1
|
Alahyari F, Halabian R, Nejad JH. Ocular tuberculosis associated with Epstein-Barr virus myelitis: A case report. INFECTIOUS MEDICINE 2024; 3:100132. [PMID: 39314808 PMCID: PMC11417542 DOI: 10.1016/j.imj.2024.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/23/2024] [Accepted: 04/06/2024] [Indexed: 09/25/2024]
Abstract
Ocular tuberculosis (OTB) is a chronic eye infection caused by Mycobacterium tuberculosis. Some cases of myelitis are associated with Epstein-Barr virus (EBV), with 1-5% of EBV infections leading to neurologic complications. We describe a 34-year-old Iranian woman with OTB and EBV coinfection. Despite initial success with anti-TB agents, the disease progressed, necessitating enucleation. Mycobacterium tuberculosis was detected by a tuberculin coagulation test, and EBV was confirmed via polymerase chain reaction. MRI showed plaques in the spinal cord and brain. The patient was treated with anti-TB and antiretroviral agents. Recognizing TB in the differential diagnosis of EBV myelitis is crucial.
Collapse
Affiliation(s)
- Fakhri Alahyari
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, 14359-44711, Iran
| | - Raheleh Halabian
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, 14359-44711, Iran
| | - Javad Hosseini Nejad
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, 14359-44711, Iran
| |
Collapse
|
2
|
Filardo TD, Andrzejewski A, Croix M, Self JL, Fraimow HS, Munsiff SS. Epidemiology and Clinical Characteristics of Ocular Tuberculosis in the United States, 1993-2019. Open Forum Infect Dis 2024; 11:ofae476. [PMID: 39282632 PMCID: PMC11393473 DOI: 10.1093/ofid/ofae476] [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: 06/03/2024] [Accepted: 08/19/2024] [Indexed: 09/19/2024] Open
Abstract
Background Data regarding ocular tuberculosis (OTB) in the United States have not been previously reported. We evaluated trends of OTB compared with other extrapulmonary TB (EPTB). Methods We estimated the proportion of all EPTB cases (with or without concurrent pulmonary involvement) with OTB reported to the National Tuberculosis Surveillance System during 1993-2019. We compared demographics and clinical characteristics of people with OTB and other EPTB during 2010-2019. P values were calculated by chi-square test for categorical variables and Kruskal-Wallis for continuous variables. Results During 1993-2019, 1766 OTB cases were reported, representing 1.6% of 109 834 all EPTB cases: 200 (0.5% of 37 167) during 1993-1999, 395 (1.0% of 41 715) during 2000-2009, and 1171 (3.8% of 30 952) during 2010-2019. In contrast to persons with other EPTB, persons with OTB were older (median, 48 vs 44 years; P < .01), more likely to be US-born (35% vs 28%; P < .01), more likely to have diabetes (17% vs 13%; P < .01), and less likely to have HIV (1% vs 8%; P < .01). OTB was less likely to be laboratory confirmed (5% vs 75%; P < .01), but patients were more likely to be tested by interferon gamma release assay (IGRA; 84% vs 56%; P < .01) and to be IGRA positive (96% vs 80%; P < .01). Conclusions Reported OTB increased during 1993-2019 despite decreasing TB, including EPTB; the largest increase occurred during 2010-2019. OTB was rarely laboratory confirmed and was primarily diagnosed in conjunction with IGRA results. More research is needed to understand the epidemiology of OTB to inform clinical and diagnostic practices.
Collapse
Affiliation(s)
- Thomas D Filardo
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Aryn Andrzejewski
- Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Michael Croix
- Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Julie L Self
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Henry S Fraimow
- Division of Infectious Diseases, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Sonal S Munsiff
- Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|
3
|
Lin CJ, Hsia NY, Hwang DK, Hwang YS, Chang YC, Hsu YR, Yeh PT, Lin CP, Hsu AY, Ho MW, Sheu SJ. Diagnosis and Treatment of Tubercular Uveitis in Taiwan - Consensus of Expert Panels. Ocul Immunol Inflamm 2024; 32:1420-1426. [PMID: 37186887 DOI: 10.1080/09273948.2023.2208660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
There is currently a lack of guidelines with regard to tubercular uveitis (TBU) management in Taiwan. We therefore propose an evidence-based consensus on the management for TBU. The Taiwan Ocular Inflammation Society conducted a meeting that included nine ophthalmologist and one infection disease expert that focused on three broad areas of (1) nomenclature for TBU, (2) assessment and diagnosis for TBU, and (3) treatment of TBU. Brief literature review on TBU diagnosis and management was conducted that informed this panel meeting in order to make decisions on each consensus statements. In terms of our results, a consensus statements and recommendations for the diagnosis and management of TBU were developed. This consensus statement provides an algorithmic approach toward diagnosing and managing TBU. These statements are meant to enhance but not replace individual clinician-patient interactions and to facilitate real-world clinical practice improvement in terms of TBU patients care.
Collapse
Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Alan Y Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mao-Wang Ho
- Division of Infectious Diseases, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Ophthalomology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
4
|
Xia J, Palestine AG, Reddy AK. Diagnostic Utility of QuantiFERON-Gold Testing in Patients with Ocular Inflammation in a Low-Endemic Tuberculosis Region. Am J Ophthalmol 2024; 264:1-7. [PMID: 38518991 DOI: 10.1016/j.ajo.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To evaluate the diagnostic value of QuantiFERON Gold (QFT-G) testing for ocular inflammation in a low prevalence tuberculosis (TB) area. DESIGN Diagnostic utility analysis. METHODS A review was performed for all uveitis patients who underwent QFT-G testing at the University of Colorado Eye Center from 2009 to 2022. Records were reviewed to assess QFT-G positivity rate and to identify which patients were tested for diagnostic purposes, defined as meeting the Standardization of Uveitis Nomenclature (SUN) criteria for tubercular uveitis (TBU): anterior uveitis with iris nodules, serpiginous-like choroiditis, choroidal nodule resembling a tuberculoma, multifocal choroiditis, or occlusive retinal vasculitis. RESULTS A total of 388 patients with uveitis underwent QFT-G testing, of which 17 (4.38%) were positive. Only one (5.88%) patient had true TBU with anterior uveitis with iris nodules. The remaining 16 (94.1%) patients did not meet SUN criteria for TBU and were incidentally found to be QFT-G positive during laboratory work-up prior to immunosuppression. The positive predictive value was 100% when QFT-G testing was performed in patients who met SUN criteria for TBU, whereas the positive predictive value was 0% for QFT-G testing performed in patients who did not meet SUN criteria for TBU. CONCLUSION In low prevalence areas, the majority of QFT-G positive tests in uveitis patients are coincidental and unrelated to their uveitic disease process. The diagnostic value of a TB test is likely to be minimal unless the SUN clinical criteria for tubercular uveitis are met.
Collapse
Affiliation(s)
- Julia Xia
- From the Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alan G Palestine
- From the Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amit K Reddy
- From the Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA.
| |
Collapse
|
5
|
Asare KK, Azumah DE, Adu-Gyamfi CO, Opoku YK, Adela EM, Afful P, Abotsi GK, Abban EA, Duntu PE, Anyamful A, Moses AB, Botchway E, Mwintige P, Kyei S, Amoah LE, Ekuman EO. Comparison of microscopic and xpert MTB diagnoses of presumptive mycobacteria tuberculosis infection: retrospective analysis of routine diagnosis at Cape Coast Teaching Hospital. BMC Infect Dis 2024; 24:660. [PMID: 38956504 PMCID: PMC11218342 DOI: 10.1186/s12879-024-09566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Tuberculosis is a global health problem that causes 1. 4 million deaths every year. It has been estimated that sputum smear-negative diagnosis but culture-positive pulmonary TB diagnosis contribute to 12.6% of pulmonary TB transmission. TB diagnosis by smear microscopy smear has a minimum detection limit (LOD) of 5,000 to 10,000 bacilli per milliliter (CFU/ml) of sputum result in missed cases and false positives. However, GeneXpert technology, with a LOD of 131-250 CFU/ml in sputum samples and its implementation is believe to facilitate early detection TB and drug-resistant TB case. Since 2013, Ghana health Service (GHS) introduce GeneXpert MTB/RIF diagnostic in all regional hospitals in Ghana, however no assessment of performance between microscopy and GeneXpert TB diagnosis cross the health facilities has been reported. The study compared the results of routine diagnoses of TB by microscopy and Xpert MTB from 2016 to 2020 at the Cape Coast Teaching Hospital (CCTH). METHODS The study compared routine microscopic and GeneXpert TB diagnosis results at the Cape Coast Teaching Hospital (CCTH) from 2016 to 2020 retrospectively. Briefly, sputum specimens were collected into 20 mL sterile screw-capped containers for each case of suspected TB infection and processed within 24 h. The samples were decontaminated using the NALC-NaOH method with the final NaOH concentration of 1%. The supernatants were discarded after the centrifuge and the remaining pellets dissolved in 1-1.5 ml of phosphate buffer saline (PBS) and used for diagnosis. A fixed smears were Ziehl-Neelsen acid-fast stain and observed under microscope and the remainings were used for GeneXpert MTB/RIF diagnosis. The data were analyze using GraphPad Prism. RESULTS 50.11% (48.48-51.38%) were females with an odd ratio (95% CI) of 1.004 (0.944-1.069) more likely to report to the TB clinic for suspected TB diagnosis. The smear-positive cases for the first sputum were 6.6% (5.98-7.25%), and the second sputum was 6.07% (5.45-6.73%). The Xpert MTB-RIF diagnosis detected 2.93% (10/341) (1.42-5.33%) in the first and 5.44% (16/294) (3.14-8.69%) in the second smear-negative TB samples. The prevalence of Xpert MTB-RIF across smear positive showed that males had 56.87% (178/313) and 56.15% (137/244) and females had 43.13% (135/313) and 43.85% (107/244) for the first and second sputum. Also, false negative smears were 0.18% (10/5607) for smear 1 and 0.31% (16/5126) for smear 2. CONCLUSION In conclusion, the study highlights the higher sensitivity of the GeneXpert assay compared to traditional smear microscopy for detecting MTB. The GeneXpert assay identified 10 and 16 positive MTB from smear 1 and smear 2 samples which were microscopic negative.
Collapse
Affiliation(s)
- Kwame Kumi Asare
- Biomedical and Clinical Research Centre, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
- Department of Biomedical Sciences, School of Allied Health Sciences, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | | | - Czarina Owusua Adu-Gyamfi
- Biomedical and Clinical Research Centre, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Yeboah Kwaku Opoku
- Department of Biology Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | | | - Philip Afful
- Biomedical and Clinical Research Centre, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Godwin Kwami Abotsi
- Biomedical and Clinical Research Centre, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Paul Ekow Duntu
- Biomedical and Clinical Research Centre, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Akwasi Anyamful
- Biomedical and Clinical Research Centre, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Emmanuel Botchway
- Laboratory Departments, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Philimon Mwintige
- Laboratory Departments, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Samuel Kyei
- Biomedical and Clinical Research Centre, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Linda Eva Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | |
Collapse
|
6
|
Herrera-Martínez Y, De Bonilla-Damiá Á, Acevedo-Bañez I, Jiménez-Hoyuela García JM. A rare case of ocular pain and unilateral vision loss. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:215-217. [PMID: 38262881 DOI: 10.1016/j.eimce.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 01/25/2024]
Affiliation(s)
| | | | - Irene Acevedo-Bañez
- Departamento de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | |
Collapse
|
7
|
Mahjoub A, Yakoubi S, Zaafrane N, Sellem I, Ben Abderrazek A, Ben Saidi O, Ben Dhif B, Benzarti W, Mahjoub H, Ghorbel M. Tuberculous subretinal abscess: Case report. J Fr Ophtalmol 2024; 47:104072. [PMID: 38696865 DOI: 10.1016/j.jfo.2024.104072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/22/2023] [Indexed: 05/04/2024]
Affiliation(s)
- A Mahjoub
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - S Yakoubi
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - N Zaafrane
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - I Sellem
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - A Ben Abderrazek
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia.
| | - O Ben Saidi
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - B Ben Dhif
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - W Benzarti
- Department of Pneumology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - H Mahjoub
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| | - M Ghorbel
- Department of Ophthalmology, Farhat Hached Hospital, Faculty of medicine, University of Sousse, Avenue Ibn El Jazzar, 4031 Sousse, Tunisia
| |
Collapse
|
8
|
Visioli G, Zeppieri M, Iannucci V, Manni P, Albanese GM, Salati C, Spadea L, Pirraglia MP. From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections. J Clin Med 2023; 12:7216. [PMID: 38068267 PMCID: PMC10707096 DOI: 10.3390/jcm12237216] [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: 10/17/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 01/23/2024] Open
Abstract
In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.
Collapse
Affiliation(s)
- Giacomo Visioli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Valeria Iannucci
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Priscilla Manni
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Giuseppe Maria Albanese
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
- Eye Clinic, Policlinico Umberto I University Hospital, 00161 Rome, Italy
| | | |
Collapse
|
9
|
Dutta Majumder P, Mochizuki M, González-López JJ, Gonzales J, Sharma M, Sharma K, Biswas J. Laboratory Investigations in Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1405-1415. [PMID: 36698066 DOI: 10.1080/09273948.2022.2164728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/27/2023]
Abstract
Laboratory investigations can play a significant role in the diagnosis and decision-making of infectious uveitis. Though direct demonstration of the infective organism remains the gold standard of diagnosis, it is not always possible with ocular tissues. Recent advancements in molecular techniques have made it possible to overcome these limitations and to identify the genomic DNA of pathogens associated with infectious uveitis. Techniques such as next-generation sequencing can analyze all DNA-based lifeforms, regardless of whether they are bacteria, fungi, viruses, or parasites and have been used in the laboratory diagnosis of intraocular inflammation. On the other hand, serological tests, though they dominate the diagnostic landscape of various infectious etiologies in uveitis in routine clinical practice, have varied specificities and sensitivities in different infectious uveitis. In this review, we focus on various methods of laboratory diagnosis of infectious uveitis and discuss the recent advances in molecular diagnosis and their role in various infectious clinical entities.
Collapse
Affiliation(s)
| | - Manabu Mochizuki
- Miyata Eye Hospital, Miyakonojo, Japan
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Julio J González-López
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Surgery Department, Universidad de Alcalá, Madrid, Spain
| | - John Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Kusum Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Jyotirmay Biswas
- Director of Uveitis & Ocular Pathology, Sankara Nethralaya, Chennai, India
| |
Collapse
|
10
|
Agrawal R, Ludi Z, Betzler BK, Testi I, Mahajan S, Rousellot A, Kempen JH, Smith JR, McCluskey P, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS) calculator-a consensus-based decision tool for initiating antitubercular therapy in ocular tuberculosis. Eye (Lond) 2023; 37:1416-1423. [PMID: 35764876 PMCID: PMC10170101 DOI: 10.1038/s41433-022-02147-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/15/2022] [Accepted: 06/14/2022] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To introduce the Collaborative Ocular Tuberculosis Study (COTS) Calculator, an online clinical scoring system for initiating antitubercular therapy (ATT) in patients with ocular tuberculosis (TB). METHOD The COTS Calculator was derived from COTS Consensus (COTS CON) data, which has previously published consensus guidelines. Using a two-step Delphi method, 81 experts evaluated 486 clinical scenario-based questions, ranking their likelihood of initiating ATT in each specific scenario. Each scenario was a permutation of the results and/or availability of five following components-clinical phenotype, endemicity, two immunological (tuberculin skin test, interferon-γ release assay) and one radiological (chest X-Ray) test results-and a sixth component further stratifying three of the clinical phenotypes. The median scores and interquartile ranges (IQR) of each scenario were tabulated, representing the expert consensus on whether to initiate ATT in that scenario. The consensus table was encoded to develop the COTS Calculator. RESULTS The COTS Calculator can be accessed online at: https://www.oculartb.net/cots-calc . The attending physician can select the conditions present in the patient, which will generate a median score from 1 to 5. 114 out of 486 scenarios (24%) deliberated had a median score of 5 indicating expert consensus to initiate ATT. CONCLUSION The COTS Calculator is an efficient, low-cost, evidence and experience-based clinical tool to guide ATT initiation. While it holds substantial promise in improving standard-of-care for ocular-TB patients, future validation studies can help to as certain its clinical utility and reliability.
Collapse
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
| | - Zhang Ludi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bjorn K Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ilaria Testi
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | | | - Andres Rousellot
- Ciudad Autónoma de Buenos Aires, Consultorios Oftalmológicos Benisek-Ascarza, Buenos Aires, Argentina
| | - John H Kempen
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear/Harvard Medical School, Boston, MA, USA
- Sight for Souls, Fort Myers, FL, USA
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, MyungSung Medical School, Addis Ababa, Ethiopia
| | - Justine R Smith
- Flinders University College of Medicine & Public Health, Adelaide, SA, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Peter McCluskey
- Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, NSW, Australia
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Palo alto, CA, USA
| | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| |
Collapse
|
11
|
Danjou W, Pradat P, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Trad S, Seve P. Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment. Br J Ophthalmol 2023; 107:500-504. [PMID: 34711577 DOI: 10.1136/bjophthalmol-2021-318868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
AIMS Few studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate the value of the QuantiFERON test in a large cohort of patients with uveitis for both the diagnosis of tubercular uveitis and antituberculosis treatment (ATT) response prediction. METHODS A single-centre retrospective study including consecutive adult patients with uveitis who were prescribed a QuantiFERON test between January 2003 and December 2019 was performed. Adjusted ORs (aORs) were calculated between patients with uveitis responding and not responding to ATT according to the Collaborative Ocular Tuberculosis Study (COTS) group diagnostic criteria. Sensitivity (SE), specificity (Sp), and positive and negative predictive values of the QuantiFERON test were calculated. RESULTS A total of 1075 patients were included in the study; 178 (16.5%) were found positive using the QuantiFERON test. Among the 178 positive patients, 62 (35%) had a diagnosis of tubercular uveitis according to the updated COTS classification; all received ATT for 6 months; and 44/62 (71%) responded to ATT. A QuantiFERON test value of >2 IU/mL was associated with a greater chance of responding to ATT (aOR=36.7, 95% CI 7.2 to 185.9, p<0.001). The optimal threshold to maximise both Sp and SE for diagnosis of TB uveitis was 4 IU/mL. CONCLUSION One-sixth of the patients diagnosed with uveitis had a positive QuantiFERON test. The QuantiFERON threshold with the optimal SE and Sp for the diagnosis of tubercular uveitis was 4 IU/mL. TRIAL REGISTRATION NUMBER NCT03863782.
Collapse
Affiliation(s)
- William Danjou
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre Pradat
- Centre de recherche clinique, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yvan Jamilloux
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Service d'ophtalmologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Salim Trad
- Service de médecine interne, Hôpital Ambroise Paré, Paris, France
| | - Pascal Seve
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Villeurbanne, France
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Tungsattayathitthan U, Boonsopon S, Tesavibul N, Dharakul T, Choopong P. Interferon-gamma release assays in tuberculous uveitis: a comprehensive review. Int J Ophthalmol 2022; 15:1520-1528. [PMID: 36124199 DOI: 10.18240/ijo.2022.09.16] [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: 10/23/2021] [Accepted: 07/19/2022] [Indexed: 12/11/2022] Open
Abstract
Tuberculous uveitis (TBU) comprises a broad clinical spectrum of ocular manifestations, making its diagnosis challenging. Ophthalmologists usually require evidence from investigations to confirm or support a clinical diagnosis of TBU. Since direct isolation of the causative organism from ocular specimens has limitations owing to the small volume of the ocular specimens, resultant test positivities are low in yield. Immunodiagnostic tests, including the tuberculin skin test and interferon-gamma release assays (IGRAs), can help support a clinical diagnosis of TBU. Unlike the tuberculin skin test, IGRAs are in vitro tests that require a single visit and are not affected by prior Bacillus Calmette-Guerin vaccination. Currently, available IGRAs consist of different techniques and interpretation methods. Moreover, newer generations have been developed to improve the sensitivity and ability to detect active tuberculosis. This narrative review collates salient practice points as a reference for general ophthalmologists, such as evidence for the utilization of IGRAs in patients with suspected TBU, and summarizes basic knowledge and details of clinical applications of these tests in a clinical setting.
Collapse
Affiliation(s)
- Usanee Tungsattayathitthan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Tararaj Dharakul
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| |
Collapse
|
14
|
Küchlin S, Glegola M, Schulz T, Auw-Hädrich C. Histological Diagnosis of Ocular and Periocular Tuberculosis 1945 - 2020. Klin Monbl Augenheilkd 2022; 239:876-885. [PMID: 35858599 DOI: 10.1055/a-1780-9031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ocular tuberculosis is a rare but important differential diagnosis for inflammatory conditions of all eye tissues, including the ocular surface and adnexa. Tissue diagnostics may prove challenging as some ocular tissues are difficult to biopsy and the detection of pathogens may be insensitive. We were interested in how many cases in the archive of the ophthalmopathological laboratory had been diagnosed with (peri)ocular tuberculosis since 1945. MATERIALS AND METHODS Retrospective analysis of historical records and specimens of the ophthalmopathology laboratory of the eye department at Freiburg university hospital. Systematic re-evaluation of available slides for presence of granuloma, necrosis, giant cells, acid fast bacteria, and chronic as well as acute inflammation, plus comparison of current and historic evaluations. In addition, we describe a recent case with tuberculoma of the iris. RESULTS There were 50,418 records archived since 1945, of which 23 specimens taken from 22 patients had been diagnosed as (peri)ocular tuberculosis. Of these, 22 (96%) were archived and available for re-interpretation. Four specimens (17%) had been excised from children. The most common tissues were enucleated eye globes (10/23, 44%), followed by the lacrimal sac (5/23, 22%) and conjunctiva (2/23, 9%). The most frequent histopathological findings were granulomas (23/23, 100%), chronic inflammation (22/23, 96%), giant cells (21/23, 91%), and necrosis (14/23, 61%). An acute inflammatory response was found in 4/23 specimens (17%). Ziehl-Neelsen stains for acid-fast bacteria had been performed in five cases, of which three were positive (60%). The greatest discrepancy between current and historical findings related to the presence of necrosis (59% consensus). In other findings, the consensus was high (78 - 96%). In a recent case of a patient with wasting syndrome attributed to lymphoma, histopathological workup of an iris tumour led to the diagnosis of tuberculosis. CONCLUSION Ocular tuberculosis is a rare but important histopathological differential diagnosis. In the available specimens, the classic finding of necrotizing inflammation was rarest and showed least consensus on histological re-evaluation. Other typical findings, such as giant cells and a predominantly lymphocytic infiltrate, are sometimes not found even with proven presence of Mycobacterium tuberculosis. They should not be considered essential in cases where there is strong clinical suspicion.
Collapse
Affiliation(s)
- Sebastian Küchlin
- Klinik für Augenheilkunde, Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Deutschland
| | - Mateusz Glegola
- Klinik für Augenheilkunde, Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Deutschland
| | - Tabea Schulz
- Klinik für Augenheilkunde, Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Deutschland
| | - Claudia Auw-Hädrich
- Klinik für Augenheilkunde, Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Deutschland
| |
Collapse
|
15
|
Isolated Retinal Vasculitis: Prognostic factors and expanding the role of immunosuppressive treatment in retinal vasculitis associated with positive QuantiFERON®-TB Gold Test. Retina 2022; 42:1897-1908. [DOI: 10.1097/iae.0000000000003558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Bair H, Lin CJ, Li YL, Hsia NY, Lai CT, Lin JM, Chen WL, Chiang CC, Tsai YY. MultiColor imaging in urticarial vasculitis with recurrent branch retinal artery occlusion in a case with positive toxoplasma IgG and interferon-gamma release assay - Case report. Am J Ophthalmol Case Rep 2022; 26:101437. [PMID: 35243172 PMCID: PMC8881411 DOI: 10.1016/j.ajoc.2022.101437] [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] [Received: 08/28/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction We report a male who presented with acute visual defect and was diagnosed with urticarial vasculitis with recurrent branch retinal artery occlusion (BRAO) after systemic disease survey, fluorescein angiography (FA), and MultiColor imaging (MCI). Case report A 47-year-old male with a history of urticarial vasculitis presented with visual defect OD. Fundus examination showed two foci of ischemic retinal whitening beneath the inferior arcade and above the superior arcade. MCI demonstrated a greenish tinge in the corresponding area. FA revealed segmental arteriolar staining and arterial occlusive changes. BRAO with retinal arteritis was diagnosed. Toxoplasma IgG was positive. Sulfamethoxazole 400mg plus trimethoprim 80mg was given. His vision worsened after 1-week of treatment. The established lesions improved, but new lesions occurred. Interferon-gamma release assay was positive but tuberculosis DNA qualitative amplification test of sputum was negative. Sputum acid-fast stain was positive and culture revealed nontuberculous mycobacteria. Left facial itching and reactive lymphadenopathy developed. Prednisolone and cyclophosphamide were started. The initial retinal artery lesions regained perfusion. Conclusions Urticarial vasculitis with recurrent BRAO is an immune complex-mediated disease. Greenish-tinged occlusive lesions were noted from MCI with high resolution and contrast. MCI could be a valuable method for retinal vessel occlusive disease detection before FA and follow up.
Collapse
|
17
|
Betzler BK, Gunasekeran DV, Kempen J, Smith JR, McCluskey P, Nguyen QD, Pavesio C, Gupta V, Agrawal R. The Historical Evolution of Ocular Tuberculosis: Past, Present, and Future. Ocul Immunol Inflamm 2022; 30:593-599. [PMID: 34752203 DOI: 10.1080/09273948.2021.1992446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/06/2021] [Indexed: 10/19/2022]
Abstract
Ocular involvement is a rare manifestation of tuberculosis. Four key issues historically faced by clinicians when diagnosing and treating ocular tuberculosis - diagnostic uncertainty, naturally heterogeneous presentations, limitations of existing laboratory diagnostic tools, and non-uniform treatment guidelines - continue to test today's physicians. Unparalleled scientific and clinical developments over the past century have greatly expanded the knowledge surrounding this challenging ophthalmic condition. Experience with large volumes of cases at tuberculosis-endemic centres has led to recent growth in knowledge and physician experience, perhaps more so in developing countries. Looking forward, the role of diverse new technologies, including artificial intelligence and proteomics, will advance ocular tuberculosis research. Efforts have been made to address the lack of standardized nomenclature, diagnostic uncertainty, and unvalidated, geographically variable treatment guidelines.
Collapse
Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, UK
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Peter McCluskey
- Save Sight Institute, Sydney Eye Hospital, Sydney, Australia
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Stanford, California, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, UK
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
18
|
Neß T, Winterhalter S, Stübiger N. Infectious Posterior Uveitis - Toxoplasmosis, Treponema, Tuberculosis (TTT). Klin Monbl Augenheilkd 2022; 239:666-675. [PMID: 35320874 DOI: 10.1055/a-1727-1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture, diagnostic and treatment strategies of these diseases are presented.
Collapse
Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | | | - Nicole Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| |
Collapse
|
19
|
Clinical Manifestations and Outcomes of Tubercular Uveitis in Taiwan—A Ten-Year Multicenter Retrospective Study. Medicina (B Aires) 2022; 58:medicina58030376. [PMID: 35334552 PMCID: PMC8950060 DOI: 10.3390/medicina58030376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background andObjectives: This 10-year multicenter retrospective study reviewed the clinical manifestations, diagnostic tests, and treatment modalities of tubercular uveitis (TBU), including direct infection and indirect immune-mediated hypersensitivity to mycobacterial antigens in Taiwan. Materials and Methods: This retrospective chart review of patients with TBU was conducted at 11 centers from 1 January 2008 to 31 December 2017. We used a multiple regression model to analyze which factors influenced best-corrected visual acuity (BCVA) improvement. Results: A total of 79 eyes from 51 patients were included in the study. The mean age was 48.9 ± 16.4 years. The mean change of LogMAR BCVA at last visit was −0.21 ± 0.45. Diagnostic tools used include chest X-ray, chest computed tomography, Mantoux test, interferon gamma release test (QuantiFERON-TB Gold test), intraocular fluid tuberculosis polymerase chain reaction, and bronchial alveolar lavage. The clinical manifestations included 48% posterior uveitis and 37% panuveitis. In the sample, 55% of the cases were bilateral and 45% unilateral. There was 60.76% retinal vasculitis, 35.44% choroiditis, 21.52% serpiginous-like choroiditis, 17.72% vitreous hemorrhage, 12.66% posterior synechiae, 6.33% retinal detachment, and 3.80% choroidal granuloma. Treatment modalities included rifampicin, isoniazid, pyrazinamide, ethambutol, oral steroid, posterior triamcinolone, non-steroidal anti-inflammatory drugs, vitrectomy, and immunosuppressants. BCVA improved in 53.2% of eyes and remained stable in 32.9% of eyes. In the final model of multiple regression, worse initial BCVA, pyrazinamide, and receiving vitrectomy predicted better BCVA improvement. Ethambutol was associated with worse visual outcomes. Seven eyes experienced recurrence. Conclusions: This is the largest 10-year multicenter retrospective study of TBU in Taiwan to date, demonstrating the distribution of clinical manifestations and clinical associations with better treatment outcomes. The study provides a comprehensive description of TBU phenotypes in Taiwan and highlights considerations for the design of further prospective studies to reliably assess the role of ATT and vitrectomy in patients with TBU.
Collapse
|
20
|
Anti-TB monotherapy for choroidal tuberculoma: an observational study. Eye (Lond) 2022; 36:612-618. [PMID: 33795836 PMCID: PMC8873194 DOI: 10.1038/s41433-021-01505-1] [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: 07/06/2020] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Choroidal tuberculoma is possibly the most unequivocal manifestation of ocular infection with Mycobacterium tuberculosis. Here, we investigate the need for adjunctive corticosteroids in the management of this infection. We have compared the efficacy of anti-tubercular therapy (ATT) with or without oral corticosteroids, in management of choroidal tuberculoma. METHODS We report a retrospective, observational study of patients treated with ATT for choroidal tuberculoma. Group A patients were treated with standard 6-month ATT alone, and Group B with ATT and oral corticosteroids, with/without intravitreal triamcinolone/ bevacizumab injections. Primary outcome measure was time to complete resolution of lesions. Secondary measures were time to first sign of resolution and change in best corrected visual acuity (BCVA) at final visit. RESULTS Fourteen patients were included in the study-seven in Group A and seven in Group B. Both groups had similar duration of symptoms and size of lesions but not baseline BCVA (p = 0.02). Perilesional fluid was noted in all eyes in each group. Mean time to complete resolution in group A was 1.89 ± 0.28 (range 1.25-2) months, significantly lesser than group B (5.17 ± 2.64 [range 2-9] months, p = 0.005, Mann-Whitney test). Mean time to first sign of resolution (range from 5 days to 10 weeks, p = 0.35) and mean change in BCVA between presentation and final follow up (p = 0.2) were comparable between both groups. CONCLUSION Anti-TB monotherapy alone, may be sufficient for resolution of at least, select cases of choroidal tuberculoma, without the need for adjunctive corticosteroids.
Collapse
|
21
|
Saati AA, Khurram M, Faidah H, Haseeb A, Iriti M. A Saudi Arabian Public Health Perspective of Tuberculosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10042. [PMID: 34639342 PMCID: PMC8508237 DOI: 10.3390/ijerph181910042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/30/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022]
Abstract
Tuberculosis is a global health challenge due to its spreading potential. The Kingdom of Saudi Arabia (KSA) faces a challenge in the spread of tuberculosis from migrant workers, but the foremost threat is the huge number of pilgrims who travel to visit sacred sites of the Islamic world located in the holy cities of Makkah and Al Madina. Pilgrims visit throughout the year but especially in the months of Ramadan and Zul-Hijah. The rise of resistance in Mycobacterium tuberculosis is an established global phenomenon that makes such large congregations likely hotspots in the dissemination and spread of disease at a global level. Although very stringent and effective measures exist, the threat remains due to the ever-changing dynamics of this highly pathogenic disease. This overview primarily highlights the current public health challenges posed by this disease to the Saudi health system, which needs to be highlighted not only to the concerned authorities of KSA, but also to the concerned global quarters since the pilgrims and migrants come from all parts of the world with a majority coming from high tuberculosis-burdened countries.
Collapse
Affiliation(s)
- Abdullah A. Saati
- Department of Community Medicine & Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Muhammad Khurram
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Abasyn University, Peshawar 25000, Pakistan
| | - Hani Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah 24382, Saudi Arabia;
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 24382, Saudi Arabia;
| | - Marcello Iriti
- Department of Agricultural and Environmental Sciences, Università degli Studi di Milano, 20133 Milano, Italy
- Phytochem Lab, Department of Agricultural and Environmental Sciences, Università degli Studi di Milano, 20133 Milano, Italy
- Center for Studies on Bioispired Agro-Environmental Technology (BAT Center), Università degli Studi di Napoli “Federico II”, 80055 Portici, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), 50121 Firenze, Italy
| |
Collapse
|
22
|
Leal SM, Rodino KG, Fowler WC, Gilligan PH. Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 PMCID: PMC8262805 DOI: 10.1128/cmr.00070-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
Collapse
Affiliation(s)
- Sixto M. Leal
- Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyle G. Rodino
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - W. Craig Fowler
- Department of Surgery, Campbell University School of Medicine, Lillington, North Carolina, USA
| | - Peter H. Gilligan
- Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
23
|
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
| |
Collapse
|
24
|
THE COLLABORATIVE OCULAR TUBERCULOSIS STUDY (COTS)-1: A Multinational Review of 251 Patients With Tubercular Retinal Vasculitis. Retina 2020; 39:1623-1630. [PMID: 29697588 DOI: 10.1097/iae.0000000000002194] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Tubercular retinal vasculitis (TRV) is a heterogeneous disease that can be difficult to manage because of nonspecific presentation and limitations of confirmatory tests for tuberculosis. This is a big data analysis on phenotypes and treatment outcomes for TRV. METHODS Multicentre retrospective study of patients with TRV between January 2004 and December 2014 and a minimum follow-up of 1 year. RESULTS Two hundred and fifty-one patients with TRV with a mean age of 38.9 ± 14.4 years (range, 9-86 years) were included. The patients were predominantly males (n = 167/251; 66.5%) of Asian ethnicity (n = 174/246; 70.7%), and geographical origin (n = 137/251; 54.6%). Most patients had features of occlusive type of RV (n = 113/185; 61.1%) except Caucasians (n = 11; 28.2%). There was no significant difference in treatment failure whether patients received antitubercular therapy (ATT) (P = 0.29), although treatment failure was less frequent in patients who received ATT (13.6%; n = 31/228) compared with those who did not (21.7%, n = 5/23). Less treatment failures were observed in patients with occlusive type RV who received ATT; however, this was not significant on survival analysis (P = 0.09). Treatment with ATT was associated with higher failure rates in patients of Hispanic and African American race and those with TRV associated with panuveitis (compared with posterior uveitis). CONCLUSION In this multinational study of TRV, there was no significant therapeutic effect of ATT. However, a definitive conclusion about the role of ATT could not be made because of a few patients who did not receive ATT. Because this is a retrospective study with a limited 1-year follow-up, the effect of ATT may have been overestimated (or underestimated) in the duration of follow-up.
Collapse
|
25
|
Nahon-Esteve S, Martel A, Maschi C, Alketbi M, Baillif S, Tieulie N. Uveitis associated with latent tuberculosis: A comparative study of the impact of antitubercular therapy combined or not with systemic corticosteroids. Eur J Ophthalmol 2020; 31:2457-2466. [PMID: 33008274 DOI: 10.1177/1120672120962066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the outcome of latent tubercular uveitis (LTBU) treated with antitubercular therapy (ATT) combined or not with adjuvant systemic corticosteroids. METHODS Twenty patients (27 eyes) with LTBU were included in a monocentric retrospective study and evaluated for the absence of active disease after treatment. Data on the clinical outcomes (active inflammation), vision (best-corrected visual acuity, BCVA) and treatment were collected retrospectively. RESULTS Fourteen patients received ATT alone and six patients received ATT combined with systemic corticosteroids. The two groups were not comparable in terms of proportion of tubercular panuveitis cases and initial BCVA (59.3 ± 8.2 letters vs 44.2 ± 15.2 letters). There was no significant difference in remission rate and in BCVA between both groups 3 months after ATT discontinuation. CONCLUSION Patients with LTBU treated with ATT alone had visual and inflammatory outcomes at least comparable to those of patients treated with ATT combined with systemic corticosteroids.
Collapse
Affiliation(s)
- Sacha Nahon-Esteve
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Arnaud Martel
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Celia Maschi
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Mohamed Alketbi
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Stephanie Baillif
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Nathalie Tieulie
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| |
Collapse
|
26
|
Seth PK, Sharma S, Senthil S. Bleb-related tuberculous endophthalmitis following combined phacoemulsification and trabeculectomy with mitomycin C. BMJ Case Rep 2020; 13:e234175. [PMID: 32209579 PMCID: PMC7103812 DOI: 10.1136/bcr-2019-234175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 11/03/2022] Open
Abstract
A one-eyed 67-year-old man with 20/400 vision, dense cataract, previously failed trabeculectomy and medically uncontrolled advanced glaucoma underwent a single-site phacoemulsification with repeat trabeculectomy and mitomycin C. One-week postoperatively, vision in the right eye improved to 20/120, good bleb and intraocular pressure (IOP) of 14 mm Hg. By third postoperative week, patient presented to the emergency with diminished vision, pain and redness in right eye of 2 days duration and was diagnosed to have bleb-related endophthalmitis (BRE). Vitreous biopsy, smear from the bleb were taken and underwent pars plana vitrectomy with intraocular antibiotic injection. Smears and cultures were negative however, aqueous DNA-PCR was positive for Mycobacterium tuberculosis Revisited history revealed treated pulmonary tuberculosis 3 years ago with a positive Mantoux test (17 mm) and hilar prominence on chest X-ray. One month after starting anti-tubercular therapy (ATT), the BRE resolved and vision improved to 20/60 with IOP of 14 mm Hg and the ATT was continued.
Collapse
Affiliation(s)
| | - Savitri Sharma
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- Glaucoma, LV Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
27
|
Murthy VK, Fava A. Connective Tissue is the Issue: Relapsing Polychondritis. Am J Med 2020; 133:195-197. [PMID: 31299177 DOI: 10.1016/j.amjmed.2019.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Vivek K Murthy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Andrea Fava
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| |
Collapse
|
28
|
Agrawal R, Agarwal A, Jabs DA, Kee A, Testi I, Mahajan S, McCluskey PJ, Gupta A, Palestine A, Denniston A, Banker A, Invernizzi A, Fonollosa A, Sharma A, Kumar A, Curi A, Okada A, Schlaen A, Heiligenhaus A, Kumar A, Gurbaxani A, Bodaghi B, Islam Shah B, Lowder C, Tappeiner C, Muccioli C, Vasconcelos-Santos DV, Goldstein D, Behra D, Das D, Makhoul D, Baglivo E, Denisova E, Miserocchi E, Carreno E, Asyari F, Pichi F, Sen HN, Uy H, Nascimento H, Tugal-Tutkun I, Arevalo JF, Davis J, Thorne J, Hisae Yamamoto J, Smith J, Garweg JG, Biswas J, Babu K, Aggarwal K, Cimino L, Kuffova L, Agarwal M, Zierhut M, Agarwal M, De Smet M, Tognon MS, Errera MH, Munk M, Westcott M, Soheilian M, Accorinti M, Khairallah M, Nguyen M, Kon OM, Mahendradas P, Yang P, Neri P, Ozdal P, Amer R, Lee R, Distia Nora RL, Chhabra R, Belfort R, Mehta S, Shoughy S, Luthra S, Mohamed SO, Chee SP, Basu S, Teoh S, Ganesh S, Barisani-Asenbauer T, Guex-Crosier Y, Ozyazgan Y, Akova Y, Habot-Wilner Z, Kempen J, Nguyen QD, Pavesio C, Gupta V. Standardization of Nomenclature for Ocular Tuberculosis – Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop. Ocul Immunol Inflamm 2019; 28:74-84. [DOI: 10.1080/09273948.2019.1653933] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
- School of Material Science and Engineering, Nanyang Technological University, Singapore
| | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Douglas A. Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aera Kee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | - Sarakshi Mahajan
- Byers Eye Institute, Department of Ophthamology, Stanford University, Palo Alto, California, United States of America
| | - Peter J. McCluskey
- Discipline of Ophthalmology, Save Sight Institute, Faculty of Medicine and Health,The University of Sydney, Sydney, Australia
| | - Amod Gupta
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Alastair Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Alay Banker
- Banker’s Retina Clinic and Laser Centre, 5 Subhash Society, Ahmedabad, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alex Fonollosa
- Hospital Universitario Cruces, Cruces-Barakaldo, Bilbao, Vizcaya (Spain)
| | - Aman Sharma
- Department of Rheumatology, PGIMER, Chandigarh, India
| | - Amitabh Kumar
- Department of Uvea, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Andre Curi
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Brazil
| | - Annabelle Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ariel Schlaen
- Hospital Universitario Austral, Hospital de Clinicas “Jose de San Martín”, Universidad de Buenos Aires
| | | | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Gurbaxani
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | - Bahram Bodaghi
- Department of Ophthalmology, Sorbonne University, Paris, France
| | | | - Careen Lowder
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cristina Muccioli
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo, SP, Brazil
| | | | - Debra Goldstein
- Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
| | - Digambar Behra
- Deptartment of Pulmonary Medicine, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Dipankar Das
- Department of Ocular Pathology, Uveitis & Neuro-Ophthalmology Services; Sankaradeva Nethralaya, Guwahati, India
| | - Dorine Makhoul
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Edoardo Baglivo
- Department of Ophthalmology, Clinique de l’oeil, Geneva, Switzerland
| | | | - Elisabetta Miserocchi
- Ophthalmology Department, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ester Carreno
- Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - Fatma Asyari
- INOIIS, Department of Ophthalmology University of Indonesia, Indonesia
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - H. Nida Sen
- The Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Harvey Uy
- Ocular Immunology and Uveitis Service, Asian Eye Institute, Makati, Philippines
| | - Heloisa Nascimento
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo, SP, Brazil
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Turkey
| | - J Fernando Arevalo
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Janet Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer Thorne
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Justine Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Justus G. Garweg
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland; University of Bern, Bern, Switzerland
| | | | - Kalpana Babu
- Vittala International Institute of Ophthalmology, Bangalore, India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | - Lucia Kuffova
- Section of Immunity, Infection and Inflammation, Division of Applied Medicine, University of Aberdeen, School of Medicine and Dentistry, Aberdeen
| | | | - Manfred Zierhut
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Manisha Agarwal
- Dr Shroff’s Charity Eye Hospital Daryaganj, New Delhi, India
| | - Marc De Smet
- Department of Ophthalmology ZNA Middelheim, Antwerp, Belgium
| | - Maria Sofia Tognon
- Ocular Immunology Unit, Department of Ophthalmology, S. Antonio Hospital, Padova, Italy
| | - Marie-Helene Errera
- Centre National d’Ophtalmologie des 15-20, Paris, Sorbonne-Universités, Paris 6, France
| | - Marion Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark Westcott
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | | | - Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | | | - Onn Minn Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Heathcare Service trust, London, United Kingdom
| | | | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Pinar Ozdal
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Richard Lee
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | | | - Romi Chhabra
- Department of Ophthalmology, University of Manchester, Manchester, United Kingdom
| | - Rubens Belfort
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo, SP, Brazil
| | - Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Bandra Reclamation, Mumbai, India
| | - Samir Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyad, Saudi Arabia
| | | | | | - Soon-Phaik Chee
- Singapore Eye Research Institute, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - 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
| | - Yan Guex-Crosier
- Jules Gonin Eye Hospital, FAA, University of Lausanne, Switzerland
| | - Yılmaz Ozyazgan
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Turkey
| | - Yonca Akova
- Department of Ophthalmology, Bayindir Kavaklidere Hospital, Ankara, Turkey
| | - Zohar Habot-Wilner
- Ophthalmology Division, Tel Aviv Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Quan Dong Nguyen
- Byers Eye Institute, Department of Ophthamology, Stanford University, Palo Alto, California, United States of America
| | - Carlos Pavesio
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | |
Collapse
|
29
|
Powers HR, Diaz MA, Mendez JC. Tuberculosis presenting as dacryoadenitis in the USA. BMJ Case Rep 2019; 12:12/11/e231694. [PMID: 31748361 DOI: 10.1136/bcr-2019-231694] [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] [Indexed: 11/04/2022] Open
Abstract
A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient's history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.
Collapse
Affiliation(s)
- Harry Ross Powers
- Division of Infectious Diseases, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - Mark Anthony Diaz
- Division of Infectious Diseases, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - Julio C Mendez
- Division of Infectious Diseases, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| |
Collapse
|
30
|
Agarwal A. Commentary: Presumed tubercular posterior scleritis - What is our understanding so far? Indian J Ophthalmol 2019; 67:1365-1366. [PMID: 31332145 PMCID: PMC6677063 DOI: 10.4103/ijo.ijo_732_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
31
|
Agrawal R, Gunasekeran DV, Raje D, Agarwal A, Nguyen QD, Kon OM, Pavesio C, Gupta V. Global Variations and Challenges With Tubercular Uveitis in the Collaborative Ocular Tuberculosis Study. Invest Ophthalmol Vis Sci 2019; 59:4162-4171. [PMID: 30120485 DOI: 10.1167/iovs.18-24102] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to examine regional variation management practices and outcomes for tubercular uveitis (TBU). Methods In this retrospective multinational cohort study, patients from 25 international eye care centers diagnosed with TBU with a minimum follow-up of 1 year were included. The geographic variation in treatment outcomes on survival analysis in patients with TBU were analyzed. Treatment failure is defined as a persistence or recurrence of inflammation within 6 months of completing antitubercular therapy, the inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. Results Records of 945 patients (1485 eyes) with TBU were analyzed. The mean age was 41.3 ± 15.0 years (range, 4-90 years), with more males (52.9%, n = 500/945) and predominant Asian ethnicity (74.4%, n = 690/927). Most patients had no symptoms (92.0%, n = 655/712) or history (76.7%, n = 604/787) suggestive of pulmonary tuberculosis (TB). Some patients had evidence of inactive pulmonary TB on chest X-rays (26.9%, n = 189/702) or chest computed tomography (68.6%, n = 109/159). Patients with western geographic origin (log-rank = 6.47, P = 0.010), African or Hispanic ethnicity (log-rank = 19.9, P < 0.001), and positive immigrant status (log-rank = 4.89, P = 0.027) had poorer survival outcomes. Conclusions This is a first-ever multinational analysis of TBU that highlights regional differences in treatment outcomes for this elusive form of extrapulmonary TB. Our findings will help in the design of future collaborative studies together with internists to develop best practice guidelines for this early opportunity to address TB infection and strategies to target at-risk groups such as immigrants.
Collapse
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom.,Singapore Eye Research Institute, Singapore
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom.,School of Medicine, National University of Singapore, Singapore
| | | | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Onn Min Kon
- Chest and Allergy Clinic, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | |
Collapse
|
32
|
Immune Mediator Profile in Aqueous Humor Differs in Patients with Primary Acquired Ocular Toxoplasmosis and Recurrent Acute Ocular Toxoplasmosis. Mediators Inflamm 2019; 2019:9356728. [PMID: 30906227 PMCID: PMC6398019 DOI: 10.1155/2019/9356728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/12/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the intraocular cytokine and chemokine profiles in patients with acute primary acquired ocular toxoplasmosis (pOT) or recurrent ocular toxoplasmosis (rOT) and to correlate them with their clinical characteristics. Methods Aqueous humor samples were collected from 62 consecutive patients (21 pOT, 30 rOT, and 11 noninfected controls) and analyzed by multiplex assay. Correlations were assessed between cytokine/chemokine levels, type of inflammatory response (Th1, Th2, and Th17), and clinical characteristics. In all OT patients, the clinical diagnosis of either pOT or rOT was confirmed by positive intraocular Goldmann/Witmer-Desmonts coefficient. Correlations were assessed between a preselected panel of immune mediators and the clinical characteristics of OT. Results In pOT patients, increased levels of IL-2, IFN-γ, TNF-α, IL-15, IL-4, IL-5, IL-9, IL-13, IL-17, IL-1Rα, IL-6, IL-1β, and chemokines MIP-1α, MIP-1β, IP-10, Eotaxin, IL-8, RANTES, PDGF-bb, GM-CSF, G-CSF, and MCP-1 were found in comparison to those in controls (p < 0.05). Patients with rOT showed elevated levels of IL-2, IFN-γ, TNF-α, IL-15, IL-4, IL-5, IL-9, IL-17, IL-1Rα, IL-6, IL-1β, and chemokines MIP-1α, IP-10, Eotaxin, IL-8, RANTES, PDGF-bb, G-CSF, and MCP-1 compared to controls (p < 0.05). In addition, IL-7 (p = 0.028) differed between pOT and rOT; IL-9 (p = 0.054) and IL-13 (p = 0.051) showed a tendency of higher concentration in pOT than in rOT. A negative correlation was found between IL-7 (p = 0.017) as well as IL-9 (p = 0.008) and the number of recurrences. Cytokine ratios showed no difference between pOT and rOT, indicating a dominant Th1-type response in both infectious groups. Moreover, a positive correlation was detected between IL-7, VEGF, IL-13 and age at aqueous humor sampling (p < 0.05). Conclusions This study for the first time shows subtle differences between the intraocular cytokine profiles in patients with either acute pOT or rOT.
Collapse
|
33
|
Hwang DK. Serpiginoid choroiditis, tuberculosis, and sarcoidosis. Taiwan J Ophthalmol 2019; 9:211. [PMID: 31572662 PMCID: PMC6759558 DOI: 10.4103/tjo.tjo_30_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
34
|
Abstract
RATIONALE Membranous nephropathy (MN), a chronic kidney disease (CKD), due to hypoproteinemia, malnutrition, anemia, long-term intake of immunosuppressive agents, changes in cellular immune state, and decrease in antimicrobial peptides, is a high risk for Mycobacterium tuberculosis (MTB) infection, which can cause tuberculosis (TB). TB manifests by various clinical symptoms. Ocular symptoms is a rare presentation of TB. Here, we describe a case of ocular tuberculosis in a patient with MN. PATIENT CONCERNS A 63-year-old man with membranous nephropathy (MN) history presented with ocular symptoms. DIAGNOSES According to the pathological manifestations of ocular tissue biopsy and a positive polymerase chain reaction (PCR) on samples from sputum and bronchoalveolar lavage fluid (BALF), we elicited a diagnosis of disseminated tuberculosis. INTERVENTION The patient received antituberculous therapy and immunosuppressive therapy. OUTCOMES The clinical manifestations significantly improved. LESSONS Clinicians should be aware of the possibility of TB in cases of immunocompromised patients and perform an appropriate diagnostic work-up for TB.
Collapse
Affiliation(s)
| | - Haibo Ge
- Nanjing Hospital of Chinese Medicine
| | - Ruifen Miao
- Department of Chronic Communicable Disease, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| |
Collapse
|
35
|
Low R, Chen EJ, Bin Ismail MA, Mi H, Ling HS, Lim WK, Teoh SC, Agrawal R. Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) - Report 2: Pattern of Uveitis Investigations in Singapore. Ocul Immunol Inflamm 2018; 28:92-99. [PMID: 30335550 DOI: 10.1080/09273948.2018.1535080] [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: 10/28/2022]
Abstract
Purpose: To analyze the pattern of laboratory investigations of uveitis at a tertiary referral eye care center in Singapore.Methods: Retrospective analysis of 2040 uveitis cases from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database over a 12-year period (2004 - 2015).Results: Patients with retinal vasculitis (RV) had the most tests utilized per patient (6.79), followed by intermediate uveitis (IU) (5.25), panuveitis (Pan) (5.12), posterior uveitis (PU) (4.17), anterior uveitis (AU) (2.75), and keratouveitis (KU) (1.10). The most frequently utilized test for infective etiology were the VDRL (41.3%), Syphilis IgG (29.5%), and T-SPOT.TB (24.6%). For autoimmune tests, ANA was most utilized (18.2%), followed by anti-dsDNA (14.8%), and HLA-B27 (12.4%).Conclusion: There was high utilization of autoimmune tests such as ANA, anti-dsDNA, RF, and ANCA, despite its limited yield. Rationalization of investigations in patients with ocular inflammation via a stepladder approach may help optimize the use of limited resources.
Collapse
Affiliation(s)
- Rebecca Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elizabeth J Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Helen Mi
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ho Su Ling
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Kiak Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Eagle Eye Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Stephen C Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Eagle Eye Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - 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
| |
Collapse
|
36
|
Dutta Majumder P, Mukherjee M, Therese L, Gopal L, Biswas J. Diagnostic Challenge with Nocardia Subretinal Abscess: A Case Report from Tuberculosis-Endemic Region. Ocul Immunol Inflamm 2018; 27:762-765. [DOI: 10.1080/09273948.2018.1462391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | | | - Lily Therese
- L&T Microbiology Research Centre, Sankara Nethralaya, Chennai, India
| | - Lingam Gopal
- Department of Vitreoretina, Sankara Nethralaya, Chennai, India
| | | |
Collapse
|
37
|
Damato EM, Dawson S, Liu X, Mukherjee C, Horsburgh J, Denniston AK, Moran E, Dedicoat M, Murray PI. A retrospective cohort study of patients treated with anti-tuberculous therapy for presumed ocular tuberculosis. J Ophthalmic Inflamm Infect 2017; 7:23. [PMID: 29204932 PMCID: PMC5714940 DOI: 10.1186/s12348-017-0141-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Uveitis involving the posterior segment is a significant and potentially blinding condition. The diagnosis and treatment of patients with uveitis associated with tuberculosis remains controversial, and commonly, patients are systemically well. Use of the interferon-gamma release assays has added to the controversy, as the significance of a positive test may be uncertain. We aim to report the outcomes of anti-tuberculous treatment in a cohort of patients treated in Birmingham, for presumed "ocular tuberculosis", based on clinical findings, systemic assessment and specific testing for tuberculosis. RESULTS We found that in our cohort of 41 patients treated between 2010 and 2014, the majority achieved disease-free remission, even in cases where anti-tuberculous treatment was delayed. CONCLUSIONS Despite controversy, this study strongly supports the use of anti-tuberculous therapy in such patients and highlights the need for formal prospective trials and treatment protocols.
Collapse
Affiliation(s)
- Erika Marie Damato
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
| | - Sarah Dawson
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
| | - Xiaoxuan Liu
- Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ UK
| | - Chandoshi Mukherjee
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
| | - John Horsburgh
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair K. Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Edward Moran
- Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Dedicoat
- Birmingham Chest Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Philip Ian Murray
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| |
Collapse
|
38
|
Agrawal R, Gunasekeran DV, Grant R, Agarwal A, Kon OM, Nguyen QD, Pavesio C, Gupta V. Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)-1. JAMA Ophthalmol 2017; 135:1318-1327. [PMID: 29075752 PMCID: PMC6583556 DOI: 10.1001/jamaophthalmol.2017.4485] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/11/2017] [Indexed: 12/25/2022]
Abstract
Importance Eradication of systemic tuberculosis (TB) has been limited by neglected populations and the HIV pandemic. Whereas ocular TB often presents as uveitis without any prior evidence of systemic TB, the existing uncertainty in the diagnosis of TB uveitis may perpetuate missed opportunities to address systemic TB. Objective To examine the clinical features of TB uveitis and the associations with response to antitubercular therapy (ATT). Design, Setting, and Participants This retrospective multinational cohort study included patients from 25 ophthalmology referral centers diagnosed with TB uveitis and treated with ATT from January 1, 2004, through December 31, 2014, with a minimum follow-up of 1 year. Main Outcomes and Measures Treatment failure, defined as a persistence or recurrence of inflammation within 6 months of completing ATT, inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. Results A total of 801 patients (1272 eyes) were studied (mean [SD] age, 40.5 [14.8] years; 413 [51.6%] male and 388 [48.4%] female; 577 [73.6%] Asian). Most patients had no known history (498 of 661 [75.3%]) of systemic TB. Most patients had bilateral involvement (471 of 801 [58.8%]). Common clinical signs reported include vitreous haze (523 of 1153 [45.4%]), retinal vasculitis (374 of 874 [42.8%]), and choroidal involvement (419 of 651 [64.4%]). Treatment failure developed in 102 of the 801 patients (12.7%). On univariate regression analysis, the hazard ratios (HRs) associated with intermediate uveitis (HR, 2.21; 95% CI, 1.07-4.55; P = .03), anterior uveitis (HR, 2.68; 95% CI, 1.32-2.35; P = .006), and panuveitis (HR, 3.28; 95% CI, 1.89-5.67; P < .001) were significantly higher compared with posterior distribution. The presence of vitreous haze had a statistically significant association (HR, 1.95; 95% CI, 1.26-3.02; P = .003) compared with absence of vitreous haze. Bilaterality had an associated HR of 1.50 (95% CI, 0.96-2.35) compared with unilaterality (HR, 1 [reference]), although this finding was not statistically significant (P = .07). On multivariate Cox proportional hazards regression analysis, the presence of vitreous haze had an adjusted HR of 2.98 (95% CI, 1.50-5.94; P = .002), presence of snow banking had an adjusted HR of 3.71 (95% CI, 1.18-11.62; P = .02), and presence of choroidal involvement had an adjusted HR of 2.88 (95% CI, 1.22-6.78; P = .02). Conclusions and Relevance A low treatment failure rate occurred in patients with TB uveitis treated with ATT. Phenotypes and test results are studied whereby patients with panuveitis having vitreous and choroidal involvement had a higher risk of treatment failure. These findings are limited by retrospective methods. A prospectively derived composite clinical risk score might address this diagnostic uncertainty through holistic and standardized assessment of the combinations of clinical features and investigation results that may warrant diagnosis of TB uveitis and treatment with ATT.
Collapse
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
- Singapore Eye Research Institute, Singapore
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
- School of Medicine, National University of Singapore, Singapore
| | - Robert Grant
- Faculty of Health, Social Care, and Education, Kingston University and St George’s, University of London, London, England
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare, National Health Service Trust, London, England
| | | | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
39
|
Darian-Smith E, Lin ML, Lim LL, McCluskey P, Hall AJ. The Incidence of Ocular Tuberculosis in Australia Over the Past 10 Years (2006-2015). Ophthalmic Epidemiol 2017; 24:406-412. [PMID: 28901810 DOI: 10.1080/09286586.2017.1336562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the incidence and clinical phenotype of ocular tuberculosis in Australia based on the mandatory jurisdictional health notification records for TB. METHODS A whole population retrospective case series (Australia). Patients diagnosed with ocular tuberculosis were identified over the past 10 years (1 January 2006 to 31 December 2015) as recorded by individual Health Department jurisdictions per mandatory health notifications. The incidence rates were calculated based on the available Australian census data. Incidence rates were age and sex standardized. RESULTS A total of 162 cases of ocular tuberculosis were identified across Australia over a 10-year time period. Of these, 156 participants were overseas born. The 10-year Australian incidence of ocular tuberculosis was 0.77 per 100,000 people. While there has been a downward trend in overall TB annual incidence rates from 2010 to 2015, over the same period the annual incidence of ocular TB has increased compared to the 4 previous years. Descriptive clinical data regarding the ocular manifestations of TB was available in 73/157 patients. In these 73 patients the commonest manifestations of ocular TB were unspecified uveitis (50.1%), focal, multifocal or serpiginous choroiditis or chorioretinitis (12.3%) and retinal vasculitis (11.0%). Of patients with ocular TB, 4/162 (2.47%) had associated pulmonary TB and 8/162 (4.94%) had associated systemic (non-pulmonary) TB. Systemic anti-TB therapy was administered to 161 patients. CONCLUSIONS The annual Australian incidence of ocular tuberculosis was 0.077 per 100,000 people. Increasing notifications in the past 6 years may demonstrate increased awareness and changing diagnostic criteria of the disease in the Australian population.
Collapse
Affiliation(s)
- Erica Darian-Smith
- a Department of Ophthalmology , Alfred Hospital , Melbourne , Victoria , Australia.,b School of Medicine, University of Tasmania , Hobart , Tasmania
| | - Ming-Lee Lin
- a Department of Ophthalmology , Alfred Hospital , Melbourne , Victoria , Australia.,d Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Lyndell L Lim
- d Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.,f Centre for Eye Research Australia , University of Melbourne, Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Peter McCluskey
- e Save Sight Institute Discipline of Ophthalmology , Sydney Medical School, University of Sydney , Camperdown , New South Wales , Australia
| | - Anthony J Hall
- a Department of Ophthalmology , Alfred Hospital , Melbourne , Victoria , Australia.,c Department of Surgery , Monash University , Clayton , Victoria , Australia
| |
Collapse
|
40
|
Garg RK, Malhotra HS, Kumar N, Uniyal R. Vision loss in tuberculous meningitis. J Neurol Sci 2017; 375:27-34. [PMID: 28320145 DOI: 10.1016/j.jns.2017.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 12/11/2022]
Abstract
Vision loss is a disabling complication of tuberculous meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in tuberculous meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of tuberculous meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of tuberculous meningitis is the only way forward to tackle this problem.
Collapse
Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
| | | | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
41
|
Little LM, Graviss EA, Foroozan R, Lee AG. Screening for tuberculosis in neuro-ophthalmology. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1248407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|