Intraocular Tuberculosis

Abstract

Intraocular manifestations of tuberculosis (TB) are rare, but TB infection is common worldwide, especially in developing economies, and in immigrant populations and immunocompromised patients in developed nations. The current review focuses on the clinical characteristics and diagnostic modalities useful in the diagnosis of intraocular TB. Specifically, IFN-gamma Release Assays (IGRAs), antigen-detection assays, and polymerase chain reactions will be discussed. Clinical management of TB patients includes counseling and testing for HIV infection. The use of corticosteroids along with anti-tuberculous medications and special therapeutic considerations in immunocompromised patients are discussed.

Algorithm of Choroiditis

“…Other less common presentations include multifocal choroiditis and a serpiginous-like choroiditis. 1,2,17 Diagnosis of tuberculous uveitis encompasses suggestive clinical history and signs, exclusion of other known etiologies of uveitis, supportive investigations, such as positive Mantoux test and chest X-ray findings, response to empiric antituberculosis treatment and in some, evidence of M. tuberculosis or its DNA in ocular fluids/tissues. 17,18 Immunological methods for the diagnosis of tuberculosis have been expanded with QuantiFERON TB gold …”

Tuberculous Uveitis

“…[1][2][3] According to the World Health Organization (WHO), 9.0 million people developed active tuberculosis (TB) in 2013 -an overall annual incidence of 126 per 100,000 persons -and among this group one in six, or 1.5 million, died from the disease. The highest incidence rates for active TB were reported from Africa (280 per 100,000 persons), Southeast Asia (183 per 100,000 persons) and India (168 per 100,000 persons).…”

“…In the vast majority of otherwise healthy exposed people, a robust adaptive immune response quickly contains the infection, such that those exposed to MTB are said to have only a 10% life-time risk of developing active pulmonary or extrapulmonary disease. [1][2][3] Among those with active TB, the reported prevalence of intraocular tuberculosis (IOTB) varies widely, from approximately 1% in patients with pulmonary TB to over 20% in those with extrapulmonary infection. 2,3 The reported regional rates of tuberculous uveitis also vary, from less than 1% in tertiary referral clinics in North America, to 10% or more in similarly specialized clinics in highly endemic regions.…”

“…[1][2][3] Among those with active TB, the reported prevalence of intraocular tuberculosis (IOTB) varies widely, from approximately 1% in patients with pulmonary TB to over 20% in those with extrapulmonary infection. 2,3 The reported regional rates of tuberculous uveitis also vary, from less than 1% in tertiary referral clinics in North America, to 10% or more in similarly specialized clinics in highly endemic regions. 2,3 Although establishing prior exposure to MTB through the use of tuberculous skin testing (TST), an interferon-release assay (IGRA), or chest X-ray or CT is fairly straightforward and can usually be done with a positive predictive value in excess of 90%, exposure is by no means equivalent to active infection.…”

“…2,3 The reported regional rates of tuberculous uveitis also vary, from less than 1% in tertiary referral clinics in North America, to 10% or more in similarly specialized clinics in highly endemic regions. 2,3 Although establishing prior exposure to MTB through the use of tuberculous skin testing (TST), an interferon-release assay (IGRA), or chest X-ray or CT is fairly straightforward and can usually be done with a positive predictive value in excess of 90%, exposure is by no means equivalent to active infection. In fact, given the global prevalence of latent infection, one would expect one-third or more of all uveitis patients in highly endemic areas to have some evidence of prior MTB exposure.…”