Review of people with retinal vasculitis and positive QuantiFERON®-TB Gold test in an area nonendemic for tuberculosis

Brunner, David O.; Zweifel, Sandrine; Barthelmes, Daniel; Meier, F; Böni, Christian

doi:10.1007/s10792-017-0739-4

Cited by 10 publications

(10 citation statements)

References 20 publications

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“…The diagnosis of ocular TB is confirmed only when the causal bacteria are isolated from the ocular tissue. The status of presumed TB uveitis is determined if any of the following signs is observed: choroidal granuloma, retinal vasculitis with or without choroiditis, broad-based posterior synechiae, or serpiginous-like choroiditis (SLC) with a positive tuberculin skin test or QuantiFERON-TB Gold test, or any other relevant tests [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

Differences between Mycobacterium chimaera and tuberculosis Using Ocular Multimodal Imaging: A Systematic Review

Zweifel

Foa

Wiest

et al. 2021

JCM

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Due to their non-specific diagnostic patterns of ocular infection, differential diagnosis between Mycobacterium (M.) chimaera and tuberculosis can be challenging. In both disorders, ocular manifestation can be the first sign of a systemic infection, and a delayed diagnosis might reduce the response to treatment leading to negative outcomes. Thus, it becomes imperative to distinguish chorioretinal lesions associated with M. chimaera, from lesions due to M. tuberculosis and other infectious disorders. To date, multimodal non-invasive imaging modalities that include ultra-wide field fundus photography, fluorescein and indocyanine green angiography, optical coherence tomography and optical coherence tomography angiography, facilitate in vivo examination of retinal and choroidal tissues, enabling early diagnosis, monitoring treatment response, and relapse detection. This approach is crucial to differentiate between active and inactive ocular disease, and guides clinicians in their decisional-tree during the patients’ follow-up. In this review, we summarized and compared the available literature on multimodal imaging data of M. chimaera infection and tuberculosis, emphasizing similarities and differences in imaging patterns between these two entities and highlighting the relevance of multimodal imaging in the management of the infections.

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Section: Resultsmentioning

confidence: 99%

Differences between Mycobacterium chimaera and tuberculosis Using Ocular Multimodal Imaging: A Systematic Review

Zweifel

Foa

Wiest

et al. 2021

JCM

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“…1,2,5,15,26,28,33 The proportion of patients with OTB including PTR experiencing clinical improvement without ATD has been reported to be as high as 50%. 1 Despite lack of clear data on the use of corticosteroids and nonsteroidal immunosuppressant therapy for the treatment of PTR, [1][2][3]5,10,15,26 therapy with corticosteroids and nonsteroidal immunosuppressant treatment has been questionably condemned as inferior or even as treatment failure, 5,25 which seems unlikely, based on our results. Our study is the first to suggest that IMT without ATD may be advantageous in patients with PTR with positive QFT living in endemic areas.…”

Section: Therapy Of Isolated Retinal Vasculitis Silpa-archa Et Almentioning

confidence: 87%

“…[6][7][8][9] The test is also recommended in the evaluation of people with retinal vasculitis. 10,11 However, in nearly all reported tuberculous retinal vasculitis cases with positive QFT, the diagnosis has been only presumptive. 12 In both uveitis clinics and research studies, presumed tuberculous retinal vasculitis (PTR) can be problematic for clinicians and researchers because of the heterogeneity of diagnoses and controversial treatments, and there has been insufficient research with confirmatory angiography and detailed immunosuppressive treatment (IMT) to truly demonstrate the benefits of IMT in patients with PTR.…”

mentioning

confidence: 99%

“…12 In both uveitis clinics and research studies, presumed tuberculous retinal vasculitis (PTR) can be problematic for clinicians and researchers because of the heterogeneity of diagnoses and controversial treatments, and there has been insufficient research with confirmatory angiography and detailed immunosuppressive treatment (IMT) to truly demonstrate the benefits of IMT in patients with PTR. 1,10 In our tertiary uveitis clinic, we hypothesize that PTR is mainly driven by immune system dysregulation. 13 As such, a full course of systemic corticosteroids followed by nonsteroidal immunosuppressants is routinely used in patients with PTR with positive QFT, just as in the usual cases of isolated retinal vasculitis.…”

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confidence: 99%

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Isolated Retinal Vasculitis

Silpa-archa

Sapthanakorn

Foster

2022

Retina

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Purpose: To identify prognostic factors for poor visual outcomes in patients with isolated retinal vasculitis and to elucidate the outcome of immunosuppressive treatment without the use of antituberculosis drugs for patients with retinal vasculitis associated with a positive QuantiFERON-TB Gold In-Tube (QFT) test.Methods: A retrospective chart review was performed of patients presenting with retinal vasculitis. After the diagnosis of active retinal vasculitis had been confirmed by fluorescein angiography and other possible causes of retinal vasculitis had been excluded, patients were categorized into two groups by their QFT result. Potential associated factors between the poor and good visual outcome groups were statistically analyzed by the chi-square test and logistic regression model with generalized estimating equations.Results: Seventy-three eyes (48 patients) were enrolled in this study. After univariate analysis, multivariate logistic regression analysis was performed and revealed that logMAR visual acuity at the initial visit (P = 0.01) and outer retinal disruption (P = 0.03) were the two factors significantly associated with poor visual outcomes. Systemic corticosteroids were administered without the use of antituberculosis drugs to all 16 cases of presumed tuberculous retinal vasculitis associated with positive QFT (26 eyes), 10 (63%) of whom were given nonsteroidal immunosuppressive drugs and achieved inflammatory control and treatment success.Conclusion: Risk factors leading to poor visual outcome in patients with isolated retinal vasculitis have been identified. Immunosuppressive treatment without antituberculosis drugs seems to be a promising regimen for selected patients with presumed tuberculous retinal vasculitis under vigilant care.

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“…However, this study evaluated all ocular inflammation associated with the positive Quantiferon-TB Gold test, including uveitis and scleritis, in both immunocompetent and immuno-deficient patients [29]. Brunner et al also evaluated patients affected by retinal vasculitis and positive TB gold in a nonendemic country and concluded that fourfold treatment did not influence the extension of vasculitis nor visual acuity, but was effective in reducing recurrences of ocular inflammation [30]. A retrospective study in a uveitis centre of Birmingham also reported that 6 months after ATT, 90% of patients were flare free, and 80% were flare free at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Epidemiological Study on Tubercular Uveitis in a Tertiary Eye Care Centre in Italy

Cava

Sacchetti

Pirraglia

et al. 2020

Journal of Ophthalmology

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Purpose. To describe frequency, clinical characteristics, and visual prognosis of tubercular uveitis (TBU) in a nonendemic country. Methods. We retrospectively reviewed 3743 charts of patients with endogenous uveitis visited from 2008 to 2018 at a tertiary referral centre in Rome, Italy. We included immunocompetent patients with diagnosis of TBU. Patients were divided in two groups: patients with history of uveitis without a previous diagnosis of TBU (group A) and patients at their first episode of TB uveitis (group B). Results. TBU was diagnosed in 28 (0.75%) out of 3743 patients. Twelve (42.9%) patients came from tuberculosis endemic areas. All patients received specific antitubercular treatment (ATT) and were evaluated for a mean follow-up of 3.2 ± 2.9 years. Group A showed a greater number of ocular complications when compared with group B. ATT was effective in reducing the frequency of recurrences of uveitis in patients of group B. Conclusion. Intraocular inflammation can be the first manifestation of tuberculosis. Our data highlight that early diagnosis and specific treatment of TBU may allow to decrease recurrences and to improve visual outcomes.

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Review of people with retinal vasculitis and positive QuantiFERON®-TB Gold test in an area nonendemic for tuberculosis

Abstract: The quantiferon test is recommended in the evaluation of people with retinal vasculitis. Interpretation of a positive result can be challenging in a country nonendemic for TB. The majority of patients with quantiferon-positive retinal vasculitis were found to have latent TB.

Cited by 10 publications

References 20 publications

Differences between Mycobacterium chimaera and tuberculosis Using Ocular Multimodal Imaging: A Systematic Review

Differences between Mycobacterium chimaera and tuberculosis Using Ocular Multimodal Imaging: A Systematic Review

Isolated Retinal Vasculitis

Clinical and Epidemiological Study on Tubercular Uveitis in a Tertiary Eye Care Centre in Italy

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