCUVAC-Centre of Ocular Inflammation and Infection, Laura Bassi Centre of Expertise, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - Peter McCluskey
- Save Sight Institute, Department of Ophthalmology, University of Sydney, Sydney, Australia
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts; MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Abeba, Ethiopia
| | - Amod Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Marc D de Smet
- MIOS SA-Medical/Surgical Retina and Ocular Inflammation, Lausanne, Switzerland
| | - Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, Singapore, Republic of Singapore
| | | | - Onn Min Kon
- Chest and Allergy Clinic, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Stanford, California
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis-Report 1: Guidelines for Initiating Antitubercular Therapy in Tubercular Choroiditis. Ophthalmology 2020; 128:266-276. [PMID: 32115264 DOI: 10.1016/j.ophtha.2020.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022] Open
Abstract
TOPIC An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular choroiditis. CLINICAL RELEVANCE The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. METHODS An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like choroiditis, tuberculoma, and tubercular focal or multifocal choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. RESULTS Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular choroiditis. Experts agreed on initiating ATT in tubercular choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. DISCUSSION Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.
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Shirley K, Dowlut S, Silvestri J, Pavesio C, Foot B. Presumed ocular tuberculosis in the United Kingdom: a British Ophthalmological Surveillance Unit (BOSU) study. Eye (Lond) 2020; 34:1835-1841. [PMID: 31896802 PMCID: PMC7608193 DOI: 10.1038/s41433-019-0748-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/01/2022] Open
Abstract
Introduction Ocular tuberculosis (TB) is an extrapulmonary manifestation of mycobacterium infection that most commonly presents as uveitis. This is the first prospective incidence study of presumed ocular tuberculosis performed in the United Kingdom (UK). Method New cases of ocular tuberculosis presenting to hospitals in the UK were prospectively ascertained between October 2016 and November 2017 with the aid of the British Ophthalmological Surveillance Unit (BOSU). Initial presentation data and 1-year follow-up data was collected using questionnaires. Results Forty-eight patients were recruited giving an overall incidence for ocular TB of 0.73 per million population per annum. The origin of birth for 71% of the patients was a non-UK country and 87.5% had their initial diagnosis of TB made by an ophthalmologist. The most common first line treatment was isoniazid, rifampicin, ethambutol and pyrazinamide which 71% of patients were treated with 60% of patients were commenced on a reducing course of oral steroids. At 1-year follow-up, 29 patients (83%) had complete resolution of active clinical signs. Mean best corrected visual acuity (BCVA) at presentation was +0.41 LogMAR(SD = 0.62), compared to +0.31 LogMAR (SD = 0.56) at 12-month follow-up. Discussion It is increasingly the responsibility of the ophthalmologist to diagnose ocular TB and although it remains a rare condition, consensus on diagnostic criteria and treatment is required. Increasing recognition and accessibility to gamma-interferon testing should enable earlier detection. Treatment with quadruple ATT treatment regimens for at least 6 months shows good clinical outcomes. However, it is still unclear whether steroid use is beneficial. Further large studies with longer follow-up would be warranted to answer these questions.
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Affiliation(s)
| | | | | | | | - Barny Foot
- Royal College of Ophthalmologists, London, UK
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15
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Testi I, Agrawal R, Mahajan S, Agarwal A, Gunasekeran DV, Raje D, Aggarwal K, Murthy SI, Westcott M, Chee SP, McCluskey P, Ho SL, Teoh S, Cimino L, Biswas J, Narain S, Agarwal M, Mahendradas P, Khairallah M, Jones N, Tugal-Tutkun I, Babu K, Basu S, Carreño E, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Herbort CP, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Esposti SD, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Singh R, Sharma A, Sharma K, Zierhut M, Rousselot A, Grant R, Kon OM, Cunningham ET, Kempen J, Nguyen QD, Pavesio C, Gupta V. Tubercular Uveitis: Nuggets from Collaborative Ocular Tuberculosis Study (COTS)-1. Ocul Immunol Inflamm 2019; 28:8-16. [DOI: 10.1080/09273948.2019.1646774] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | | | - Kanika Aggarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Soon Phaik Chee
- Singapore Eye Research Institute, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter McCluskey
- Department of Clinical Ophthalmology & Eye Health, Central Clinical School, Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Su Ling Ho
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Stephen Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | | | - Shishir Narain
- Department of Ophthalmology, Shroff Eye Centre, New Delhi, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff’s Charity Eye Hospital Daryaganj, New Delhi, India
| | | | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nicholas Jones
- Department of Ophthalmology, University of Manchester, Manchester, UK
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Instanbul, Turkey
| | - Kalpana Babu
- Prabha Eye Clinic & Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Soumayava Basu
- Department of Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, India
| | - Ester Carreño
- Departamento de Oftalmología, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Richard Lee
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Hassan Al-Dhibi
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bahram Bodaghi
- DHU SightRestore, Department of Ophthalmology, Sorbonne University, Paris, France
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Debra A. Goldstein
- Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Carl P. Herbort
- Centre for Ophthalmic Specialised Care, University of Lausanne, Lausanne, Switzerland
| | - Talin Barisani-Asenbauer
- The Centre for Ocular Inflammation and Infection (OCUVAC), Laura Bassi Centre of Expertise Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Larissa, Greece
| | - Reema Bansal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bruttendu Moharana
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Simona Degli Esposti
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | | | | | - Mamta Agarwal
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India
| | | | - Ruchi Vala
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Rheumatology, PGIMER, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, PGIMER, Chandigarh, India
| | - Manfred Zierhut
- Centre of Ophthalmology, Department of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Andres Rousselot
- Department of Ophthalmology, Universidad del Salvador of Buenos Aires, Buenos Aires, Argentina
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emmett T. Cunningham
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- MCM Eye Unit, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
| | | | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Elangovan S, Govindarajan S, Mayilvakanam L, Gunasekaran N. Clinical Profile and Treatment Response of Patients with Ocular Inflammation due to Presumed Ocular Tuberculosis: A Retrospective Study. Turk J Ophthalmol 2019; 49:188-193. [PMID: 31486605 PMCID: PMC6761386 DOI: 10.4274/tjo.galenos.2019.05874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: Ocular tuberculosis is an extrapulmonary tuberculous infection and has varying manifestations which pose a huge challenge to diagnosis and treatment. The purpose of this study is to describe the various clinical manifestations of ocular inflammations due to tuberculosis and to assess the response to treatment following antituberculous therapy (ATT) and corticosteroids in these patients. Materials and Methods: We performed a retrospective analysis of 29 patients with presumed ocular tuberculosis who were started on ATT and completed follow-up of at least 6 months after ATT was initiated. The data collected were: age at presentation, sex, laterality, presence or absence of pulmonary/extrapulmonary tuberculosis, history of exposure to tuberculosis, site of ocular involvement and duration of illness, visual acuity at presentation and at 6-month follow-up, and response to treatment. Results: Most of the patients were of economically productive age, between 21-60 years. This most common presentation in our study population was unilateral nongranulomatous anterior uveitis. In spite of the delay between symptom onset and start of therapy, favorable response was noted in 79.3% of patients at completion of 6 months of ATT. The various reasons for the delay in start of therapy were also evaluated. Conclusion: In this case series, we presented the various ocular manifestations and the difficulties faced in the diagnosis of presumed ocular tuberculosis. Outcomes of ATT were favorable in most of our patients. Thus, the clinician should exercise a very high degree of suspicion and should not withhold a trial of ATT.
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Affiliation(s)
- Suma Elangovan
- Department of Ophthalmology, ESIC Medical College and PGIMSR, The TN. Dr. MGR Medical University, Chennai, India
| | - Senthamarai Govindarajan
- Department of Ophthalmology, ESIC Medical College and PGIMSR, The TN. Dr. MGR Medical University, Chennai, India
| | - Lakshmi Mayilvakanam
- Consultant Ophthalmologist, Chennai, India (Past Affiliation: ESIC Medical College and PGIMSR, K.K. Nagar, Chennai)
| | - Nithya Gunasekaran
- Consultant Ophthalmologist, Puducherry, India (Past Affiliation: ESIC Medical College and PGIMSR, K.K. Nagar, Chennai)
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Abhishek S, Ryndak MB, Choudhary A, Sharma S, Gupta A, Gupta V, Singh N, Laal S, Verma I. Transcriptional signatures of Mycobacterium tuberculosis in mouse model of intraocular tuberculosis. Pathog Dis 2019; 77:5561443. [PMID: 31504463 DOI: 10.1093/femspd/ftz045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/03/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Studies on human intraocular tuberculosis (IOTB) are extremely challenging. For understanding the pathogenesis of IOTB, it is important to investigate the mycobacterial transcriptional changes in ocular environment. METHODS Mice were challenged intravenously with Mycobacterium tuberculosis H37Rv and at 45 days post-infection, experimental IOTB was confirmed based on bacteriological and molecular assays. M. tuberculosis transcriptome was analyzed in the infected eyes using microarray technology. The identified M. tuberculosis signature genes were further validated and investigated in human IOTB samples using real-time polymerase chain reaction. RESULTS Following intravenous challenge with M. tuberculosis, 45% (5/12) mice showed bacilli in the eyes with positivity for M. tuberculosis ribonucleic acid in 100% (12/12), thus confirming the paucibacillary nature of IOTB similar to human IOTB. M. tuberculosis transcriptome in these infected eyes showed significant upregulation of 12 M. tuberculosis genes and five of these transcripts (Rv0962c, Rv0984, Rv2612c, Rv0974c and Rv0971c) were also identified in human clinically confirmed cases of IOTB. CONCLUSIONS Differentially expressed mycobacterial genes identified in an intravenously challenged paucibacillary mouse IOTB model and presence of these transcripts in human IOTB samples highlight the possible role of these genes for survival of M. tuberculosis in the ocular environment, thus contributing to pathogenesis of IOTB.
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Affiliation(s)
- Sudhanshu Abhishek
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Michelle Beth Ryndak
- Department of Pathology, New York University Langone Medical Center, New York, NY 10010, USA
| | - Alpa Choudhary
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sumedha Sharma
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Amod Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vishali Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Nirbhai Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Suman Laal
- Department of Pathology, New York University Langone Medical Center, New York, NY 10010, USA.,Veterans Affairs New York Harbor Healthcare System, NY 10010, USA
| | - Indu Verma
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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18
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Llorenç V, Benejam G, Mesquida M, Sainz de la Maza M, Molins B, Alba C, Pelegrin L, Martínez JA, Adán A. Antituberculous Treatment Itself Might Prevent Visual Impairment in Presumed Tuberculosis-Related Uveitis. Ocul Immunol Inflamm 2018; 28:103-110. [PMID: 30395738 DOI: 10.1080/09273948.2018.1541326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: To study the risk factors for visual loss in presumed tuberculosis-related uveitis (TRU).Methods: Retrospective observational cohort study of patients with TRU, either treated or not for tuberculosis, from January 2005 to January 2017. Clinical and demographic variables were recorded. Main outcome measure was a loss of visual acuity (VA) of ≥2 Snellen lines. A Generalized Estimation Equation was used to control between-eyes bias. A backward stepwise logistic regression multivariate analysis was conducted to elucidate independent risk factors.Results: One hundred and thirty-eight eyes from 82 patients were included. There were 45 males, median age at onset of uveitis was 40 years (Interquartile range, IQR 24). The median follow-up was 36 months (IQR 49.75) and 51 patients completed antituberculous treatment (ATT) for a mean of 9.37 months. In the multivariate model, ATT was the only independent protective factor for loss of VA (OR 0.13, 95% CI 0.04-0.37, p < 0.001).Conclusion: ATT itself may prevent visual loss in TRU.
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Affiliation(s)
- Victor Llorenç
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Gibet Benejam
- Ophthalmology Department, Sant Joan Hospital, Reus (Tarragona), Spain
| | - Marina Mesquida
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Maite Sainz de la Maza
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Blanca Molins
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Carmen Alba
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Laura Pelegrin
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain
| | | | - Alfredo Adán
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
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19
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Teixeira-Lopes F, Alfarroba S, Dinis A, Gomes M, Tavares A. Ocular tuberculosis – A closer look to an increasing reality. Pulmonology 2018; 24:289-293. [DOI: 10.1016/j.pulmoe.2018.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/24/2018] [Accepted: 02/04/2018] [Indexed: 11/16/2022] Open
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20
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Trad S, Saadoun D, Errera MH, Abad S, Bielefeld P, Terrada C, Sène D, Bodaghi B, Sève P. [Ocular tuberculosis]. Rev Med Interne 2018; 39:755-764. [PMID: 29891262 DOI: 10.1016/j.revmed.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
Despite extensive investigations, including the use of Interferon-gamma release assays (IGRA), the diagnosis of intraocular tuberculosis (TB) remains challenging. Ocular evidence of Mycobacterium tuberculosis in low endemic countries for TB is extremely rare, leading mostly to a TB-related ocular inflammation presumptive diagnosis. This present work aims: to highlights the main clinical patterns suggestive of ocular TB; and the latest recommended guidelines for diagnosing ocular TB to clarify interferon-gamma release assay (IGRA) contribution and accuracy to the management of intraocular TB and its diagnosis, in addition to other available diagnostic tools, such as tuberculin skin test, bacteriologic and histologic analysis from intra/extra ocular sample and radiographic investigations; to define the accuracy of these diagnostic tools according to the endemic TB prevalence; and finally to identify therapeutic strategies adapted to the main clinical presentations of ocular TB. Our review of the literature shows that management of suspected ocular TB differs significantly based on whether patients are from high or low TB prevalence countries since accuracy of chest X-ray, tuberculin skin test and IGRA is significantly different. Taking into account these discrepancies, distinct guidelines should be determined for managing patients with suspected ocular TB, taking into consideration home prevalence of TB-patients.
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Affiliation(s)
- S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt France.
| | - D Saadoun
- Centre national de référence maladies autoimmunes systémiques rares, centre national de référence maladies autoinflammatoires et amylose, département de médecine interne et d'immunologie clinique, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France
| | - M H Errera
- Service d'ophthalmologie du centre hospitalier national des Quinze-Vingts et DHU Sight Restore, 75012 Paris, France; Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne assistance publique-hôpitaux de Paris (AP-HP), 125, route de Stalingrad, 93000 Bobigny, France; UMR1125, LI2P, faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, France
| | - P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon Bourgogne 21000 Dijon, France
| | - C Terrada
- Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France; Centre médical Roule-Péretti, 169, avenue Achille-Peretti, 92200, Neuilly-sur-Seine, France
| | - D Sène
- Département de médecine interne, APHP, hôpital Lariboisière, 75010 Paris, France; Université Paris Diderot, 75010 Paris, France
| | - B Bodaghi
- Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France; Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France; Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France
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Grumet P, Kodjikian L, de Parisot A, Errera MH, Sedira N, Heron E, Pérard L, Cornut PL, Schneider C, Rivière S, Ollé P, Pugnet G, Cathébras P, Manoli P, Bodaghi B, Saadoun D, Baillif S, Tieulie N, Andre M, Chiambaretta F, Bonin N, Bielefeld P, Bron A, Mouriaux F, Bienvenu B, Vicente S, Bin S, Labetoulle M, Broussolle C, Jamilloux Y, Decullier E, Sève P. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis). Autoimmun Rev 2018; 17:331-343. [DOI: 10.1016/j.autrev.2017.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/19/2022]
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22
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La Distia Nora R, Sitompul R, Bakker M, Susiyanti M, Edwar L, Sjamsoe S, Singh G, van Hagen MP, Rothova A. Tuberculosis and other causes of uveitis in Indonesia. Eye (Lond) 2018; 32:546-554. [PMID: 29099497 PMCID: PMC5848274 DOI: 10.1038/eye.2017.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/10/2017] [Indexed: 12/18/2022] Open
Abstract
PurposeThe purpose of this study is to assess the causes of uveitis in Indonesia and determine the importance of tuberculosis (TB) as a cause of uveitis.Patients and methodsProspective cohort study examining 146 consecutive new human immunodeficiency virus-negative patients with active uveitis between June 2014 and May 2015. We assessed the anatomic locations and specific causes of uveitis, as well as associations with infectious and non-infectious systemic diseases. We determined the prevalence of positive QuantiFERON Tb Gold test (QFT) results in Indonesian patients with uveitis and calculated the number of patients with active systemic TB.ResultsPosterior and panuveitis were the most common anatomic entities (38% each). Infections represented the most frequent cause of uveitis (33%); the most prevalent were toxoplasmosis (19%) and active systemic TB (8%). The majority of patients were QFT positive (61%). A specific diagnosis could not be established in 45% of the patients. At first presentation to the ophthalmologist, the majority of patients (66%) had a visual acuity of less than finger counting at 3 m and already exhibited various complications of uveitis. When classifying the QFT-positive patients with unexplained uveitis into a TB-related group, the percentage of 'TB-associated' uveitis cases increased from 8-48%. Highly elevated QFT levels were observed in patients with uveitis of unknown cause and no signs of active systemic TB.ConclusionsIn Indonesia, infectious uveitis was the most common type of uveitis and the leading causes consisted of toxoplasmosis and TB. The association observed between highly elevated QFT results and uveitis of otherwise unexplained origins indicates that a link exists between the latent TB infection and the development of uveitis.
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Affiliation(s)
- R La Distia Nora
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
- Department of Clinical Immunology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Sitompul
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - M Bakker
- Department of Pulmonary Diseases, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Susiyanti
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - L Edwar
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - S Sjamsoe
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - G Singh
- Respirology and Critical Illness Division, Department of Internal Medicine, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - M P van Hagen
- Department of Clinical Immunology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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23
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Presumed tuberculous uveitis in a university-based tertiary referral center in Saudi Arabia. Int Ophthalmol 2018; 39:317-333. [DOI: 10.1007/s10792-017-0815-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/15/2017] [Indexed: 11/26/2022]
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24
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Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, Gupta V, Gupta A, Do DV, Nguyen QD. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary-referral institutions. Clin Exp Ophthalmol 2017; 46:62-74. [DOI: 10.1111/ceo.12997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Aniruddha Agarwal
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Samendra Karkhur
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital; University of Milan; Milan Italy
| | - Ramandeep Singh
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Mangat R Dogra
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Amod Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Diana V Do
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
| | - Quan D Nguyen
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
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25
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Ng KK, Nisbet M, Damato EM, Sims JL. Presumed tuberculous uveitis in non-endemic country for tuberculosis: case series from a New Zealand tertiary uveitis clinic. Clin Exp Ophthalmol 2017; 45:357-365. [DOI: 10.1111/ceo.12881] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/19/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ken K Ng
- Ophthalmology Department; Greenlane Clinical Centre; Auckland New Zealand
| | - Mitzi Nisbet
- Infectious Disease Department; Auckland City Hospital; Auckland New Zealand
| | - Erika M Damato
- Ophthalmology Department; Greenlane Clinical Centre; Auckland New Zealand
| | - Joanne L Sims
- Ophthalmology Department; Greenlane Clinical Centre; Auckland New Zealand
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Treatment outcome in patients with presumed tubercular uveitis at a tertiary referral eye care centre in Singapore. Int Ophthalmol 2016; 38:11-18. [DOI: 10.1007/s10792-016-0401-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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Ocular tuberculosis: Position paper on diagnosis and treatment management. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 23:31-38. [PMID: 27988134 DOI: 10.1016/j.rppnen.2016.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/30/2016] [Indexed: 01/12/2023] Open
Abstract
Delay in diagnosis or treatment of ocular tuberculosis can result in loss of vision. However, due to the fact that early diagnosis is rarely achieved, there are still a broad variety of diagnostic and treatment approaches. Our aim was to reach a consensus on the management of diagnosis and treatment of ocular tuberculosis. METHODS Critical appraisal of the literature and expert opinion on diagnosis and treatment of ocular tuberculosis. RESULTS AND CONCLUSION The currently recommended method for ocular TB diagnosis is screening for tuberculosis in any uveitis of unknown etiology, recurrent or not responding to conventional therapy; in ocular findings highly suggestive of ocular TB and before immunosuppression (particularly biologic agents). TB screening in these cases includes tuberculosis skin testing and interferon gamma testing, along with complete medical history, ophthalmologic evaluation and chest imaging. Positively screened patients should be treated for active tuberculosis with 4 drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) for 6-9 months. Patients should be reviewed at the end of the initiation phase (two months) and at the end of the overall treatment (6-9 months).
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Ang M, Vasconcelos-Santos DV, Sharma K, Accorinti M, Sharma A, Gupta A, Rao NA, Chee SP. Diagnosis of Ocular Tuberculosis. Ocul Immunol Inflamm 2016; 26:208-216. [PMID: 27379384 DOI: 10.1080/09273948.2016.1178304] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ocular tuberculosis remains a presumptive clinical diagnosis, as the gold standard tests for diagnosing ocular tuberculosis are often not useful: Mycobacterium tuberculosis cultures require weeks to process on Lowenstein-Jenson media and have low yield from ocular samples; while acid-fast bacilli smears or polymerase chain reaction detection of M. tuberculosis DNA have low sensitivities. Thus, diagnosis is often based on suggestive clinical signs, which are supported by positive investigations: tuberculin skin test or interferon-gamma release assays; chest X-ray findings suggestive of pulmonary tuberculosis, and/or evidence of associated systemic tuberculosis infections in the absence of other underlying disease. The aim of this review is to provide an update on the methods of diagnosing ocular tuberculosis, and discuss the challenges of its diagnosis. We also suggest a step-ladder approach to a more accurate diagnosis of ocular tuberculosis by combining the available diagnostic tests.
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Affiliation(s)
- Marcus Ang
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,d Department of Ophthalmology and Visual Sciences , Duke-National University of Singapore, Graduate Medical School , Singapore
| | - Daniel V Vasconcelos-Santos
- e Department of Ophthalmology , Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,f Hospital São Geraldo/HC - Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Kusum Sharma
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Massimo Accorinti
- h Department of Ophthalmology , Sapienza University of Rome , Rome , Italy
| | - Aman Sharma
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Amod Gupta
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India.,i Department of Ophthalmology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Narsing A Rao
- j USC Eye Institute , Los Angeles , USA.,k Keck School of Medicine, University of Southern California , Los Angeles , USA
| | - Soon-Phaik Chee
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,d Department of Ophthalmology and Visual Sciences , Duke-National University of Singapore, Graduate Medical School , Singapore
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Does the phthisioophthalmology section of our Ophthalmologic Society contribute in the promotion of quality care for patients with ocular tuberculosis? OPHTHALMOLOGY JOURNAL 2016. [DOI: 10.17816/ov9156-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The phthisioophthalmology section work over the last 15 years is analyzed. Due to the antituberculous care system reform the number of section members decreased from 27 to 17. Scientific meetings are regular, their frequency decreased up to 5-6/year. Ever and again presentations are made at plenary sessions of the St.Petersburg Scientific Medical Society of Ophthalmology (6 presentations in 15 years) and at the congresses of associations of ophthalmologists and phthisiologists. In 15 years, session members performed and published 102 studies on ocular tuberculosis, including 38 articles in scientific magazines, 5 teaching editions for doctors, 4 monographs. Based on work reports and inspection results of several institutions, it follows that the section makes positive impact on the formation in clinicians of a scientific approach to clinical care process. Some shortcomings are revealed in the application of recommended methods. We believe that for their elimination, besides social activity of the section, it is necessary to publish teaching editions at federal level on ocular tuberculosis diagnosis and treatment, as well as enhancement of diagnosis and treatment quality control by local administration.
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Kee AR, Gonzalez-Lopez JJ, Al-Hity A, Gupta B, Lee CS, Gunasekeran DV, Jayabalan N, Grant R, Kon OM, Gupta V, Westcott M, Pavesio C, Agrawal R. Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis. Surv Ophthalmol 2016; 61:628-53. [PMID: 26970263 DOI: 10.1016/j.survophthal.2016.03.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 03/01/2016] [Indexed: 02/01/2023]
Abstract
Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of anti-tubercular therapy (ATT) in patients with intraocular tuberculosis and factors associated with favorable outcome. Twenty-eight studies are included in this review, with a total of 1,917 patients. Nonrecurrence of inflammation was observed in pooled estimate of 84% of ATT-treated patients (95% CI 79-89). There was minimal difference in the outcome between patients treated with ATT alone (85% successful outcome; 95% CI 25-100) and those with concomitant systemic corticosteroid (82%; 95% CI 73-90). The use of ATT may be of benefit to patients with suspected intraocular tuberculosis; however, this conclusion is limited by the lack of control group analysis and standardized recruitment and treatment protocols. We propose further prospective studies to better establish the efficacy of ATT and ascertain the factors associated with favorable treatment outcomes.
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Affiliation(s)
- Ae Ra Kee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Aws Al-Hity
- Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Bhaskar Gupta
- Royal Berkshire Hospitals NHS Foundation Trust, Reading, UK; Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | | | - Nirmal Jayabalan
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, Singapore
| | - Robert Grant
- Kingston and St George's University of London, Kingston, UK
| | - Onn Min Kon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vishali Gupta
- Advance Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; School of Materials Science & Engineering, Nanyang Technological University, Singapore, Singapore; Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
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MAHDAVI FARD A, SORKHABI R, TAJLIL A. Extrapulmonary Tuberculosis Presenting With Isolated Uveitis. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1720-2. [PMID: 26811831 PMCID: PMC4724753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ali MAHDAVI FARD
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rana SORKHABI
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou TAJLIL
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding Author:
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Severe tuberculous retinal vasculitis in healthy adults. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60926-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mehta H, Sim DA, Keane PA, Zarranz-Ventura J, Gallagher K, Egan CA, Westcott M, Lee RWJ, Tufail A, Pavesio CE. Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis. Eye (Lond) 2015; 29:1060-8. [PMID: 26021867 DOI: 10.1038/eye.2015.65] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/21/2015] [Indexed: 12/31/2022] Open
Abstract
AIM The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid- and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT). METHODS Twenty-seven patients (27 eyes) diagnosed with sarcoid- (13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a six-month period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software. RESULTS The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 (=140.71/95.72 μm)) compared with sarcoid uveitis (1.07 (=137.70/128.69 μm)) (P=0.001). A thinner choroid was observed in eyes with a VA ≥0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR)=147.0-253.4 μm) compared with those with VA <0.3 LogMAR (292.4 μm (IQR=240.1-347.6 μm)) at the total macula circle (P=0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR=272.3-375.4 μm) in active compared with 239.3 μm (IQR=195.3-330.9 μm) in quiescent disease (P=0.04). CONCLUSION A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.
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Affiliation(s)
- H Mehta
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - D A Sim
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - P A Keane
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - J Zarranz-Ventura
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] Vitreo-Retinal Service, Bristol Eye Hospital, Bristol, UK
| | - K Gallagher
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - C A Egan
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - M Westcott
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - R W J Lee
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK [4] School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A Tufail
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK
| | - C E Pavesio
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK
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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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Khochtali S, Gargouri S, Abroug N, Ksiaa I, Attia S, Sellami D, Feki J, Khairallah M. The spectrum of presumed tubercular uveitis in Tunisia, North Africa. Int Ophthalmol 2014; 35:663-71. [DOI: 10.1007/s10792-014-9992-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 12/19/2022]
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Ischemic retinal vasculitis and its management. J Ophthalmol 2014; 2014:197675. [PMID: 24839552 PMCID: PMC4009272 DOI: 10.1155/2014/197675] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/21/2014] [Accepted: 03/25/2014] [Indexed: 12/14/2022] Open
Abstract
Ischemic retinal vasculitis is an inflammation of retinal blood vessels associated with vascular occlusion and subsequent retinal hypoperfusion. It can cause visual loss secondary to macular ischemia, macular edema, and neovascularization leading to vitreous hemorrhage, fibrovascular proliferation, and tractional retinal detachment. Ischemic retinal vasculitis can be idiopathic or secondary to systemic disease such as in Behçet's disease, sarcoidosis, tuberculosis, multiple sclerosis, and systemic lupus erythematosus. Corticosteroids with or without immunosuppressive medication are the mainstay treatment in retinal vasculitis together with laser photocoagulation of retinal ischemic areas. Intravitreal injections of bevacizumab are used to treat neovascularization secondary to systemic lupus erythematosus but should be timed with retinal laser photocoagulation to prevent further progression of retinal ischemia. Antitumor necrosis factor agents have shown promising results in controlling refractory retinal vasculitis excluding multiple sclerosis. Interferon has been useful to control inflammation and induce neovascular regression in retinal vasculitis secondary to Behçet's disease and multiple sclerosis. The long term effect of these management strategies in preventing the progression of retinal ischemia and preserving vision is not well understood and needs to be further studied.
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La Distia Nora R, van Velthoven ME, ten Dam-van Loon NH, Misotten T, Bakker M, van Hagen MP, Rothova A. Clinical manifestations of patients with intraocular inflammation and positive QuantiFERON-TB gold in-tube test in a country nonendemic for tuberculosis. Am J Ophthalmol 2014; 157:754-61. [PMID: 24262781 DOI: 10.1016/j.ajo.2013.11.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate clinical manifestations of patients with uveitis and scleritis of unknown origin and positive QuantiFERON-TB Gold In-Tube test (quantiferon) in a country not endemic for tuberculosis. DESIGN Multicenter retrospective cohort study. METHODS Retrospective review of the clinical, laboratory, and imaging data of 77 patients. Main outcome measures consisted of ocular and systemic features as well as results of laboratory examinations. RESULTS Out of all, 60 of 71 (85%) were living for at least 6 months in tuberculosis-endemic regions. Location of uveitis was variable; posterior uveitis (29/77; 38%) was the most frequent. Two clinical entities were commonly noted: retinal occlusive vasculitis (21/77; 27%) and serpiginoid choroiditis (11/77; 14%). Antituberculosis treatment was completed in 32 patients; 29 of them (91%) achieved complete remission. Mean quantiferon level was 7.5 U/mL; 71% had values above 2 U/mL and 41% above 10 U/mL. We observed no associations between quantiferon levels and clinical and/or imaging features. Previous tuberculosis infection was diagnosed in 5 of 77 patients (6.5%), while hilar/mediastinal lymphadenopathy was found in 25 of 76 patients (33%). Of these, 12 were consistent with the diagnosis of sarcoidosis, 9 were typical for (prior) tuberculosis, and 4 were compatible with both diagnoses. CONCLUSIONS Ocular features of patients with idiopathic uveitis and positive quantiferon were diverse, but retinal occlusive vasculitis and serpiginoid choroiditis were common. The quantiferon levels were usually highly elevated and 33% of patients exhibited lymphadenopathy, suggesting frequently the diagnosis of sarcoidosis. Ocular inflammation reacted favorably to antituberculosis treatment, although only a small minority had documented (prior) tuberculosis.
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Manousaridis K, Ong E, Stenton C, Gupta R, Browning AC, Pandit R. Reply to Wakefield and Kumar. Eye (Lond) 2014; 28:111-2. [DOI: 10.1038/eye.2013.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wakefield MJ, Kumar P. Liver failure following antituberculosis (ATT) chemotherapy for presumed tuberculous uveitis. Eye (Lond) 2013; 28:110-1. [PMID: 24136572 DOI: 10.1038/eye.2013.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- M J Wakefield
- Ophthalmology Department, Leicester Royal Infirmary, Leicestershire, UK
| | - P Kumar
- Ophthalmology Department, Leicester Royal Infirmary, Leicestershire, UK
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