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Danjou W, Pradat P, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Trad S, Seve P. Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment. Br J Ophthalmol 2023; 107:500-504. [PMID: 34711577 DOI: 10.1136/bjophthalmol-2021-318868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
AIMS Few studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate the value of the QuantiFERON test in a large cohort of patients with uveitis for both the diagnosis of tubercular uveitis and antituberculosis treatment (ATT) response prediction. METHODS A single-centre retrospective study including consecutive adult patients with uveitis who were prescribed a QuantiFERON test between January 2003 and December 2019 was performed. Adjusted ORs (aORs) were calculated between patients with uveitis responding and not responding to ATT according to the Collaborative Ocular Tuberculosis Study (COTS) group diagnostic criteria. Sensitivity (SE), specificity (Sp), and positive and negative predictive values of the QuantiFERON test were calculated. RESULTS A total of 1075 patients were included in the study; 178 (16.5%) were found positive using the QuantiFERON test. Among the 178 positive patients, 62 (35%) had a diagnosis of tubercular uveitis according to the updated COTS classification; all received ATT for 6 months; and 44/62 (71%) responded to ATT. A QuantiFERON test value of >2 IU/mL was associated with a greater chance of responding to ATT (aOR=36.7, 95% CI 7.2 to 185.9, p<0.001). The optimal threshold to maximise both Sp and SE for diagnosis of TB uveitis was 4 IU/mL. CONCLUSION One-sixth of the patients diagnosed with uveitis had a positive QuantiFERON test. The QuantiFERON threshold with the optimal SE and Sp for the diagnosis of tubercular uveitis was 4 IU/mL. TRIAL REGISTRATION NUMBER NCT03863782.
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Affiliation(s)
- William Danjou
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre Pradat
- Centre de recherche clinique, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yvan Jamilloux
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Service d'ophtalmologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Salim Trad
- Service de médecine interne, Hôpital Ambroise Paré, Paris, France
| | - Pascal Seve
- Service de médecine interne, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Villeurbanne, France
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Betzler BK, Putera I, Testi I, La Distia Nora R, Kempen J, Kon OM, Pavesio C, Gupta V, Agrawal R. Anti-tubercular therapy in the treatment of tubercular uveitis: A systematic review and meta-analysis. Surv Ophthalmol 2023; 68:241-256. [PMID: 36272559 DOI: 10.1016/j.survophthal.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
We quantitatively evaluated the efficacy of antitubercular therapy (ATT) in tubercular uveitis (TBU) patients. Main outcome measures include inflammation recurrence, inflammation reduction, complete resolution of inflammation, improved visual acuity (VA), ability to taper corticosteroids to < 10 mg/day without inflammatory progression, and use of adjunctive immunosuppressants while on ATT. This review is prospectively registered in PROSPERO (CRD42020206845). Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI:0.19-0.60) for TBU patients treated with ATT±corticosteroid versus no ATT. For TBU patients treated with ATT±corticosteroid, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation, and visual acuity improvement were 13% (n=310/2,216; 95%CI:9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI:51-78), respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI:78-99) of patients, 9% (n=121/1,376; 95%CI:6-13) of whom were administered concomitant immunosuppressive agents alongside ATT. We conclude that treatment of TBU with ATT±corticosteroid is associated with a high level of control or improvement of inflammation. More prospective studies with detailed reporting of ATT regimens, patient subgroups, and outcomes are required to better evaluate ATT effectiveness.
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Affiliation(s)
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Indonesia; Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Indonesia; Erasmus Medical Center, Rotterdam, The Netherlands
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, United States; Myungsung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and Myungsung Medical School, Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, England
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, Singapore.
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Garneret E, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Trad S, Sève P. Prevalence of Positive QuantiFERON-TB Test among Sarcoid Uveitis Patients and its Clinical Implications in a Country Non-endemic for Tuberculosis. Ocul Immunol Inflamm 2022:1-9. [PMID: 35797278 DOI: 10.1080/09273948.2022.2073238] [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: 10/17/2022]
Abstract
AIM To report on the prevalence and clinical implications of positive QuantiFERON-TB (QFT) test results in the diagnostic evaluation of a cohort of consecutive sarcoid uveitis patients in France. DESIGN Retrospective cross-sectional study. METHODS This study included consecutive sarcoid uveitis patients who all underwent QFT testing. RESULTS A total of 234 patients were included in the study, among them 28 (12%) were QFT-positive. Previously treated tuberculosis (TB) was documented in 2 patients. QFT-positive patients were older (59 ± 16 years vs. 51 ± 18 years, p = .025) and more in proportion to suffer from chronic uveitis and panuveitis compared to QFT-negative patients. Moderate and severe visual impairment were significantly more frequent in the QFT-positive group (35.7% vs. 18.9%, p = .049 and 25.0% vs. 9.2%, p = .022, respectively). CONCLUSION The significant proportion of QFT-positive patients (12%) in this large series of sarcoid uveitis patients makes us suggest not to exclude the diagnosis of sarcoidosis in case of positive QFT in a low-endemic country for tuberculosis, and to manage these patients early by initiating without delay systemic steroids associated with latent tuberculosis therapy.
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Affiliation(s)
- Etienne Garneret
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Université Claude Bernard Lyon 1, Lyon, France.,Department of Ophthalmology, Hôpital de la Croix Rousse, Université Claude Bernard Lyon 1, Lyon, France
| | - Salim Trad
- Department of Internal Medicine, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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4
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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.
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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
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5
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Betzler BK, Gupta V, Agrawal R. Clinics of ocular tuberculosis: A review. Clin Exp Ophthalmol 2021; 49:146-160. [DOI: 10.1111/ceo.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Vishali Gupta
- Advanced Eye Centre Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
- National Healthcare Group Eye Institute Tan Tock Seng Hospital Singapore Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust London UK
- Singapore Eye Research Institute Singapore Singapore
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6
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Agrawal R, Betzler BK, Testi I, Mahajan S, Agarwal A, Gunasekeran DV, Raje D, Aggarwal K, Murthy SI, Westcott M, Chee SP, McCluskey P, Ho SL, Teoh S, Cimino L, Biswas J, Narain S, Agarwal M, Mahendradas P, Khairallah M, Jones N, Tugal-Tutkun I, Babu K, Basu S, Carreño E, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Esposti SD, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Singh R, Sharma A, Sharma K, Zierhut M, Kon OM, Cunningham ET, Kempen JH, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 447 Patients with Tubercular Intermediate Uveitis and Panuveitis. Ocul Immunol Inflamm 2020; 28:27-37. [DOI: 10.1080/09273948.2020.1808226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Ocular Infections and Anti-Microbials, Singapore Eye Research Institute, Singapore
| | - Bjorn Kaijun Betzler
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Ocular Infections and Anti-Microbials, Singapore Eye Research Institute, Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Sarakshi Mahajan
- Department of Medicine, St Joseph Mercy Hospital, Oakland, Pontiac, Michigan, USA
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | - Kanika Aggarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Soon-Phaik Chee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Ocular Infections and Anti-Microbials, Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
- Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Peter McCluskey
- Department of Clinical Ophthalmology & Eye Health, Central Clinical School, Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Su Ling Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stephen Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | | | - Shishir Narain
- Department of Ophthalmology, Shroff Eye Centre, New Delhi, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff’s Charity Eye Hospital Daryaganj, New Delhi, India
| | | | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nicholas Jones
- Department of Ophthalmology, University of Manchester, Manchester, UK
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Kalpana Babu
- Prabha Eye Clinic & Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Soumayava Basu
- Department of Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, India
| | - Ester Carreño
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Richard Lee
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Hassan Al-Dhibi
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bahram Bodaghi
- DHU SightRestore, Department of Ophthalmology, Sorbonne University, Paris, France
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco HospitalUniversity of Milan, Milan, Italy
| | - Debra A Goldstein
- Northwestern University, Feinberg School of Medicine, Department of Ophthalmology, Chicago, Illinois, USA
| | - Talin Barisani-Asenbauer
- The Centre for Ocular Inflammation and Infection (OCUVAC), Laura Bassi Centre of Expertise Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Thessaly, Greece
| | - Reema Bansal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bruttendu Moharana
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | | | - Mamta Agarwal
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India
| | | | - Ruchi Vala
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Rheumatology, PGIMER, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, PGIMER, Chandigarh, India
| | - Manfred Zierhut
- Centre of Ophthalmology, Department of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Emmett T Cunningham
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- MCM Eye Unit, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Palo Alto, California, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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7
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Amara A, Ben Salah E, Guihot A, Fardeau C, Touitoue V, Saadoun D, Bodaghi B, Sève P, Trad S. [Observational study of QuantiFERON® management for ocular tuberculosis diagnosis: Analysis of 244 consecutive tests]. Rev Med Interne 2020; 42:162-169. [PMID: 33143863 DOI: 10.1016/j.revmed.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/19/2020] [Accepted: 09/30/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Ocular tuberculosis (TB) diagnosisremains difficult and quantiferon (QFT) contribution needs still yet to be specified, despite its generalization in France. The purpose of this observational study is to assess in which ocular inflammation (OI) presentation QFT is prescribed and to evaluate the added value of new QuantiFERON®-TB Gold Plus (QFT-Plus) test for diagnosis ocular TB diagnosis. PATIENTS AND METHODS Monocentric, observational study, carried out in an ophthalmology department over a period of 5 months. Inclusion criteria were defined as an existence of an OI for which a QFT-Plus test was part of the etiological investigations. Of the 316 consecutive files, 72 were excluded (indeterminate test, prescription before anti-TNFα or immunosuppressant initiation, missing data, wrong indication) and 244 were selected and divided into two groups: group one (anterior uveitis/episcleritis, n=129) and group two (intermediate/posterior uveitis/optic neuritis/ocular myositis, n=115). All positive QFT patients underwent an etiological investigation including thoracic imaging. RESULTS Forty-five patients, aged 52±12 years, had positive QFT (18.5%), including 18 patients for group 1 and 27 for group 2. Living in TB-endemic area, TB exposure and chest imaging abnormalities were identified in 70%, 27% and 22% of cases, respectively. OI was chronic in 36% of cases (group one, 4/18; group two, 12/27). None of the 18 patients, in group 1, received anti-tuberculosis treatment (ATT) or experienced a relapse during one-year follow-up. Four QFT+ patients, from group 2 (15%) had another associated disease explaining their uveitis. Among the 23 other patients without identified etiology, 13 had at least one relevant ophthalmological signs predictive of TB uveitis (posterior synechiae, retinal vasculitis and/or choroidal granuloma) (59%). Eleven patients received a 6-month ATT trial. Radiological abnormalities and granulomas at angiography were significantly more frequent among treated patients (p=0.03 and 0.001, respectively). A full OI recovery was observed for 8 patients (73%), considered ex-post as ocular TB. Nine patients in group 2 received rifampicin/isoniazid dual therapy for 3 months, but no conclusion could be drawn as to the benefit of such prescription on OI. QFT rate comparison, according to CD4 stimulation by ESAT-6/CFP-10 peptides or by CD4/CD8 co-stimulation, was comparable and found only 4 cases of discrepancy (1.6%). None of these 4 cases had ocular TB diagnosis. CONCLUSION Positive QFT frequency among patients consulting for posterior OI remains high. In this study, radiological abnormalities and granulomas at angiography seemed to be more closely related to clinician decision for starting ATT trial in QFT+ patients, which was effective in 73% of cases. QFT-Plus does not seem more relevant than QFT-TB in exploring an OI. Prospective studies are necessary to codify QFT management in the etiological assessment of OI and clearly define ATT trial indications as well as their modalities.
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Affiliation(s)
- A Amara
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - E Ben Salah
- Département d'immunologie, hôpital Pitié Salpêtrière, AP-HP, Paris, France; UPMC UMRS CR7 - Inserm U1135, centre d'immunologie et des maladies infectieuses, Paris, France
| | - A Guihot
- Département d'immunologie, hôpital Pitié Salpêtrière, AP-HP, Paris, France; UPMC UMRS CR7 - Inserm U1135, centre d'immunologie et des maladies infectieuses, Paris, France
| | - C Fardeau
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - V Touitoue
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - D Saadoun
- Département de médecine interne et d'immunologie clinique, centre national de référence maladies autoimmunes systémiques rares, centre national de référence maladies autoinflammatoires et amylose, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; UMR 7211, département d'inflammation-immunopathologie-biothérapie (DHU i2B), UPMC université Paris 06, université de la Sorbonne, 75005 Paris, France
| | - B Bodaghi
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, 103, Grande Rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Pôle IMER, hospices civils de Lyon, 69003 Lyon, France; HESPER EA 7425, université Claude Bernard, Lyon 1, 69008 Lyon, France
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, 92104 Boulogne-Billancourt, France; Université de Versailles-Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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8
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Agrawal R, Betzler B, Testi I, Mahajan S, Agarwal A, Gunasekeran DV, Raje D, Aggarwal K, Murthy SI, Westcott M, Chee SP, Mccluskey P, Ho SL, Teoh S, Cimino L, Biswas J, Narain S, Agarwal M, Mahendradas P, Khairallah M, Jones N, Tugal-Tutkun I, Babu K, Basu S, Carreño E, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Herbort CP, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Esposti S, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Singh R, Sharma A, Sharma K, Zierhut M, Kon OM, Cunningham ET, Kempen JH, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 165 Patients with Tubercular Anterior Uveitis. Ocul Immunol Inflamm 2020; 28:17-26. [PMID: 32600163 DOI: 10.1080/09273948.2020.1761400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The Collaborative Ocular Tuberculosis Study (COTS) Group sought to address the diagnostic uncertainty through retrospective cohort analysis of treatment regimens and therapeutic outcomes for patients with tubercular Anterior Uveitis (TAU) across international centers. METHODS Multicentre retrospective analysis of patients diagnosed with TAU between January 2004 to December 2014 that had a minimum follow-up of 1 year. RESULTS One hundred and sixty-five patients were included. One hundred and seven subjects received antitubercular therapy (ATT) (n = 107/165; 64.9%) with all the patients receiving topical steroid therapy. Treatment failure was noted in 17 patients (n = 17/165; 10.3%), more frequently described in patients that received ATT (n = 13/107, 12.2%), than those that did not receive ATT (n = 4/58, 6.9%). CONCLUSION In this retrospective study, addition of ATT did not have any statistically significant impact on outcome in patients with TAU.
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Affiliation(s)
- 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, NHS Foundation Trust, London, UK.,Singapore Eye Research Institute, Singapore, Singapore
| | - Bjorn Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Sarakshi Mahajan
- Byres Eye Institute, Stanford University, Palo Alto, California, USA
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | - Kanika Aggarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Somasheila I Murthy
- Tej Kohli Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Soon-Phaik Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Peter Mccluskey
- Department of Clinical Ophthalmology & Eye Health, Central Clinical School, Save Sight Institute, the University of Sydney, Sydney, Australia
| | - Su Ling Ho
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Stephen Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | | | - Shishir Narain
- Department of Ophthalmology, Shroff Eye Centre, New Delhi, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff's Charity Eye Hospital Daryaganj, New Delhi, India
| | | | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Singapore, Singapore
| | - Nicholas Jones
- Department of Ophthalmology, University of Manchester, Manchester, UK
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Kalpana Babu
- Prabha Eye Clinic & Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Soumayava Basu
- Department of Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, India
| | - Ester Carreño
- Servicio de Oftalmología, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Richard Lee
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Hassan Al-Dhibi
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bahram Bodaghi
- DHU SightRestore, Department of Ophthalmology, Sorbonne University, Paris, France
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Debra A Goldstein
- Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
| | - Carl P Herbort
- Centre for Ophthalmic Specialised Care & University of Lausanne, Lausanne, Switzerland
| | - Talin Barisani-Asenbauer
- The Centre for Ocular Inflammation and Infection (OCUVAC), Laura Bassi Centre of Expertise Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Reema Bansal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bruttendu Moharana
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Simona Esposti
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | | | - Mamta Agarwal
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India
| | | | - Ruchi Vala
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Rheumatology, PGIMER, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, PGIMER, Chandigarh, India
| | - Manfred Zierhut
- Centre of Ophthalmology, Department of Ophthalmology, University of Tuebingen, Germany
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emmett T Cunningham
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.,MCM Eye Unit, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Quan Dong Nguyen
- Byres Eye Institute, Stanford University, Palo Alto, California, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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9
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Agrawal R, Testi I, Bodaghi B, Barisani-Asenbauer T, McCluskey P, Agarwal A, Kempen JH, Gupta A, Smith JR, de Smet MD, Yuen YS, Mahajan S, Kon OM, Nguyen QD, Pavesio C, Gupta V. Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis-Report 2: Guidelines for Initiating Antitubercular Therapy in Anterior Uveitis, Intermediate Uveitis, Panuveitis, and Retinal Vasculitis. Ophthalmology 2020; 128:277-287. [PMID: 32603726 DOI: 10.1016/j.ophtha.2020.06.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022] Open
Abstract
TOPIC The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular Immunological Society, set up an international, expert-led consensus project to develop evidence- and experience-based guidelines for the management of tubercular uveitis (TBU). CLINICAL RELEVANCE The absence of international agreement on the use of antitubercular therapy (ATT) in patients with TBU contributes to a significant heterogeneity in the approach to the management of this condition. METHODS Consensus statements for the initiation of ATT in TBU were generated using a 2-step modified Delphi technique. In Delphi step 1, a smart web-based survey based on background evidence from published literature was prepared to collect the opinion of 81 international experts on the use of ATT in different clinical scenarios. The survey included 324 questions related to tubercular anterior uveitis (TAU), tubercular intermediate uveitis (TIU), tubercular panuveitis (TPU), and tubercular retinal vasculitis (TRV) administered by the experts, after which the COTS group met in November 2019 for a systematic and critical discussion of the statements in accordance with the second round of the modified Delphi process. RESULTS Forty-four consensus statements on the initiation of ATT in TAU, TIU, TPU, and TRV were obtained, based on ocular phenotypes suggestive of TBU and corroborative evidence of tuberculosis, provided by several combinations of immunologic and radiologic test results. Experts agreed on initiating ATT in recurrent TAU, TIU, TPU, and active TRV depending on the TB endemicity. In the presence of positive results for any 1 of the immunologic tests along with radiologic features suggestive of past evidence of tuberculosis infection. In patients with a first episode of TAU, consensus to initiate ATT was reached only if both immunologic and radiologic test results were positive. DISCUSSION The COTS consensus guidelines were generated based on the evidence from published literature, specialists' opinions, and logic construction to address the initiation of ATT in TBU. The guidelines also should inform public policy by adding specific types of TBU to the list of conditions that should be treated as tuberculosis.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom; Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Baharam Bodaghi
- Department of Ophthalmology, Sorbonne University, Paris, France
| | - Talin Barisani-Asenbauer
- OCUVAC-Centre of Ocular Inflammation and Infection, Laura Bassi Centre of Expertise, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - Peter McCluskey
- Save Sight Institute, Department of Ophthalmology, University of Sydney, Sydney, Australia
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts; MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Abeba, Ethiopia
| | - Amod Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Marc D de Smet
- MIOS SA-Medical/Surgical Retina and Ocular Inflammation, Lausanne, Switzerland
| | - Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, Singapore, Republic of Singapore
| | | | - Onn Min Kon
- Chest and Allergy Clinic, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Stanford, California
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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10
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Prevalence of Positive QuantiFERON-TB Gold In-Tube Test in Uveitis and its Clinical Implications in a Country Nonendemic for Tuberculosis. Am J Ophthalmol 2020; 211:151-158. [PMID: 31734135 DOI: 10.1016/j.ajo.2019.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To report on the prevalence and clinical implications of positive QuantiFERON-Gold (QFT-G) test results in the diagnostic evaluation of a large cohort of consecutive patients with uveitis in the Netherlands. DESIGN Retrospective cross-sectional study. METHODS This study included 710 consecutive patients who all underwent evaluation for uveitis including QFT-G testing. The ocular features, comorbidity, and abnormalities in diagnostic imaging and laboratory tests were registered for QFT-G-positive patients with uveitis. RESULTS Of all patients, 13% (92/710) were positive for QFT-G. Previously treated tuberculosis (TB) was documented in 2 patients. Of all 92 QFT-G-positive patients, culture-proven active TB was observed in 1 case. The proportion of patients with uveitis of unknown etiology was higher in QFT-G-positive than in the QFT-G-negative patients (54/92, 59% vs 238/618, 39%; P = .0004). The uveitis features of QFT-G-positive patients were mainly nonspecific. Of all QFT-G-positive patients with uveitis, 17 patients had chest imaging changes suggesting either TB or sarcoidosis. Twenty-nine QFT-G-positive patients with otherwise unexplained uveitis completed antituberculous therapy (29/710; 4% of all included patients) with beneficial effect in most cases. CONCLUSION The QFT-G tested positive in 13% of patients with uveitis in the Netherlands, whereas only sporadic patients had a documented previous or active TB infection. The proportion of patients with unexplained uveitis was higher in QFT-G-positive patients. Though the association between uveitis and a positive QFT-G test might be coincidental, the majority of treated QFT-G-positive patients with otherwise unexplained severe uveitis cause had a beneficial response to antituberculous therapy.
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11
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Llorenç V, Benejam G, Mesquida M, Sainz de la Maza M, Molins B, Alba C, Pelegrin L, Martínez JA, Adán A. Antituberculous Treatment Itself Might Prevent Visual Impairment in Presumed Tuberculosis-Related Uveitis. Ocul Immunol Inflamm 2018; 28:103-110. [PMID: 30395738 DOI: 10.1080/09273948.2018.1541326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: To study the risk factors for visual loss in presumed tuberculosis-related uveitis (TRU).Methods: Retrospective observational cohort study of patients with TRU, either treated or not for tuberculosis, from January 2005 to January 2017. Clinical and demographic variables were recorded. Main outcome measure was a loss of visual acuity (VA) of ≥2 Snellen lines. A Generalized Estimation Equation was used to control between-eyes bias. A backward stepwise logistic regression multivariate analysis was conducted to elucidate independent risk factors.Results: One hundred and thirty-eight eyes from 82 patients were included. There were 45 males, median age at onset of uveitis was 40 years (Interquartile range, IQR 24). The median follow-up was 36 months (IQR 49.75) and 51 patients completed antituberculous treatment (ATT) for a mean of 9.37 months. In the multivariate model, ATT was the only independent protective factor for loss of VA (OR 0.13, 95% CI 0.04-0.37, p < 0.001).Conclusion: ATT itself may prevent visual loss in TRU.
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Affiliation(s)
- Victor Llorenç
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Gibet Benejam
- Ophthalmology Department, Sant Joan Hospital, Reus (Tarragona), Spain
| | - Marina Mesquida
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Maite Sainz de la Maza
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Blanca Molins
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Carmen Alba
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain
| | - Laura Pelegrin
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain
| | | | - Alfredo Adán
- Clínic Institute of Ophthalmology (ICOF), Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Clínic Hospital of Barcelona, Barcelona, Spain
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12
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Sève P, Bodaghi B, Trad S, Sellam J, Bellocq D, Bielefeld P, Sène D, Kaplanski G, Monnet D, Brézin A, Weber M, Saadoun D, Cacoub P, Chiquet C, Kodjikian L. Prise en charge diagnostique des uvéites : recommandations d’un groupe d’experts. Rev Med Interne 2018; 39:676-686. [DOI: 10.1016/j.revmed.2017.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022]
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13
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Trad S, Saadoun D, Errera MH, Abad S, Bielefeld P, Terrada C, Sène D, Bodaghi B, Sève P. [Ocular tuberculosis]. Rev Med Interne 2018; 39:755-764. [PMID: 29891262 DOI: 10.1016/j.revmed.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
Despite extensive investigations, including the use of Interferon-gamma release assays (IGRA), the diagnosis of intraocular tuberculosis (TB) remains challenging. Ocular evidence of Mycobacterium tuberculosis in low endemic countries for TB is extremely rare, leading mostly to a TB-related ocular inflammation presumptive diagnosis. This present work aims: to highlights the main clinical patterns suggestive of ocular TB; and the latest recommended guidelines for diagnosing ocular TB to clarify interferon-gamma release assay (IGRA) contribution and accuracy to the management of intraocular TB and its diagnosis, in addition to other available diagnostic tools, such as tuberculin skin test, bacteriologic and histologic analysis from intra/extra ocular sample and radiographic investigations; to define the accuracy of these diagnostic tools according to the endemic TB prevalence; and finally to identify therapeutic strategies adapted to the main clinical presentations of ocular TB. Our review of the literature shows that management of suspected ocular TB differs significantly based on whether patients are from high or low TB prevalence countries since accuracy of chest X-ray, tuberculin skin test and IGRA is significantly different. Taking into account these discrepancies, distinct guidelines should be determined for managing patients with suspected ocular TB, taking into consideration home prevalence of TB-patients.
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Affiliation(s)
- S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt France.
| | - D Saadoun
- Centre national de référence maladies autoimmunes systémiques rares, centre national de référence maladies autoinflammatoires et amylose, département de médecine interne et d'immunologie clinique, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France
| | - M H Errera
- Service d'ophthalmologie du centre hospitalier national des Quinze-Vingts et DHU Sight Restore, 75012 Paris, France; Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne assistance publique-hôpitaux de Paris (AP-HP), 125, route de Stalingrad, 93000 Bobigny, France; UMR1125, LI2P, faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, France
| | - P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon Bourgogne 21000 Dijon, France
| | - C Terrada
- Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France; Centre médical Roule-Péretti, 169, avenue Achille-Peretti, 92200, Neuilly-sur-Seine, France
| | - D Sène
- Département de médecine interne, APHP, hôpital Lariboisière, 75010 Paris, France; Université Paris Diderot, 75010 Paris, France
| | - B Bodaghi
- Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France; Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France; Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France
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14
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La Distia Nora R, Sitompul R, Bakker M, Susiyanti M, Edwar L, Sjamsoe S, Singh G, van Hagen MP, Rothova A. Tuberculosis and other causes of uveitis in Indonesia. Eye (Lond) 2018; 32:546-554. [PMID: 29099497 PMCID: PMC5848274 DOI: 10.1038/eye.2017.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/10/2017] [Indexed: 12/18/2022] Open
Abstract
PurposeThe purpose of this study is to assess the causes of uveitis in Indonesia and determine the importance of tuberculosis (TB) as a cause of uveitis.Patients and methodsProspective cohort study examining 146 consecutive new human immunodeficiency virus-negative patients with active uveitis between June 2014 and May 2015. We assessed the anatomic locations and specific causes of uveitis, as well as associations with infectious and non-infectious systemic diseases. We determined the prevalence of positive QuantiFERON Tb Gold test (QFT) results in Indonesian patients with uveitis and calculated the number of patients with active systemic TB.ResultsPosterior and panuveitis were the most common anatomic entities (38% each). Infections represented the most frequent cause of uveitis (33%); the most prevalent were toxoplasmosis (19%) and active systemic TB (8%). The majority of patients were QFT positive (61%). A specific diagnosis could not be established in 45% of the patients. At first presentation to the ophthalmologist, the majority of patients (66%) had a visual acuity of less than finger counting at 3 m and already exhibited various complications of uveitis. When classifying the QFT-positive patients with unexplained uveitis into a TB-related group, the percentage of 'TB-associated' uveitis cases increased from 8-48%. Highly elevated QFT levels were observed in patients with uveitis of unknown cause and no signs of active systemic TB.ConclusionsIn Indonesia, infectious uveitis was the most common type of uveitis and the leading causes consisted of toxoplasmosis and TB. The association observed between highly elevated QFT results and uveitis of otherwise unexplained origins indicates that a link exists between the latent TB infection and the development of uveitis.
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Affiliation(s)
- R La Distia Nora
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
- Department of Clinical Immunology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Sitompul
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - M Bakker
- Department of Pulmonary Diseases, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Susiyanti
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - L Edwar
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - S Sjamsoe
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - G Singh
- Respirology and Critical Illness Division, Department of Internal Medicine, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - M P van Hagen
- Department of Clinical Immunology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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15
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Sève P, Cacoub P, Bodaghi B, Trad S, Sellam J, Bellocq D, Bielefeld P, Sène D, Kaplanski G, Monnet D, Brézin A, Weber M, Saadoun D, Chiquet C, Kodjikian L. Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee. Autoimmun Rev 2017; 16:1254-1264. [DOI: 10.1016/j.autrev.2017.10.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
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16
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Trad S. Authors Reply to Letter to the Editor-In response to: "Tripathy, K. Update on Immunological Test (Quantiferon-TB Gold) Contribution in the Management of Tuberculosis-Related Ocular Inflammation". Ocul Immunol Inflamm 2017; 27:140. [PMID: 29020493 DOI: 10.1080/09273948.2017.1375120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Salim Trad
- a Internal Medicine Department , Ambroise-Paré Hospital , Boulogne-Billancourt , France
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17
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Trad S, Bodaghi B, Saadoun D. Update on Immunological Test (Quantiferon-TB Gold) Contribution in the Management of Tuberculosis-Related Ocular Inflammation. Ocul Immunol Inflamm 2017; 26:1192-1199. [DOI: 10.1080/09273948.2017.1332232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S. Trad
- Internal Medicine Department, AP-HP, Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - B. Bodaghi
- Ophthalmology Department, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Univ Paris, UMR 7211, Paris, France
| | - D. Saadoun
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France
- INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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18
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Pathanapitoon K, Kunavisarut P, Sirirungsi W, Rothova A. Looking for Ocular Tuberculosis: Prevalence and Clinical Manifestations of Patients with Uveitis and Positive QuantiFERON®-TB Gold Test. Ocul Immunol Inflamm 2016; 26:819-826. [DOI: 10.1080/09273948.2016.1245760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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19
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Kee AR, Gonzalez-Lopez JJ, Al-Hity A, Gupta B, Lee CS, Gunasekeran DV, Jayabalan N, Grant R, Kon OM, Gupta V, Westcott M, Pavesio C, Agrawal R. Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis. Surv Ophthalmol 2016; 61:628-53. [PMID: 26970263 DOI: 10.1016/j.survophthal.2016.03.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 03/01/2016] [Indexed: 02/01/2023]
Abstract
Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of anti-tubercular therapy (ATT) in patients with intraocular tuberculosis and factors associated with favorable outcome. Twenty-eight studies are included in this review, with a total of 1,917 patients. Nonrecurrence of inflammation was observed in pooled estimate of 84% of ATT-treated patients (95% CI 79-89). There was minimal difference in the outcome between patients treated with ATT alone (85% successful outcome; 95% CI 25-100) and those with concomitant systemic corticosteroid (82%; 95% CI 73-90). The use of ATT may be of benefit to patients with suspected intraocular tuberculosis; however, this conclusion is limited by the lack of control group analysis and standardized recruitment and treatment protocols. We propose further prospective studies to better establish the efficacy of ATT and ascertain the factors associated with favorable treatment outcomes.
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Affiliation(s)
- Ae Ra Kee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Aws Al-Hity
- Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Bhaskar Gupta
- Royal Berkshire Hospitals NHS Foundation Trust, Reading, UK; Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | | | - Nirmal Jayabalan
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, Singapore
| | - Robert Grant
- Kingston and St George's University of London, Kingston, UK
| | - Onn Min Kon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vishali Gupta
- Advance Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; School of Materials Science & Engineering, Nanyang Technological University, Singapore, Singapore; Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
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Negative Mantoux test in a patient with definite pulmonary and ocular tuberculosis. Taiwan J Ophthalmol 2015; 5:182-186. [PMID: 29018695 PMCID: PMC5602137 DOI: 10.1016/j.tjo.2014.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/10/2014] [Accepted: 08/12/2014] [Indexed: 11/27/2022] Open
Abstract
The case is reported of a patient with pulmonary and ocular tuberculosis presenting with blurred vision in both eyes. A 27-year-old well-nourished male nursing-home resident with a previous history of traumatic intracerebral hemorrhage was brought to the ophthalmological clinic due to progressively blurred vision. His best-corrected visual acuity was 20/400 in the right eye with only light perception in the left eye. Fundus examinations revealed retinal segmental periphlebitis and hemorrhagic retinitis in the right eye and dense vitreous hemorrhage in the left eye. The Mantoux test was negative; however, the results of an interferon gamma release assay were positive. Ocular tuberculosis was suspected. Although he had never had any respiratory symptoms, his chest radiograph and computed tomography scan showed a multiple centrilobular glandular and ground-glass appearance with air-space consoli dations and atelectasis in both lower lobes. Pulmonary tuberculosis was confirmed by a positive acid-fast stain of a bronchial alveolar lavage sample. A GEN-PROBE amplified Mycobacterium tuberculosis direct test of the vitreous fluids was also positive. Ocular tuberculosis was confirmed. After treatment for tuberculosis and vitrectomies, his final best-corrected visual acuity improved to 20/30 in the right eye and 20/200 in the left eye. Ocular tuberculosis is rarely reported as the primary presentation of systemic tuberculosis in young patients. A negative Mantoux test may lead to misdiagnosis and delayed treatment. Doctors should become more familiar with the manifestations of systemic tuberculosis and use advanced diagnostic tools in cases of clinical suspicion.
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Babu K, Bhat SS, Philips M, Subbakrishna DK. Review of Results of QuantiFERON TB Gold Test in Presumed Ocular Tuberculosis in a South Indian Patient Population. Ocul Immunol Inflamm 2015; 24:498-502. [DOI: 10.3109/09273948.2015.1010094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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