1
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Helal RS, Attia S, Al-Baker ZM, Al-Shweiki S, Abu Sbeit R, Abukhattab M, Abdulla N, Khairallah M. The Spectrum of Presumed Tubercular Uveitis in a Referral Eye Clinic in Qatar. Ocul Immunol Inflamm 2024:1-8. [PMID: 38981050 DOI: 10.1080/09273948.2024.2368668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE To analyze the clinical spectrum of patients with presumed tubercular uveitis in a referral eye clinic in Qatar. METHODS We retrospectively reviewed the clinical records of 50 patients (80 eyes) diagnosed with presumed ocular tuberculosis who presented to the uveitis clinic, department of Ophthalmology Hamad Medical Corporation, Qatar, from January 2014 till December 2019. RESULTS Mean age at presentation was 34.5 ± 9.3 years. Forty one patients were males (82%) and 30 patients had bilateral involvement (60%). Forty eyes (50%) had posterior uveitis, 21 eyes (26.3%) intermediate uveitis, 11 eyes (13.7%) panuveitis, and 8 eyes (10%) anterior uveitis. Ocular findings included vitritis in 82.5% of eyes, retinal vasculitis in 46.3% (92% of which were occlusive in nature), multifocal choroiditis in 18.8%, serpiginous-like choroiditis in 11.3%, Most common complications at presentation or during follow-up included macular edema in 32 eyes (40%), preretinal or optic disc neovascularization in 29 eyes (36.3%) and vitreous hemorrhage in 17 eyes (21.3%). Anti-tubercular treatment was provided to 46 patients (92%). Systemic corticosteroids and corticosteroid sparing agents were associated, respectively, in 39 patients (78%) and 14 patients (28%). After 1 year of follow up, inflammation was controlled, with a significant improvement in visual acuity (p < 0.0001). CONCLUSIONS In Qatar, tubercular uveitis has a broad spectrum of ocular features, with posterior and intermediate uveitis being the most common anatomic forms. Vitritis, multifocal choroiditis without or with a serpiginous-like pattern, and occlusive retinal vasculitis are the most common ocular findings. Main sight-threatening ocular complications are macular edema, posterior segment neovascularization, and vitreous hemorrhage.
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Affiliation(s)
| | - Sonia Attia
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | | | | | - Rami Abu Sbeit
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar
| | | | - Nabeel Abdulla
- Department of Rheumatology, Hamad Medical Corporation, Doha, Qatar
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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2
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Curi ALL, de-la-Torre A, Schlaen A, Mahendradas P, Biswas J. Pediatric Posterior Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1944-1954. [PMID: 38096404 DOI: 10.1080/09273948.2023.2284990] [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: 08/22/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS Review of the literature. RESULTS The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
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Affiliation(s)
- André Luiz Land Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Disease - INI/Fiocruz, Rio de Janeiro, Brazil
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Derqui-Pilar, Argentina
| | | | - Jyortimay Biswas
- Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India
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3
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Wang Y, Wen J, Kong C, Xu Z, Hu S, Li M, Wang X, Zhang H, Jia X, Ding Q, Wu J, Hou D. Regional homogeneity alterations in multifrequency bands in patients with extracranial multi-organ tuberculosis: a prospective cross-sectional study. Quant Imaging Med Surg 2023; 13:1753-1767. [PMID: 36915302 PMCID: PMC10006160 DOI: 10.21037/qims-22-229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023]
Abstract
Background This study aimed to clarify the spontaneous neural activity in the conventional frequency band (0.01-0.08 Hz) and 2 subfrequency bands (slow-4: 0.027-0.073 Hz; slow-5: 0.01-0.027 Hz) in patients with extracranial multi-organ tuberculosis (EMTB) through regional homogeneity (ReHo) analysis. Methods In all, 32 patients with EMTB and 31 healthy controls (HCs) were assessed by resting-state functional magnetic resonance imaging (rs-fMRI) scans to clarify the abnormal spontaneous neural activity through ReHo analysis in the conventional frequency band and 2 subfrequency bands. Results Compared with the HCs, the patients with EMTB exhibited decreased ReHo in the left postcentral gyrus [t=-4.79; 95% confidence interval (CI): -0.79 to -0.31] and the left superior cerebellum (t=-4.45; 95% CI: -0.54 to -0.21) in the conventional band. Conversely, increased ReHo was observed in the right middle occipital gyrus (t=3.94; 95% CI: 0.18-0.53). In the slow-4 band, patients with EMTB only exhibited decreased ReHo in the superior cerebellum (t=-4.69; 95% CI: -0.54 to -0.22); meanwhile, in the slow-5 band, these patients exhibited decreased ReHo in the right postcentral gyrus (t=-3.76; 95% CI: -0.74 to -0.21) and the left superior cerebellum (t=-5.20, 95% CI: -0.72 to -0.31). After Bonferroni correction, no significant correlation was observed between the ReHo values in clusters showing significant between-group differences and cognitive test scores. Conclusions ReHo showed abnormal synchronous neural activity in patients with EMTB in different frequency bands, which provides a novel understanding of the pathological mechanism of EMTB.
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Affiliation(s)
- Yichuan Wang
- Department of Medical Imaging, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.,Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jianjie Wen
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Chengcheng Kong
- Department of Medical Imaging, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.,Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Zexuan Xu
- Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Su Hu
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Mengting Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Xinguang Wang
- School of Information Science and Electronic Technology, Jiamusi University, Jiamusi, China
| | - Hongqiang Zhang
- Department of Radiology, Changshu No. 2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Xize Jia
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China.,Department of Radiology, Changshu No. 2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Qingguo Ding
- Department of Radiology, Changshu No. 2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Jili Wu
- Department of Medical Imaging, Fourth People's Hospital of Taiyuan, Taiyuan, China
| | - Dailun Hou
- Department of Medical Imaging, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.,Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
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4
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Yen DJ, Betzler BK, Neo E, Lai SS, Arora A, Agrawal R, Gupta V. An excursion into ocular tuberculosis. Saudi J Ophthalmol 2022; 36:365-373. [PMID: 36618567 PMCID: PMC9811922 DOI: 10.4103/sjopt.sjopt_195_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 01/10/2023] Open
Abstract
Till today, ocular tuberculosis (OTB) presents clinicians with significant challenges in diagnosis and management. There is no one-size-fits-all approach to a heterogeneous disease like OTB, and clinicians often have to consider a multitude of factors when initiating treatment, such as tuberculosis endemicity, the probability of a true OTB diagnosis in the setting of nonspecific ocular features, the effective duration of treatment, and the likelihood of vision-threatening complications in the patient. It is no wonder that treatment protocols are widely varied globally. There have been recent developments in the standardization of nomenclature and therapeutic strategies for OTB, as established by the Collaborative OTB Study Working Group. In this review, we referred to findings in retrospective studies, international clinical guidelines, and OTB consortiums, to explore the clinical presentations, investigations, and updated management principles for patients with presumed tubercular uveitis.
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Affiliation(s)
- Dayna J.S. Yen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bjorn K. Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elvine Neo
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ser S. Lai
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Atul Arora
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, 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 National Eye Center, Nanyang Technological University, Singapore,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Nanyang Technological University, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Vishali Gupta, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
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5
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Interlandi E, Pellegrini F, Pavesio C, De Luca M, De Marco R, Papayannis A, Mandarà E, Cuna A, Cirone D, Ciabattoni C, Liberali T, Zappacosta A, Latanza L. Intraocular Tuberculosis: A Challenging Case Mimicking Wet Age-Related Macular Degeneration. Case Rep Ophthalmol 2021; 12:519-524. [PMID: 34248585 PMCID: PMC8255741 DOI: 10.1159/000512578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
An otherwise healthy 72-year-old Chinese patient diagnosed with exudative age-related macular degeneration and decreased vision in left eye was fully investigated. The retrospective analysis of past multimodal imaging revealed bilateral severe choroidal neovascularization and choroiditis associated with a positive tuberculin skin testing and interferon-gamma release assay (QuantiFERON-TB Gold - Cellestis®, Chadstone, VIC, Australia) suggestive of latent ocular tuberculosis. The variable presentation and tests' results interpretation represent the greatest limitations in understanding and treating intraocular TB (IOTB). This may present without any other systemic symptoms, the intraocular tissues are of limited access to biopsies and other tests, including imaging and immunological tests, are of relative value. This case highlights how variable may be the presentation of IOTB, which can be easily misdiagnosed leading to a delayed treatment and worse prognosis.
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Affiliation(s)
| | | | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Marco De Luca
- Department of Ophthalmology, "Ospedale del Mare" Hospital, Naples, Italy
| | - Rocco De Marco
- Department of Ophthalmology, "Ospedale del Mare" Hospital, Naples, Italy
| | | | - Erika Mandarà
- Department of Ophthalmology, "De Gironcoli" Hospital, Conegliano, Italy
| | - Alessandra Cuna
- Department of Ophthalmology, "De Gironcoli" Hospital, Conegliano, Italy
| | - Daniele Cirone
- Department of Ophthalmology, "Villa Anna" Hospital, San Benedetto del Tronto, Italy
| | | | - Tatiana Liberali
- Department of Ophthalmology, "Santo Spirito" Hospital, Pescara, Italy
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6
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Rahman S, Irfan M, Siddiqui MAR. Role of interferon gamma release assay in the diagnosis and management of Mycobacterium tuberculosis-associated uveitis: a review. BMJ Open Ophthalmol 2021; 6:e000663. [PMID: 34046524 PMCID: PMC8118067 DOI: 10.1136/bmjophth-2020-000663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
Tuberculosis (TB)-associated uveitis is a common cause of infectious uveitis in the developing world. Diagnosis of TB uveitis remains a challenge. The role of interferon gamma release assays (IGRAs) is uncertain. Herein we summarise the available literature on the utility of IGRAs in the diagnosis and management of TB uveitis. We searched PubMed database from 1 August 2010 to 31 July 2020 using the following keywords alone and in combination: 'interferon-gamma release assay', 'QuantiFERON', 'T-SPOT.TB', 'TB uveitis', 'serpiginous like choroiditis', 'tuberculoma', 'TB vasculitis', 'TB panuveitis' and 'ocular tuberculosis'. Data from 58 relevant studies were collated. The review is focused on currently marketed versions of IGRA tests: QuantiFERON-TB Gold In-Tube assay, QuantiFERON-TB Gold Plus assay (QFT-Plus) and T-SPOT.TB. We found limited evidence regarding the diagnostic utility of IGRA in patients with uveitis. No study was identified evaluating the newer QFT test-the QFT-Plus-in patients with uveitis. Similarly, there is lack of data directly comparing QFT-Plus with T-SPOT.TB specifically for the diagnosis of TB uveitis.
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Affiliation(s)
- Samra Rahman
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Muhammad Irfan
- Section of Pulmonology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - M A Rehman Siddiqui
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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7
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Implementation of the LOOP pathway-a framework for the management of ocular tuberculosis across the United Kingdom? Eye (Lond) 2021; 35:1797-1798. [PMID: 33446875 DOI: 10.1038/s41433-020-01348-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 11/09/2022] Open
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8
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Choroidal granuloma resolution with tuberculosis treatment. Am J Ophthalmol Case Rep 2020; 20:100969. [PMID: 33117917 PMCID: PMC7581821 DOI: 10.1016/j.ajoc.2020.100969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/03/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a case of presumed ocular tuberculosis, successfully treated with anti-tubercular therapy alone. Observations Resolution of a presumed tubercular choroidal granuloma occurred after initiation of 4-drug anti-tubercular therapy, without any adjunct corticosteroid treatment. Conclusions Though corticosteroids are commonly used as adjunctive treatment for ocular tuberculosis, treatment with anti-tubercular therapy alone is possible in select patients with close follow-up.
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9
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Testi I, Agrawal R, Mehta S, Basu S, Nguyen Q, Pavesio C, Gupta V. Ocular tuberculosis: Where are we today? Indian J Ophthalmol 2020; 68:1808-1817. [PMID: 32823397 PMCID: PMC7690544 DOI: 10.4103/ijo.ijo_1451_20] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/14/2023] Open
Abstract
Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.
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Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
| | - Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Mumbai, India
| | | | - Quan Nguyen
- Byres Eye Institute, Stanford University, Palo Alto, California, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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10
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Testi I, Agrawal R, Mahajan S, Agarwal A, Gunasekeran DV, Raje D, Aggarwal K, Murthy SI, Westcott M, Chee SP, Mccluskey P, Ho SL, Teoh S, Cimino L, Biswas J, Narain S, Agarwal M, Mahendradas P, Khairallah M, Jones N, Tugal-Tutkun I, Babu K, Basu S, Carreño E, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Herbort CP, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Esposti SD, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Singh R, Sharma A, Sharma K, Zierhut M, Kon OM, Cunningham ET, Kempen JH, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Descriptive Review of Tubercular Uveitis in Paediatric Population. Ocul Immunol Inflamm 2020; 28:58-64. [PMID: 32804578 DOI: 10.1080/09273948.2020.1781197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine disease profile of tubercular uveitis (TBU) in Paediatric population. METHODS Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed. RESULTS Mean age of disease presentation was 12.8 (range 4-18 years), with predominance of males (n = 14/20; 70.0%) and Asian ethnicity (n = 25/29; 86.2%). Posterior uveitis (n = 14/28; 50%) was the most frequent uveitis phenotype, with choroidal involvement occurring in 64.7% (n = 11/17). Incidence of optic disc edema and macular edema was higher in children (n = 8/18; 44.4% and n = 5/18; 27.8%, respectively) than in adults (n = 160/942; 16.9% and n = 135/942; 14.3%, respectively). Comparison of optic disc edema between subgroups showed a significant difference (P =.006). All patients received oral corticosteroids, most of them with antitubercular therapy. Treatment failure developed in 4.8% (n = 1/21). CONCLUSIONS Children have a more severe inflammatory response to the disease, and an intensive anti-inflammatory therapeutic regimen is required to achieve a positive treatment outcome.
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Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Singapore Eye Research Institute, Singapore
| | - 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
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - 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 Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,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
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Stephen Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, 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
- 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, Italy
| | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, 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
| | | | | | | | - 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, 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, USA.,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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11
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Agrawal R, Gunasekeran DV, Agarwal A, Testi I, Carreño E, Westcott M, Mahajan S, Raje D, Aggarwal K, Murthy SI, 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, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Herbort CP, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Esposti SD, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Singh R, Sharma A, Sharma K, Zierhut M, Kon OM, Cunningham ET, Kempen JH, Nguyen QD, Pavesio C, Gupta V. Visual Morbidity in Ocular Tuberculosis – Collaborative Ocular Tuberculosis Study (COTS)-1: Report #6. Ocul Immunol Inflamm 2020; 28:49-57. [DOI: 10.1080/09273948.2020.1774905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
- 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, National Health Service Foundation Trust, London, UK
- School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ilaria Testi
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Ester Carreño
- Departamento de Oftalmología, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Mark Westcott
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Sarakshi Mahajan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | | | - 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
| | - Soon-Phaik Chee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 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, Tunisia
| | - Nicholas Jones
- Department of Ophthalmology, University of Manchester, Manchester, UK
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Turkey
| | - Kalpana Babu
- Prabha Eye Clinic & Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Soumayava Basu
- Departamento de Oftalmología, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
- Department of Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, India
| | - Richard Lee
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Hassan Al-Dhibi
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bahram Bodaghi
- Department of Ophthalmology, DHU SightRestore, Sorbonne University, Paris, France
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science “L. Sacco”, Eye Clinic, Luigi Sacco Hospital, University of Milan, Italy
| | - Debra A. Goldstein
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, 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, 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
| | | | | | - Sengal Nadarajah
- Moorfields Eye Hospital, National Health Service 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, 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, United States
| | - 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
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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12
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Testi I, Mahajan S, Agrawal R, Agarwal A, Marchese A, Curi A, Khairallah M, Leo YS, Nguyen QD, Gupta V. Management of Intraocular Infections in HIV. Ocul Immunol Inflamm 2020; 28:1099-1108. [PMID: 32162992 DOI: 10.1080/09273948.2020.1727533] [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: 02/07/2023]
Abstract
Purpose: Overview of treatment options for the most common intraocular opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), including ocular syphilis, ocular tuberculosis, toxoplasmic chorioretinitis, and viral retinitis. Method: Narrative Review. Results: Despite the huge advances in the development of combined antiretroviral therapy (cART) for the management of patients with human immunodeficiency virus (HIV) infection, opportunistic infections still represent a significant diagnostic dilemma and cause of ocular morbidity in patients with HIV. Conclusion: Although the treatment of intraocular infections in patients with AIDS may be challenging, prompt assessment of the clinical features and appropriate aggressive management of the underlying etiology are critical to avoid life and vision threatening.
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Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust , London, UK
| | - Sarakshi Mahajan
- Byers Eye Institute, Stanford University , Palo Alto, California, USA
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust , London, UK.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore, Singapore.,Singapore Eye Research Institute , Singapore, Singapore
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | - Alessandro Marchese
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele , Milan, Italy
| | - Andre Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases, Oswaldo Cruz Foundation , Rio de Janeiro, Brazil
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir , Monastir, Tunisia
| | - Yee Sin Leo
- National Center for Infectious Disease, Tan Tock Seng Hospital , Singapore, Singapore
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University , Palo Alto, California, USA
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
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13
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Shah A, Biswas J. Cytopathology and Polymerase Chain Reaction of Vitreous Fluid in Tubercular Intermediate Uveitis. Ocul Immunol Inflamm 2020; 29:854-856. [PMID: 31906764 DOI: 10.1080/09273948.2019.1697825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose: Cytopathology of vitreous is most commonly done to diagnose vitreoretinal lymphoma in eyes with nonspecific inflammation. Vitreous cytopathology features of tuberculous intermediate uveitis have not been described in literature.Case report: We report a case of a healthy 35-year-old female who showed granulomatous inflammatory changes on vitreous cytopathology with polymerase chain reaction confirming a diagnosis of intraocular tuberculosis.Conclusion: This case highlights the role of cytopathology in determining the etiology and pathogenesis behind the elusive diagnosis of intermediate uveitis. Polymerase chain reaction can further help in confirming the diagnosis and allowing commencement of appropriate therapy.
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Affiliation(s)
- Amravi Shah
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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14
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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
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15
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Testi I, Agrawal R, Mahajan S, Agarwal A, Gunasekeran DV, Raje D, Aggarwal K, Murthy SI, Westcott M, Chee SP, McCluskey P, Ho SL, Teoh S, Cimino L, Biswas J, Narain S, Agarwal M, Mahendradas P, Khairallah M, Jones N, Tugal-Tutkun I, Babu K, Basu S, Carreño E, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Herbort CP, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Esposti SD, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Singh R, Sharma A, Sharma K, Zierhut M, Rousselot A, Grant R, Kon OM, Cunningham ET, Kempen J, Nguyen QD, Pavesio C, Gupta V. Tubercular Uveitis: Nuggets from Collaborative Ocular Tuberculosis Study (COTS)-1. Ocul Immunol Inflamm 2019; 28:8-16. [DOI: 10.1080/09273948.2019.1646774] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | | | - Kanika Aggarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Soon Phaik Chee
- Singapore Eye Research Institute, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter McCluskey
- Department of Clinical Ophthalmology & Eye Health, Central Clinical School, Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Su Ling Ho
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Stephen Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | | | - Shishir Narain
- Department of Ophthalmology, Shroff Eye Centre, New Delhi, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff’s Charity Eye Hospital Daryaganj, New Delhi, India
| | | | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nicholas Jones
- Department of Ophthalmology, University of Manchester, Manchester, UK
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Instanbul, Turkey
| | - Kalpana Babu
- Prabha Eye Clinic & Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Soumayava Basu
- Department of Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, India
| | - Ester Carreño
- Departamento de Oftalmología, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Richard Lee
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Hassan Al-Dhibi
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bahram Bodaghi
- DHU SightRestore, Department of Ophthalmology, Sorbonne University, Paris, France
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Debra A. Goldstein
- Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Carl P. Herbort
- Centre for Ophthalmic Specialised Care, University of Lausanne, Lausanne, Switzerland
| | - Talin Barisani-Asenbauer
- The Centre for Ocular Inflammation and Infection (OCUVAC), Laura Bassi Centre of Expertise Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Larissa, Greece
| | - Reema Bansal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bruttendu Moharana
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Simona Degli Esposti
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | | | | | - Mamta Agarwal
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India
| | | | - Ruchi Vala
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Rheumatology, PGIMER, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, PGIMER, Chandigarh, India
| | - Manfred Zierhut
- Centre of Ophthalmology, Department of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Andres Rousselot
- Department of Ophthalmology, Universidad del Salvador of Buenos Aires, Buenos Aires, Argentina
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emmett T. Cunningham
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- MCM Eye Unit, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
| | | | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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16
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Elangovan S, Govindarajan S, Mayilvakanam L, Gunasekaran N. Clinical Profile and Treatment Response of Patients with Ocular Inflammation due to Presumed Ocular Tuberculosis: A Retrospective Study. Turk J Ophthalmol 2019; 49:188-193. [PMID: 31486605 PMCID: PMC6761386 DOI: 10.4274/tjo.galenos.2019.05874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: Ocular tuberculosis is an extrapulmonary tuberculous infection and has varying manifestations which pose a huge challenge to diagnosis and treatment. The purpose of this study is to describe the various clinical manifestations of ocular inflammations due to tuberculosis and to assess the response to treatment following antituberculous therapy (ATT) and corticosteroids in these patients. Materials and Methods: We performed a retrospective analysis of 29 patients with presumed ocular tuberculosis who were started on ATT and completed follow-up of at least 6 months after ATT was initiated. The data collected were: age at presentation, sex, laterality, presence or absence of pulmonary/extrapulmonary tuberculosis, history of exposure to tuberculosis, site of ocular involvement and duration of illness, visual acuity at presentation and at 6-month follow-up, and response to treatment. Results: Most of the patients were of economically productive age, between 21-60 years. This most common presentation in our study population was unilateral nongranulomatous anterior uveitis. In spite of the delay between symptom onset and start of therapy, favorable response was noted in 79.3% of patients at completion of 6 months of ATT. The various reasons for the delay in start of therapy were also evaluated. Conclusion: In this case series, we presented the various ocular manifestations and the difficulties faced in the diagnosis of presumed ocular tuberculosis. Outcomes of ATT were favorable in most of our patients. Thus, the clinician should exercise a very high degree of suspicion and should not withhold a trial of ATT.
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Affiliation(s)
- Suma Elangovan
- Department of Ophthalmology, ESIC Medical College and PGIMSR, The TN. Dr. MGR Medical University, Chennai, India
| | - Senthamarai Govindarajan
- Department of Ophthalmology, ESIC Medical College and PGIMSR, The TN. Dr. MGR Medical University, Chennai, India
| | - Lakshmi Mayilvakanam
- Consultant Ophthalmologist, Chennai, India (Past Affiliation: ESIC Medical College and PGIMSR, K.K. Nagar, Chennai)
| | - Nithya Gunasekaran
- Consultant Ophthalmologist, Puducherry, India (Past Affiliation: ESIC Medical College and PGIMSR, K.K. Nagar, Chennai)
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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.
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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
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Abhishek S, Saikia UN, Gupta A, Bansal R, Gupta V, Singh N, Laal S, Verma I. Transcriptional Profile of Mycobacterium tuberculosis in an in vitro Model of Intraocular Tuberculosis. Front Cell Infect Microbiol 2018; 8:330. [PMID: 30333960 PMCID: PMC6175983 DOI: 10.3389/fcimb.2018.00330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/28/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Intraocular tuberculosis (IOTB), an extrapulmonary manifestation of tuberculosis of the eye, has unique and varied clinical presentations with poorly understood pathogenesis. As it is a significant cause of inflammation and visual morbidity, particularly in TB endemic countries, it is essential to study the pathogenesis of IOTB. Clinical and histopathologic studies suggest the presence of Mycobacterium tuberculosis in retinal pigment epithelium (RPE) cells. Methods: A human retinal pigment epithelium (ARPE-19) cell line was infected with a virulent strain of M. tuberculosis (H37Rv). Electron microscopy and colony forming units (CFU) assay were performed to monitor the M. tuberculosis adherence, invasion, and intracellular replication, whereas confocal microscopy was done to study its intracellular fate in the RPE cells. To understand the pathogenesis, the transcriptional profile of M. tuberculosis in ARPE-19 cells was studied by whole genome microarray. Three upregulated M. tuberculosis transcripts were also examined in human IOTB vitreous samples. Results: Scanning electron micrographs of the infected ARPE-19 cells indicated adherence of bacilli, which were further observed to be internalized as monitored by transmission electron microscopy. The CFU assay showed that 22.7 and 8.4% of the initial inoculum of bacilli adhered and invaded the ARPE-19 cells, respectively, with an increase in fold CFU from 1 dpi (0.84) to 5dpi (6.58). The intracellular bacilli were co-localized with lysosomal-associated membrane protein-1 (LAMP-1) and LAMP-2 in ARPE-19 cells. The transcriptome study of intracellular bacilli showed that most of the upregulated transcripts correspond to the genes encoding the proteins involved in the processes such as adherence (e.g., Rv1759c and Rv1026), invasion (e.g., Rv1971 and Rv0169), virulence (e.g., Rv2844 and Rv0775), and intracellular survival (e.g., Rv1884c and Rv2450c) as well as regulators of various metabolic pathways. Two of the upregulated transcripts (Rv1971, Rv1230c) were also present in the vitreous samples of the IOTB patients. Conclusions:M. tuberculosis is phagocytosed by RPE cells and utilizes these cells for intracellular multiplication with the involvement of late endosomal/lysosomal compartments and alters its transcriptional profile plausibly for its intracellular adaptation and survival. The findings of the present study could be important to understanding the molecular pathogenesis of IOTB with a potential role in the development of diagnostics and therapeutics for IOTB.
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Affiliation(s)
- Sudhanshu Abhishek
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirbhai Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suman Laal
- Department of Pathology, New York University Langone Medical Center, New York, NY, United States
- Veterans Affairs New York Harbor Healthcare System, New York, NY, United States
| | - Indu Verma
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma RK, Sharma J, Khan ZK, Pattekar A, Gupta V, Bansal R, Sharma K, Aggarwal AN, Gupta A, Sachdeva N. Diminished TLR2-TLR9 mediated CD4+ T cell responses are associated with increased inflammation in intraocular tuberculosis. Sci Rep 2018; 8:13812. [PMID: 30218032 PMCID: PMC6138653 DOI: 10.1038/s41598-018-32234-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 09/05/2018] [Indexed: 12/18/2022] Open
Abstract
Intraocular tuberculosis (IOTB) is amongst the leading causes of uveitis in tropical countries. Despite reports on involvement of proinflammatory cytokines, studies on innate immune responses in disease pathogenesis are lacking. Reports from animal models and patients with pulmonary tuberculosis indicate that defects in toll like receptor (TLR)2 and TLR9 signalling predispose them to tuberculosis. In this context, we investigated the role of TLR2, TLR4 and TLR9 in generation of CD4+ T effector (Teff) cell responses during IOTB. Firstly, the cells in vitreous fluids showed lower expression of TLR2 and TLR9 in IOTB as compared to non-uveitis and non-TB uveitis groups. Next, peripheral CD4+ Teff cells of subjects with IOTB showed decreased proliferative responses and lower induction of Tregs following TLR2 and TLR9 stimulation. Further, TLR9 ligation resulted in increased IFN-γ and IL-17a but decreased expression of IL-10 and TGF-β. Lastly, lower expression of genes involved in TLR9 signalling after direct TLR9 ligation was observed in IOTB. Collectively, our results show that a subdued response to direct TLR2 and TLR9 stimulation in CD4+ T cells is associated with increased proinflammatory responses in IOTB. These findings reveal an important link between innate immune signalling and ensuing adaptive immune responses in IOTB with implications in other forms of extrapulmonary tuberculosis.
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Affiliation(s)
- Ravi Kumar Sharma
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Microbiology and Immunology and the Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jyoti Sharma
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Zafar K Khan
- Department of Microbiology and Immunology and the Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ajinkya Pattekar
- Department of Microbiology and Immunology and the Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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20
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Ocular tuberculosis: Position paper on diagnosis and treatment management. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 23:31-38. [PMID: 27988134 DOI: 10.1016/j.rppnen.2016.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/30/2016] [Indexed: 01/12/2023] Open
Abstract
Delay in diagnosis or treatment of ocular tuberculosis can result in loss of vision. However, due to the fact that early diagnosis is rarely achieved, there are still a broad variety of diagnostic and treatment approaches. Our aim was to reach a consensus on the management of diagnosis and treatment of ocular tuberculosis. METHODS Critical appraisal of the literature and expert opinion on diagnosis and treatment of ocular tuberculosis. RESULTS AND CONCLUSION The currently recommended method for ocular TB diagnosis is screening for tuberculosis in any uveitis of unknown etiology, recurrent or not responding to conventional therapy; in ocular findings highly suggestive of ocular TB and before immunosuppression (particularly biologic agents). TB screening in these cases includes tuberculosis skin testing and interferon gamma testing, along with complete medical history, ophthalmologic evaluation and chest imaging. Positively screened patients should be treated for active tuberculosis with 4 drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) for 6-9 months. Patients should be reviewed at the end of the initiation phase (two months) and at the end of the overall treatment (6-9 months).
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21
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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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