Presumed tuberculosis-associated uveitis: rising incidence and widening criteria for diagnosis in a non-endemic area

Abstract

PurposeTo assess the incidence, clinical ocular involvement and effectiveness of anti-tuberculous treatment in patients with chronic uveitis presumed to be associated with tuberculosis in a non-endemic community.Patients and methodsRetrospective case series of patients with uveitis and evidence of tuberculosis, with no other identified cause of uveitis, who underwent a 6-month course of standard anti-tuberculosis treatment between 2008 and 2015. The response to treatment was assessed at 6 and 12 months after initiation of treatment.ResultsForty-eight patients were included of whom 36 (75%) were born outside the United Kingdom. Only five had concurrent active pulmonary or nodal tuberculosis. There were 85 affected eyes, including 25 with granulomatous anterior uveitis, 32 with retinal vasculitis (occlusive in 21), and 20 with multifocal choroiditis or serpiginous-like retinochoroiditis. Gamma-interferon testing was positive in 95%. Complete resolution at end point was seen in only 60%, but a further 19% were inflammation-free on topical steroid only. Resolution was lower (50%) in those with panuveitis compared to other anatomical types (75%). Sixty-four eyes (75%) had a LogMAR visual acuity of 0.1 or better at the end of the study.ConclusionsThe incidence of presumed tuberculosis-associated uveitis (TBU) has almost quadrupled in this region. The efficacy of treatment has not been enhanced by the introduction of gamma-interferon testing to support diagnosis. Some patients may require more prolonged antibiotic therapy to ensure quiescence, but chronic non-infective anterior uveitis may in any case follow treated TBU.

Presumed ocular tuberculosis in the United Kingdom: a British Ophthalmological Surveillance Unit (BOSU) study

“…There was on average an improvement in VA of 0.1 LogMAR unit, from +0.41 LogMAR (SD = 0.62) at presentation to +0.31 LogMAR (SD = 0.56) at 12-month follow-up. This level of visual improvement is in keeping with similar retrospective studies [ 14 ]. There is understandably a positive correlation between presenting BCVA and VA at outcome.…”

“…There have been few incidence studies of ocular TB in non-endemic areas. One recent study reported 8 new cases of ocular TB in 2015 in the Manchester area [ 14 ]. By comparison our study reports 12 new cases from Manchester in 2017.…”

Autoimmunity, Autoinflammation, and Infection in Uveitis

“…81 MTb is believed to have infected up to a third of the world's population, the majority of whom remain latently infected, with a significant mortality rate. 82 MTb is a major cause of uveitis in humans, both in developed and in developing countries, 83,84 and presents in a large variety of clinical phenotypes, some of which are included in the category undifferentiated or noninfectious, such as atypical serpiginous choroiditis. 85 How might MTb cause ocular inflammation?…”

Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey

“…TB-associated uveitis (TBU) has several clinical manifestations that are generally diagnosed on the basis of specific clinical signs, ancillary tests supportive of TB and exclusion of non-TB entities [ 2 ]. During the past two decades, several studies have attempted to analyze the diagnostic criteria and treatment paradigms for intraocular TB, both in TB-endemic and nonendemic countries [ 3 – 11 ]. However, no attempt has been made to specifically evaluate prognostic factors for this condition.…”