Ocular Tuberculosis—A Clinical Conundrum

Lee, Cecilia; Agrawal, Rupesh; Pavésio, Carlos

doi:10.3109/09273948.2014.985387

Cited by 39 publications

(56 citation statements)

References 49 publications

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“…48 Similarly, there is no agreed consensus between ophthalmologists and other physicians with regard to the role of antitubercular therapy (ATT) and duration of treatment in cases of isolated intraocular TB (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis

Kee

González‐López

Al-Hity

et al. 2016

Survey of Ophthalmology

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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.

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Section: Introductionmentioning

confidence: 99%

Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis

Kee

González‐López

Al-Hity

et al. 2016

Survey of Ophthalmology

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“…Mycobacterial cultures and MTB-PCR also have poor sensitivities, so negative findings do not rule out the disease 12. Presumptive diagnosis usually involves suspicious clinical histopathological findings plus 1 of the following: systemic findings consistent with TB infection, positive interferon gamma release assay or positive tuberculin skin test 14. Diagnosis can be substantiated through response to treatment 9–11…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis presenting as dacryoadenitis in the USA

2019

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A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis. She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient’s history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.

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“…IOTB is an underdiagnosed uveitic disease, as the proportion of subjects presenting with its clinical signatures is quite low, mostly requiring treatment with anti-tubercular therapy (ATT) 23 , 24 . Like pulmonary tuberculosis 25 , 26 , variety of host factors including, genetic makeup, antigenic exposure, initial innate immune responses and the ensuing adaptive immune responses may determine the clinical outcomes in IOTB.…”

Section: Discussionmentioning

confidence: 99%

Diminished TLR2-TLR9 mediated CD4+ T cell responses are associated with increased inflammation in intraocular tuberculosis

Sharma

Khan

et al. 2018

Sci Rep

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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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Ocular Tuberculosis—A Clinical Conundrum

Cited by 39 publications

References 49 publications

Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis

Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis

Tuberculosis presenting as dacryoadenitis in the USA

Diminished TLR2-TLR9 mediated CD4+ T cell responses are associated with increased inflammation in intraocular tuberculosis

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