Various Spectrum Of Ocular Tuberculosis

Mycobacterium Tuberculosis may infect any organ in the body, when it affects ocular tissue symptoms are vague and hence diagnosis is challenging, through a number of cases reported in our clinic it is emphasized to make quantiferon test as part of routine investigation for cases of presenting with uveitis thus leading to timely diagnosis and accurate treatment.

Primary tubercular dacryocystitis - a case report and review of 18 cases from the literature

Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy. Abbreviations: PCR: polymerase chain reaction; NAAT: nucleic acid amplification test.

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.

[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.

The study of ocular tuberculosis during the 19th and early 20th century

During the 19th and early 20th century the achievements in the study of ocular tuberculosis were of great significance. The development of pathological anatomy in those years helped physicians to understand the histological image and the pathophysiology of the disease and allowed the scientists to detect the specific anatomical structures of the eye, where the disease could be present. The physicians of those years tried to describe the clinical image of the disease and to give value information, in order to facilitate the diagnosis. Despite major efforts made in the field of clinical approach to ocular tuberculosis, the treatment of the disease in those years was not very effective. Nevertheless, the physicians of the time used every new pharmacological or not pharmacological treatment to fight the disease.

OCULAR AND OSTEOARTICULAR TUBERCULOSIS IN A YOUNG PATIENT. CASE REPORT

CASE REPORT

A young healthy patient, health-care worker in a state hospital, presented in the eye department complaining of pain and blurred vision in the left eye for approx. 2 weeks. Examination revealed a VA of 12/20 in the left eye, an interstitial keratitis, some signs of vitreal inflammation and two chorioretinal mass lesions (at echography appearing cystic) in the affected eye. She also mentioned a chronic pain in the right wrist. No systemic association was found. Based on the orthopaedic examination, biopsy, and surgical intervention, a strong suspicion of ocular tuberculosis was made and the patient was advised to start tuberculostatic treatment for 12 months and ocular steroidian treatment for 4 months. The ocular manifestations regressed totally after 3 months of treatment, the VA of the left eye improving at 20/ 20.

CONCLUSION

Tuberculosis can present many manifestations, with multi systemic involvement. Ocular tuberculosis is a difficult diagnosis and thus requires thorough multi-disciplinary investigations.

[Tolerance of porous polyethylene orbital implants in children]

INTRODUCTION

The purpose of our study is to determine the incidence of orbital complications that occurred after insertion of orbital porous polyethylene implant in children under the age of 15 years.

MATERIAL AND METHODS

We report a series of 21 eyes of 21 patients younger than 15 years and in which a porous polyethylene implant is used for reconstruction of the orbital cavity after enucleation between January 2003 and December 2008.All patients were operated on by the same surgeon using the same technique.

RESULTS

These 11 boys and 10 girls, whose average age is 5.7 years. Histopathologic diagnoses after enucleation are dominated by the retinoblastoma (10 eyes) and phthisis bulbi (6 eyes). After a mean follow up of 23 months it was observed two cases of implant extrusion in children enucleated for retinoblastoma. No cases of orbital cellulitis or enucleated syndrome have been reported.

DISCUSSION

The most common complication of porous polyethylene implants in children is exposure. Risk factors may be related to surgical technique, infection, the implant, use of wrapping material and the association with adjuvant chemotherapy. Using a porous polyethylene implant uncovered remains an appropriate technique in children under 15 years for the reconstruction of the anophthalmic cavity, provided a rigorous surgical technique.

Successful Management of Tubercular Subretinal Granulomas

PURPOSE

To report the successful management of 12 eyes of 11 patients with tubercular subretinal granulomas.

METHODS

Eleven consecutive patients with a presumed or confirmed diagnosis of tubercular subretinal granulomas were treated with four-drug anti-tuberculosis chemotherapy with concomitant oral corticosteroids. Two patients underwent pars plana vitrectomy.

RESULTS

The study included seven males and four women with a median age of 30.5 years. Ten eyes responded well to medical management and a final visual acuity of 20/80 or better was achieved in eight of them. The eyes subjected to pars plana vitrectomy had a relatively worse outcome.

CONCLUSIONS

Tubercular subretinal granulomas are amenable to medical management provided an early diagnosis is made and treatment is initiated promptly. Once the diagnosis of presumed or confirmed tuberculosis is established, surgical intervention should be avoided.

[Implication of specialized sanatoria in the improvement of care to patients with ocular tuberculosis at the present stage]

A total of 6230 case histories and the data of annual reports over the past 7 years were examined. A therapeutic-and-diagnostic process continues to be improved under the present-day conditions. Patients admitted to the sanatorium for the inadequately substantiated etiology of ocular tuberculosis underwent an additional differential diagnostic study. The diagnosis of tuberculosis was verified only in 31.29% of cases. The optimized procedure for etiotropic chemotherapy for patients with new-onset ocular tuberculosis has been introduced. A scheme for intensifying the treatment of recurrent ocular tuberculosis, which permits high therapeutic results to be achieved, has been proposed. It is expedient to reorganize the sanatorium "Red Bank" as one of the sanatorium centers of therapeutic-and-rehabilitative and differential diagnostic care to patients with ocular tuberculosis.

Alterações oculares em pacientes com tuberculose

PURPOSE

To analyze clinical findings of ocular tuberculosis and its epidemiological features.

METHODS

Were reviewed clinical files of patients who attended the Ophthalmology-Uveitis and AIDS sector of UNIFESP-EPM, São Paulo, Brazil between January 1999 and July 2002 and had a diagnosis of ocular tuberculosis. Patients who had Mantoux test higher than 10 mm, epidemiological history of tuberculosis and ocular findings that improved after specific treatment were included.

RESULTS

Seventeen medical files were analyzed, of those, 12 (70.6%) were females. The mean age was 54 (24-84) years. The average time between symptoms and diagnosis was 100 days. Ocular findings at the first interview were multiple but most were at the anterior segment of the eye and 41% of patients who had clinical findings that suggested tuberculosis other than ocular. Situations as glaucoma, retinal detachment and vitreous hemorrhage were responsible for reduction of visual acuity.

CONCLUSIONS

Ocular tuberculosis showed a low prevalence but important visual loosing morbidity. The multiplicity of clinical findings is responsible for the delay of diagnosis.

Orbital tuberculoma extending into the cranium

Orbital tuberculoma is not uncommon in the developing countries, but intracranial extension of orbital tuberculoma is extremely rare. Our case, a 14-year-old girl, presented with proptosis and progressive painless diminution of vision eventually leading to loss of vision. MRI showed a mass with peripheral enhancement of contrast, separate from the optic nerve and extending into the cranium through the optic foramen. Early decompression and chemotherapy resulted in marked visual recovery. Histopathology of the excised lesion confirmed tuberculosis. The case is reported to highlight both the rare presentation as well as remarkable visual recovery in a patient with orbital tuberculosis.

[New approaches to formation of registration group of individuals followed up by antituberculosis institutions in Uzbekistan]

The paper presents the results of a three-year (2000-2002) follow-up of the movement of dispensary contingents registered in tuberculosis facilities in order to develop new dispensary groups. The dispensary groups of patients with active forms of tuberculosis have been ascertained to accumulate a great number of patients with its inactive forms due to the untimely of their transfer to the inactive groups in terms of effective treatment and the clinical forms of tuberculosis. New dispensary grouping will more definitely regulate the transfer of patients from active to inactive groups and strike from the list of dispensary patients. The proposed new grouping excludes registration Groups 0, II, and VII. If required, the persons struck from Groups III and VB and those followed up as Groups 0 and VII patients will be transferred to adult and pediatric polyclinics and followed up in recurrent tuberculosis risk groups.

New diagnostic approach for ocular tuberculosis by ELISA using the cord factor as antigen

BACKGROUND/AIMS

Diagnosis of ocular tuberculosis is difficult, particularly the retinal vasculitis type, because most cases occur without concurrent active pulmonary tuberculosis. Recently, it has been reported that detection of antibodies against purified cord factor (trehalose-6,6'-dimycolate, TDM), the best studied, most antigenic, and most abundant cell wall component of tubercule bacilli, is very useful for rapid serodiagnosis of pulmonary tuberculosis. In this study, an attempt was made to evaluate whether the detection of anticord factor antibody is also useful for diagnosis of ocular tuberculosis and the necessity of antituberculous therapy for tuberculous retinochoroiditis was discussed.

METHODS

Cases consisted of 15 patients with uveitis and retinal vasculitis, nine patients with presumed ocular tuberculosis, three patients with sarcoidosis, and three patients with Behçet's disease. IgG antibodies against purified cord factor prepared from Mycobacterium tuberculosis H37Rv were detected by enzyme linked immunosorbent assay.

RESULTS

All cases of clinically presumed ocular tuberculosis were positive, whereas all of the cases of sarcoidosis or Behçet's disease were negative for anticord factor antibodies. When the anticord factor antibody titres were compared on the basis of the presence or absence of previous antituberculosis chemotherapy, the mean anticord factor antibody titre of the untreated group showed a tendency to be higher than in the treated group, but not significantly (p=0.07).

CONCLUSIONS

The detection of anticord factor antibody may be useful to support the diagnosis of ocular tuberculosis. Additionally, a positive result for anticord factor antibody may indicate that tubercule bacilli are present in some organ(s) of the patient even in the absence of active systemic disease.

[Cardiovascular diseases and ocular tuberculosis]

The pattern of cardiovascular diseases (61%) was studied in patients with tuberculous uveitis, there was a prevalence of primary (34.6%) and secondary (8.6%) arterial hypertensions. There was an association of complicated tuberculous uveitis (subretinal neovascularization, pigment and neuronal epithelial detachment) with the presence of cardiovascular diseases, central and peripheral hemodynamic disorders. A greater reduction in visual functions was ascertained in concurrent abnormalities in the experimental group (0.55 +/- 0.07) than in the controls (0.80 +/- 0.04). The paper recommends that patients with eye tuberculosis and contaminant cardiovascular diseases should be registered and the continuity of their combined antituberculous and pathogenetic treatments ensured; functional studies expanded to make an early diagnosis of cardiovascular diseases in patients with tuberculous uveitis; the efficiency of treating the underlying and concomitant cardiovascular diseases separately evaluated.

[Ocular tuberculosis]

The frequency of tuberculous uveitis has extremely decreased in Japan. Anterior granulomatous or non-granulomatous uveitis, chorioretinitis and retinal vasculitis are common ocular manifestations, while tuberculoma, scleritis, keratitis and orbital tuberculosis are rare. The diagnosis of ocular tuberculosis is extremely difficult because ocular tuberculosis tends to be negative in chest x-ray or tuberclin skin test. To diagnose ocular tuberculosis clinically some ophthalmologists recommend subconjunctival tuberculin test or therapeutic isoniazide (INH) test. Recently, for confirmed diagnosis, polymerase chain reaction (PCR) technique has been used to detect mycobacterium in intraocular samples such as aqueous or vitreous humor. The mainstay of treatment is antituberculosis agents. Active retinal vasculitis or tuberculoma are generally responsive to corticosteroid therapy. Although ocular tuberculosis is rare, it must be considered as one of the possible causes of uveitis.

[Treatment effectiveness of patients with ocular tuberculosis at specialized sanatoria]

The outcomes of treatment of 2908 patients with ocular tuberculosis who were treated at the Vyborg-3, Krasnyi Val, and Plyos sanatoria in 1993 - 1995 are analyzed. These sanatoria used the common guide in evaluating the efficacy of treatment, namely a separate assessment of the outcomes of treatment of the underlying and concurrent diseases. There were no statistical significant differences in therapeutical efficiency at these sanatoria. Therapeutical benefits were obtained in 99.8% of patients in the active phase of the disease.

Bilateral tuberculous abscesses on the face (eyelids) of a child

PURPOSE

To report a rare case of tuberculosis with facial abscess.

METHODS

A 4 1/2-year-old girl had an acute left upper eyelid abscess and a large, spherical tumescence involving the right upper eyelid, eyebrow, and forehead. The left upper eyelid abscess was drained, and the mass involving the right eyelid, eyebrow, and forehead was excised.

RESULTS

Histopathologic and microbiologic examination established a human type of tuberculous mycobacterium as the cause of the bilateral facial lesions.

CONCLUSION

Tuberculosis should be considered as a possible cause of abscess even when clinical features are not typical.