Assessment of quality of life, psychosocial, and epidemiological aspects in patients diagnosed with tuberculous uveitis

PURPOSE

To assess the quality of life in patients diagnosed as having tuberculous uveitis and its association with sociodemographic, clinical, and psychosocial aspects.

METHOD

By conducting standardized interviews, clinical and demographic data were collected using a measure developed in this study. This measure was applied in addition to other measures, namely SF-12, Hospital Anxiety and Depression Scale, and NEI-VFQ-39, which were used to assess health-related quality of life, anxiety and depression symptoms, and visual functioning.

RESULTS

The study included 34 patients [mean age: 46.5 ± 15.1 years, female patients: 21 (61.8%)]. The mean of the VFQ-39 score was 74.5 ± 16.6 and that of SF-12 physical and mental component scores were 45.8 ± 10.1 and 51.6 ± 7.5, respectively, for the health-related quality of life. Anxiety symptoms were the most prevalent compared with depression symptoms and were found in 35.3% of the participants.

CONCLUSION

Tuberculous uveitis affects several scales of quality of life, thereby affecting a population economically active with a social, psychological, and economic burden.

Pattern of Tubercular Uveitis in Active Pulmonary Tuberculosis

Ocular tuberculosis is an extra-pulmonary form of systemic Tuberculosis (TB). It is rarely found concomitant with active pulmonary tuberculosis (PTB). The aim of this prospective observational study was to evaluate the pattern of tubercular uveitis (TBU) in the patients with active PTB who attended in our Uvea clinic at NIO&H from July 2018 to December 2020. Active PTB patients who had uveitis consistent with TBU and TBU patients who were confirmed as active lung lesion were included in the study. Chest X-ray, TST, IGRA (QuantiFERON-TB Gold Test), RT PCR of aqueous fluid for tubercular bacillus, Gene Xpert TB test of sputum were done to confirm the diagnosis of ocular and primary TB. If the induration is 15 mm of TST was considered patient in this study. Among 33 patients of active PTB, 4 had TBU (12.12%). Among 48 patients of TBU, 5 had active PTB (10.41%). 13 eyes of 9 patients were affected. Mean age at presentation was 41.8 years. There were anterior uveitis in 23.00% eyes, posterior uveitis in 69% eyes and panuveitis in 7.00% eyes. Choroidal granuloma was the most common presentation of posterior uveitis (46.00%). There were more than 4 times chance to develop choroidal granuloma in patients with active PTB than extrapulmonary TB (Χ²=4.53, <0.05), TBU patients with choroidal granuloma should be evaluated meticulously for active PTB and active PTB patients should be evaluated routinely by ophthalmologist for the search of TBU.

Program-wide review and follow-up of erythema Induratum of Bazin and tuberculosis-associated ocular inflammation management in a TB low-incidence setting: need for improved treatment candidate selection, therapy standardization, and care collaboration

BACKGROUND

Erythema induratum of Bazin (EIB) - nodular vasculitis associated with Mycobacterium tuberculosis (TB) - and Tuberculosis-Associated Ocular Inflammation (TB-AOI) represent uncommon manifestations of TB. There is limited data and a lack of diagnostic and treatment standards for these conditions.

METHODS

Eleven-year retrospective review of EIB and TB-AOI cases managed in a provincial TB program with prospective phone-based follow-up of anti-tubercular therapy (ATT) recipients. Presumptive TB-AOI and EIB diagnoses were determined by ophthalmologist or dermatologist assessments correlated with positive tuberculin skin test and/or QuantiFERON-TB Gold, along with pathologic criteria in EIB cases.

RESULTS

Of 21 EIB and 20 TB-AOI cases that received ATT, 13 and 11, respectively, were reached for follow-up. The majority of EIB and TB-AOI cases were female and immigrated from TB high-burden countries. Median durations of pre-diagnosis symptoms were 2 and 0.8 years (IQR 2.5 & 1.1) for EIB and TB-AOI cases, respectively. Overall, 14 different ATT regimens were used for a median duration of 6 months (range 5-9). ATT related adverse events resulting in treatment discontinuation occurred in 14% of EIB and 10% of TB-AOI cases. On last follow-up, 76% of EIB and 42% of TB-AOI had improvement or resolution of disease.

CONCLUSION

EIB and TB-AOI were uncommon presentations receiving variable therapy. While treatment response was modest for EIB cases, TB-AOI cases had sub-optimal treatment outcomes. The unique diagnostic and management challenges presented by these conditions in TB low-incidence settings highlight a need for improved treatment candidate selection, therapy standardization, and cross-specialty medical collaboration.

Presumed Tuberculous uveitis: clinical features and management

AIM

To illustrate the various clinical features and management of presumed tuberculous uveitis in an endemic area in Tunisia.

METHODS

This is a retrospective study including 14 patients (26 eyes) diagnosed with presumed tuberculous uveitis at the Department of Ophthalmology Habib Bourguiba University Hospital of Sfax-Tunisia.

RESULTS

Mean age at onset was 31.7 years. Uveitis was bilateral in 86 % of cases (12 eyes). Panuveitis was the most common manifestation and represented 50% of cases (13 eyes). Ocular findings include mutton-fat keratic precipitates in 35% of cases (9 eyes), posterior synechiae in 31% of cases (8 eyes), vitritis in 81% of cases (21eyes), multifocal choroiditis in 23% of cases (6 eyes), periphlebitis in 27% of cases (7 eyes), and macular edema in 42% of cases (11eyes). Anti-tubercular treatment was prescribed in all patients and was associated with systemic corticosteroids in 71% of cases (10 patients). After a mean follow-up of 16.27 months (range, 6-36), inflammation was controlled with improvement in visual acuity. Recurrence developed in 7 % of cases (1 patient).

CONCLUSION

In the present study, posterior synechiae, vitritis, multifocal choroiditis, and retinal vasculitis are the most common manifestations of tuberculous uveitis in tuberculosis endemic area in Tunisia. These manifestations are suggestive of a tubercular cause of uveitis and merit specific treatment.

[Ocular tuberculosis]

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.

[Ocular tuberculosis should not be neglected]

As increasingly frequent immigration in China, the prevalence of drug-resistant tuberculosis (TB) as well as special populations (acquired immune deficiency syndrome, diabetes, etc.) continue to increase, ocular tuberculosis has become an important cause of infectious uveitis. Because the clinical manifestations of this disease manifested in various forms, currently it lacks a unified reliable diagnostic criteria. Misdiagnosis could occur and cause patients' visual loss. The diagnostic criteria for tuberculous uveitis in Chinese patients, the standardized anti-TB therapy and the prevention of tuberculous uveitis in immune dysfunctionalpatients should be made and noted as early as possible by all the ophthalmologists.

Ocular inflammatory disease and ocular tuberculosis in a cohort of patients co-infected with HIV and multidrug-resistant tuberculosis in Mumbai, India: a cross-sectional study

BACKGROUND

The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART).

METHODS

Lilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation of HIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations.

RESULTS

Between February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158-361). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of seven patients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). 'These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%). Patients with extrapulmonary TB and patients<39 years old were at significantly higher risk of having ocular TB [Risk Ratio: 13.65 (95% CI: 2.4-78.5) and 6.38 (95% CI: 1.05-38.8) respectively].

CONCLUSIONS

Ocular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai, India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.

Choroidal Tubercles in Neurotuberculosis: Prevalence and Significance

PURPOSE

Neurotuberculosis is a relatively common form of tuberculosis and may be seen in 1-10% of patients of systemic tuberculosis and may present in several forms. Ocular lesions are frequently seen, most commonly optic nerve lesions. Limited data are available for choroidal tubercles. We conducted a prospective study 1) to determine the prevalence of choroidal tubercles in a cohort of patients of neurotuberculosis as well as its relative prevalence in the various morphological manifestations and 2) to study the role of co-existent systemic tuberculous infection.

METHODS

IRB-approved prospective cross-sectional observational study. A hospital-based cohort of patients underwent a detailed physical, laboratory and ocular evaluation.

RESULTS

A total of 52 (20 male, 32 female) patients were evaluated with tubercles being seen in 23 eyes (18 patients, 34.6%). Twenty four patients (46.12%, 16 female, 8 male) presented with intracranial granulomas and 28 (53.8%, 16 female, 12 male) presented with tuberculous meningitis. Tubercles were seen in 10 eyes of 8 (28.5%) patients with tuberculous meningitis and in 13 eyes of 10 patients (41.6%) with intracranial granulomas. This result is not statistically significant. Twenty seven patients (51.9%) had neurotuberculosis without systemic infection, whereas 25 (48.1%) patients had systemic foci. Tubercles were seen in 18 eyes (13 patients) with systemic foci and in 5 eyes (5 patients) of neurotuberculosis alone. The odds ratio for the presence of systemic tuberculosis when choroidal tubercles are present is 5.6 (95% confidence interval: 1.39-24.49, statistically significant [p = 0.005]).

CONCLUSIONS

Tubercles were equally likely to occur in either manifestation of neurotuberculosis, and their presence was related to the presence of systemic focus of tuberculous infection. The presence of choroidal tubercles may serve as a diagnostic marker for the presence of an underlying systemic infection.

Ocular lesions in acute disseminated tuberculosis

PURPOSE

To determine the prevalence of ocular involvement in patients with acute disseminated tuberculosis and to assess the findings associated with ocular involvement.

METHODS

Assessment of all intensive care (ICU) admissions with a differential diagnosis of mycobacterial sepsis during a period of one year, with a detailed systemic and ophthalmic evaluation.

RESULTS

Of 342 admissions, 24 patients were suspected to have mycobacterial infection. Of these 24 cases, 10 were proven to have mycobacterial sepsis, six of which (60%) showed evidence of ocular involvement. Five (83%) of the six patients had choroidal tubercles and one (16%) had retinal vasculitis. Detection of the lesions allowed a lead time of 12-72 hours in which to start earlier targeted therapy.

CONCLUSIONS

Ocular involvement in acute disseminated tuberculosis is often seen, with the most common manifestation being choroidal tubercles. Early detection of these lesions may be important in treatment.

[Prevalence of tuberculosis among children and adolescents in the Russian Federation: analysis of official statistics]

The paper provides the analysis of the prevalence rates of tuberculosis among children and adolescents in the Russian Federation, which has been made on the basis of the data available in official reporting forms Nos. 8, 33 (approved by the Resolution of the Russian Statistics Agency on November 11, 2005), and 47 (approved by Resolution No. 175 of the Russian Statistics Agency on September 10, 2002). Correlations between epidemiological indices have been calculated and assessed. The age-related features of the occurrence and course of tuberculosis have been studied among various age groups of children. It is concluded that in this situation in order to improve the epidemic situation among children and adolescents, emphasis should be primarily placed on the activation of intersectoral interaction of primary health care and tuberculosis service: to actively attract general practitioners, local pediatricians and therapists to prophylaxis in children.

[The ocular tuberculosis epidemic situation in the Sverdlovsk Region]

In the Sverdlovsk Region the proportion of extrapulmonary tuberculosis reduced from 9.7 +/- 0.2% in the 1990s to 3.8 +/- 0.2% in 2001-2007. The notified cases of extrapulmonary tuberculosis do not reflect the real situation. Ocular tuberculosis (9.6 +/- 0.49%) ranked fourth in the pattern of extrapulmonary tuberculosis, next to tuberculosis of the urinary tract (48.9 +/- 0.83%), peripheral lymph nodes (20.3 +/- 0.67%), and bones and joints (15.8 +/- 0.6). In 2001-2007, there was a rise in ocular tuberculosis morbidity and proportions in the pattern of extrapulmonary tuberculosis, the highest morbidity (0.75 per 100,000 population) being registered in the large towns of the Sverdlovsk Region. Uveitis amounted to 90.9 +/- 1.47% among all the clinical forms of ocular tuberculosis, posterior ocular vascular tunic lesion being most common (56.97 +/- 5.97 to 71.8 +/- 7.2%). In 2001-2007, there was an increase in the common forms of tuberculous uveitis up to 10.6 +/- 2.89%.

Orbital tuberculosis: a review of the literature

PURPOSE

To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB).

METHODS

Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals.

RESULTS

Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved.

CONCLUSIONS

Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-gamma immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.

A clinical review of 128 cases of head and neck tuberculosis presenting over a 10-year period in Bradford, UK

Aims: To analyse the epidemiology, presentation and diagnosis of head and neck tuberculosis (TB).

Methods: We conducted a 10-year retrospective study of all cases of tuberculosis of the head and neck region occurring in Bradford, UK.

Results: Of a total of 1315 cases of TB, 128 presented with head and neck TB (12 per cent of which (15/128) were in children). Cervical lymph nodes were most commonly involved (87 per cent, 111/128), other sites being: salivary glands (five cases); larynx, oral cavity, eyes and ears (two cases each); and skin, thyroid, nasopharynx and retropharyngeal space (one case each). Patients' ethnic origins were Asian (89 per cent, 114/128), Caucasian (10 per cent, 13/128) and African (one case). Only 26 per cent (33/128) had constitutional symptoms, and 20 per cent (25/128) had a coexistent site of TB. Only 39 per cent (40/105) of surgical specimens were sent for culture.

Conclusions: Isolated head and neck TB is not uncommon. Atypical presentations render diagnosis challenging, so awareness aids early diagnosis. Mycobacterial cultures should be performed, where possible, for diagnosis.

Tuberculosis and the eye

OBJECTIVES

1. To refresh knowledge on the epidemiology, pathogenesis, clinical features, investigations and treatment of ocular tuberculosis; 2. To highlight the ocular complication of tuberculosis.

METHOD

Through an internet search and review of current literature on tuberculosis and its ocular complications, the information relevant to the objectives was obtained.

CONCLUSIONS

TB can affect any structure in the eye and adnexae. Ocular TB is not easy to diagnose because most times there is no concurrent active systemic tuberculosis. However, once TB is confirmed, treatment is generally the same as for systemic TB. Topical steroids are given in addition, in cases like phlyctenulosis. Early diagnosis and treatment of ocular TB can prevent blindness or severe ocular morbidity. With the growing epidemic of HIV and the consequent increased risk of developing TB, ophthalmologist and eye care workers are, therefore, advised to heighten their suspicion of ocular TB.

Changing patterns of intraocular inflammatory disease in Japan

PURPOSE

We investigated the frequencies and clinical characteristics of Japanese patients with uveitis.

METHODS

Records of 189 patients referred from April 1999 to March 2001 were retrospectively reviewed.

RESULTS

Fifty-six patients (29.6%) had anterior uveitis, 13 (6.9%) intermediate uveitis, 59 (31.2%) posterior uveitis, 58 (30.7%) panuveitis, and three (1.6%) papillitis. The most common diagnoses were Vogt-Koyanagi-Harada (VKH) disease (10.1%), biopsy-proven or presumed sarcoidosis (9.5%), acute anterior uveitis (7.9%), tuberculosis (6.9%), and Behçet's disease (5.8%). Seventy-three patients (38.6%) were treated with local therapy alone, and 95 patients (50.3%) required systemic therapy. Ocular complications developed in 19.6% of patients, and systemic complications in 2.1%.

CONCLUSIONS

These results confirm a continued high frequency of VKH disease and sarcoidosis, but suggest a decreased frequency of Behçet's disease and an increased frequency of tuberculosis. Roughly one-half of the patients required systemic treatment in addition to local therapy, and ocular and/or systemic complications developed in one-fifth of the patients.

[Clinical and epidemiological aspects in ocular tuberculosis]

150 new cases of ocular tuberculosis, representing 1% of total tuberculose cases, was diagnosticated during the last 10 years, in both Ophthalmological and Pneumophtisiological Clinics of Craiova. Ocular tuberculosis is the local manifestation of a general latent tuberculosis; the uveal diseases represent 46% of cases of ocular tuberculosis. 51 of 150 cases of ocular tuberculosis was corioretinal forms, which evaluated uni or bilateral, with one and multiple focares; in only one case we constated a coroidian tuberculom form.

Ocular tuberculosis

Despite the use of highly sensitive molecular tools, such as polymerase chain reaction, for the detection of Mycobacterium tuberculosis, ocular tuberculosis remains a subject of controversy. The diagnosis is often presumptive in the absence of ocular biopsies. Choroiditis is the most common ocular manifestation in patients with pulmonary and systemic tuberculosis. Indocyanine green angiography seems to be an interesting method to determine choroidal involvement. PCR technology is proposed to evaluate the presence of the tubercule bacillus DNA in ocular fluids and tissues when conventional microbiologic methods fail to confirm a bacterial etiology. Most of the presumed cases of ocular tuberculosis should be treated with associations of antituberculous drug, especially when a systemic steroid regimen is required.

[Specific features of tuberculous uveitis pathomorphology]

There have been great changes in the clinical picture and course of ocular tuberculosis in the 90s versus the 70-80s. There has been a upward trend in the incidence of ocular tuberculosis in the population, in children and teenagers in particular. Patients with tuberculous uveitis involving the posterior eye makes up over 70%. A specific eye tissue inflammatory process is mainly exudative and infiltrative with rapid development of the complications masking a tuberculous focus, which hampers treatment and causes a significant decrease in visual functions.

[Clinical and epidemiological characteristics of patients with eye tuberculosis]

The study has analyzed 514 new cases of eye tuberculosis registered in the dispensaries of 23 regions. Eye tuberculosis more frequently affects young and middle-aged women, urban citizens, persons who have adequate living and domestic conditions, moderate income, who are clerks or skilled workers, who have no bad habits, who suffer one or two concurrent diseases, who have no opportunity of receiving adequate treatment in a hospital or sanatorium due to familial or professional circumstances and more commonly those whose posterior eyeball is involved (chorioretinitis). Of great concern is eye tuberculosis detected in 87.4% of referrals, which determines the high proportion of advanced and far-advanced cases.

Ocular tuberculosis. A prospective study in a general hospital

Ocular tuberculosis has traditionally been considered uncommon or anecdotal. Imprecise and variable diagnostic criteria have contributed to the confusion surrounding this topic. The increase in extrapulmonary manifestations of tuberculosis during the AIDS era established the need for a prospective study of ocular involvement in patients with all types of tuberculosis using well-defined criteria. During a 15-month period, 300 cases had culture-proven tuberculosis at our institution. We randomly selected 100 for systematic ophthalmologic evaluation. Our criteria for ocular tuberculosis were divided as follows: certainty (isolation of Mycobacterium tuberculosis from ocular specimens), probability (patients with isolation of M. tuberculosis from extraocular samples, with ocular lesions not attributable to other causes that respond to anti-tuberculous treatment), and possibility (same as probability but follow-up impossible). Ocular tuberculosis was present in 18 patients (18%) of which 10 patients fulfilled probability and 8 patients fulfilled possibility criteria. Eleven of 18 patients had HIV infection. In 11 patients, ocular involvement was asymptomatic. Almost all patients (17/18) had choroiditis, and other ocular lesions included papillitis, retinitis, vitritis, vasculitis, dacryoadenitis, and scleritis. Multivariate analysis showed as risk factors independently predicting ocular involvement in patients with ocular tuberculosis the presence of miliary disease (odd ratio 43.92, p = 0.002), ocular symptoms (odds ratio 6.35, p = 0.0143), and decreased visual acuity (odds ratio 0.04, p = 0.012). We observed an unexpectedly high (18%) incidence of ocular involvement, frequently asymptomatic, in patients with tuberculosis. Miliary disease is a clear predisposing factor in both HIV-infected and noninfected populations. Ocular examination should be routinely considered in patients with proven or suspected tuberculosis.

Pattern of uveitis in a referral uveitis clinic in India

This report describes a retrospective study of all new patients in our uveitis clinic between January 1992 and December 1994, undertaken to identify the pattern of uveitis in the Indian subcontinent. A standard clinical protocol, and the naming-meshing system with tailored laboratory investigations were used to arrive at a final uveitic diagnosis. Uveitis comprised 1.5% of new cases seen at the centre. Out of 1,273 uveitis cases, anterior uveitis was the most common type (39.28%), followed by posterior uveitis (28.75%), intermediate uveitis (17.44%), and panuveitis (14.53%). The most commonly affected age group were patients in their forties (23.57%). Uveitis was less common in children below 10 years (3.61%) and in adults over 60 years of age (6.44%). Men (62.21%) were more commonly affected than women (37.79%). Aetiology remained undetermined in 59.31% of cases. Anterior uveitis was most commonly idiopathic (58.6%). The most common cause of posterior uveitis was toxoplasmosis (27.87%), and that of panuveitis was the Vogt-Koyanagi-Harada syndrome (21.08%). A higher incidence of microbiologically proven tubercular uveitis (5 cases), and uveitis due to live intraocular nematode (4 cases), and malaria (1 case), were seen, in contrast to other studies. Only 2 cases of AIDS with ocular lesions were seen. This paper reveals the pattern of uveitis seen at a major referral eye institute in India.

Ocular morbidity in patients with active systemic tuberculosis

The ocular morbidity pattern in 2010 eyes of 1005 patients with active pulmonary and extrapulmonary tuberculosis was studied prospectively. A complete clinical (ocular and systemic) examination, radiologic evaluation, Mantoux test and sputum analysis for acid-fast bacilli were carried out in all patients. The ocular morbidity in patients in this study with active tuberculosis was 1.39%. The most common ocular finding was bilateral healed focal choroiditis (50%). No case of Eales' disease was found in this series. There was no statistically significant correlation between the ocular lesions and Mantoux positivity.

Detection of the new tuberculosis: ocular examination as a diagnostic imperative

BACKGROUND

Until recently, tuberculosis in the U.S. had been considered a public health concern of the past, largely conquered by therapy devised in the 1950s. However, in the past several years, the incidence of tuberculosis has increased steeply and unexpectedly, owing to a conspiracy of new factors. These include: the epidemic of acquired immune deficiency, the emergence of drug-resistant strains, the confinement of susceptibles in crowded shelters, and the premature demolition of public health programs.

METHODS

A dynamic interplay exists between the tubercle bacillus and the declining immune system in AIDS patients. Because of this, many atypical, clinical presentations of tuberculosis have emerged.

RESULTS

The detection of ocular manifestations of tuberculosis has thus assumed increased importance. It can allow not only for an earlier diagnosis of TB, but an earlier diagnosis of AIDS, preventing spread of both diseases within the population.

CONCLUSIONS

Evaluation of ocular signs of tuberculosis should now be a diagnostic imperative.

[Statistical importance of tuberculosis and toxoplasmosis of the eye in recent years (1971-1974, Eye-Clinic, Davos) (author's transl)]

Tbc has not yet been eradicated in Western Europe. Among 311 human/bovin-tuberculin tested cases out of 500 patients with uveitis (1971-1974), 37-50% (average age 40-45 years) reacted highly positive. Chorioretinitis disseminata and periphlebitis retinae (Eales' disease): 90% positive. The criteria for a long term tuberculostatic treatment are exposed. 20% of all cases of uveitis and 90% of Jensen Retinochorioditis have been interpreted as caused by toxoplasmosis. 75% are relapses. The gigantic toxoplasmotic lesions of the eyeground is stressed. As a rule low Sabin Feldmann titers are found. Quantitative serology is valuable. In the closing discussion the immunologically well known adjuvans-effect of Koch's bacillus-extract is supposed to be of importance in highly tuberculin positive uveitis.

Primary tuberculosis of the conjunctiva

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