Clinics of ocular tuberculosis: A review

Betzler, Bjorn Kaijun; Gupta, Vishali; Agrawal, Rupesh

doi:10.1111/ceo.13847

Cited by 23 publications

(34 citation statements)

References 86 publications

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“…As mentioned above, M cells take up E.coli in a GP2-dependent manner ( 11 ). Furthermore, Mycobacterium tuberculosis causes ocular tuberculosis ( 37 ), and Pseudomonas aeruginosa is the most common Gram-negative organism causing bacterial keratitis ( 38 ). These pathogens have also been known to exploit M cells for invasion ( 39 , 40 ).…”

Section: Discussionmentioning

confidence: 99%

Characterization of M Cells in Tear Duct-Associated Lymphoid Tissue of Mice: A Potential Role in Immunosurveillance on the Ocular Surface

et al. 2021

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The ocular mucosal tissues are exposed to potentially harmful foreign antigens in the air and tear fluid. The tear duct-associated lymphoid tissue (TALT) may contribute to immune surveillance in the eye region. Follicle-associated epithelium (FAE) of TALTs is classified as stratified squamous epithelium and consists of squamous epithelial cells arranged in layers on the basement membrane. In contrast, most mucosa-associated lymphoid tissue is covered by a monolayer of epithelium containing microfold (M) cells. Therefore, antigen uptake and the presence of M cells in TALT are not fully understood. The present study found that a small population of FAE cells in the TALT expressed intestinal M-cell markers, namely Sox8, Tnfaip2, GP2, and OPG. This cell population was identified as functional M cells because of their uptake capacity of luminal nanoparticles. In addition, RANKL, which is essential for M-cell differentiation, was expressed by stroma-like cells at the subepithelial region and its receptor RANK by the FAE in the TALT. The administration of RANKL markedly increased the number of Sox8+ M cells. In contrast, deficiency in OPG, an endogenous inhibitor of RANKL, increased the number of M cells in the TALT. These data demonstrate that the RANKL-RANK axis is essential for M-cell differentiation in the TALT. Furthermore, immunization via eye drops elicited the production of antigen-specific antibodies in tears, which was enhanced by RANKL administration. Thus, TALT M cells play an important role in the immunosurveillance of the eye region.

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Section: Discussionmentioning

confidence: 99%

Characterization of M Cells in Tear Duct-Associated Lymphoid Tissue of Mice: A Potential Role in Immunosurveillance on the Ocular Surface

et al. 2021

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“…It may present as anterior, intermediate, posterior uveitis, panuveitis or retinal vasculitis; posterior uveitis is the most common presentation. 4 , 5 Tubercular posterior uveitis (choroiditis) could in turn present as serpiginous-like choroiditis, choroidal granuloma or focal/multifocal choroiditis. 4 , 6 The variability of clinical picture is only the beginning of the diagnostic riddle.…”

Section: The Conundrum Of Ocular Tuberculosismentioning

confidence: 99%

“… 4 , 5 Tubercular posterior uveitis (choroiditis) could in turn present as serpiginous-like choroiditis, choroidal granuloma or focal/multifocal choroiditis. 4 , 6 The variability of clinical picture is only the beginning of the diagnostic riddle. 7 TB is a smoldering low-grade paucibacillary infection which is difficult to culture, more so from the intraocular issue due to inaccessibility, small sample size and inherent risk during culture harvest.…”

Section: The Conundrum Of Ocular Tuberculosismentioning

confidence: 99%

“…Two specific manifestations of OTB, serpiginous-like choroiditis and TRV, are probably apt candidates for corticosteroids since both are likely to have a significant immunologic component in their etiology. 4 In the context of TRV, corticosteroids may be required when the inflammation is sight-threatening: posterior, severe, hemorrhagic vasculitis with vitritis and macular edema, which probably indicates an added immune response to bacterial infection. 26 Another indication for steroids in OTB is in cases of paradoxical worsening due to exaggerated inflammatory response after ATT.…”

Section: Indications Rationale and Modalities Of Pharmacotherapymentioning

confidence: 99%

“… 11 , 15 , 25 , 26 , 39 In the presence of a clinical picture suggestive of TRV, detection of latent and healed TB is sufficient to start ATT; molecular/ histopathologic diagnosis is an impractical gold standard. 4 , 6 , 20 , 31 If the vasculitis is not severe and sight-threatening, ATT alone may suffice to treat if fully. 26 Corticosteroids, when required for sight-threatening conditions, should start and stop under ATT cover, 11 to tide over the acute inflammation without aggravating infection.…”

Section: Summing Up the Clarity On Evidence And Consensusmentioning

confidence: 99%

See 2 more Smart Citations

Tubercular Retinal Vasculitis: Diagnostic Dilemma and Management Strategies

Shukla¹,

Kalliath²,

Dhawan³

2021

OPTH

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Ocular tuberculosis (OTB) is a rare, extrapulmonary manifestation of systemic TB, which has been a global etiology of uveitis for centuries, though concentrated in the developing world. OTB remains difficult to diagnose clinically despite a plethora of conventional and modern investigations. Tubercular retinal vasculitis (TRV) is a common and specific presentation of OTB but is variably defined in the literature in terms of clinical profile and the investigations essential for diagnosis and treatment. Ironically, the need and duration of antitubercular treatment is uncertain for this manifestation of ocular TB. The rationale and utility for corticosteroids is similarly equivocal for TRV. This review attempts to tease out a commonsense approach from the best available evidence and consensus in the literature to suspect, investigate and diagnose TRV with reasonable certainty, and institute appropriate treatment with due ethnic and geographic considerations.

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