Role of Anti-Tubercular Therapy in Uveitis With Latent/Manifest Tuberculosis

Bansal, Reema; Gupta, Amod; Gupta, Vishali; Dogra, Mangat R; Bambery, P; Arora, Sunil

doi:10.1016/j.ajo.2008.06.011

Cited by 193 publications

(140 citation statements)

References 29 publications

Supporting

Mentioning

124

Contrasting

Unclassified

Order By: Relevance

“…6,8,16 This was evident in our series, in which only eight patients had active TB. A history of previous TB (1/21), TB contact history (5/21), constitutional symptoms (2/21), chest symptoms (0/21), abnormal chest signs (0/21), elevated inflammatory markers (2/21), or an abnormal chest radiograph (6/21) were very poor indicators of TB infection, and their absence should not discourage this diagnosis.…”

Section: Discussionsupporting

confidence: 49%

“…All patients were UK residents, of whom nine were born in the UK, six in India, four in Pakistan, one in Sudan, and one in Nigeria. In all, 11 patients were Asian (52%), 8 were White Caucasian (32%), and 2 were African (10%). There were no HIV-positive or otherwise immunocompromised patients in this series.…”

Section: Resultsmentioning

confidence: 99%

“…It is based upon the presence of ophthalmological features consistent with intraocular TB, the exclusion of other causes of uveitis, immunological evidence of TB infection (either positive IGRA or TST) with or without evidence of active TB elsewhere in the body, and a beneficial response to ATT. [6][7][8][9] Definitive proof of intraocular TB by the demonstration of AFBs or culture of MTb from ocular specimens is exceedingly rare. 7,10 Failure to demonstrate AFBs or negative cultures do not exclude the possibility of intraocular TB, as the yield of micro-organisms from ocular fluids might be very low.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Manousaridis

Ong

Stenton

et al. 2013

Eye

View full text Add to dashboard Cite

Purpose To report the clinical manifestations and treatment outcomes of patients with presumed intraocular tuberculosis (TB) seen at the Newcastle Uveitis Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 10-year period. Methods Retrospective review of case notes. Results A total of 21 patients were identified. Occlusive retinal vasculitis was the commonest ophthalmological presentation (12 patients). Eight patients (38%) were found to have underlying active systemic TB (four with mediastinal lymphadenopathy, three with pulmonary TB, one with cutaneous TB). Constitutional or respiratory symptoms, elevated inflammatory markers, and an abnormal chest radiograph were poor indicators of active TB. Two patients had inactive intrathoracic TB. Eleven patients had latent TB. Eighteen patients received anti-tuberculous treatment. Final visual acuity was better than or equal to initial visual acuity in 14 out of 16 patients who completed at least 6 months of standard anti-tuberculous treatment. Conclusions Most patients with presumed intraocular TB have latent TB, but a significant minority has hitherto undetected active TB. Our series suggests that either proven or presumed intraocular TB occurs frequently in the absence of constitutional or respiratory symptoms, elevated inflammatory markers, or an abnormal chest radiograph. A minimum of 6 months standard anti-tuberculous treatment provides good visual outcomes in the majority of patients.

show abstract

Section: Discussionsupporting

confidence: 49%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Manousaridis

Ong

Stenton

et al. 2013

Eye

View full text Add to dashboard Cite

show abstract

“…2 The type of uveitis exhibited may suggest TB to the ophthalmologist, although the reasons for this may be unreliable; observations made especially in the early twentieth century (when TB was endemic in the Western world) have taught generations of ophthalmologists to consider certain types of uveitis (particularly granulomatous anterior uveitis, choroiditis, and certain types of retinal vasculitis) more suggestive of TB than other forms of uveitis, an approach used for diagnosis in a recent study. 9 However, in the absence of definitive intraocular evidence of aetiology, responsiveness to ATT may indicate the correct diagnosis; our series provides little support for a narrow diagnostic approach; recovery of 'atypical' uveitis including non-granulomatous anterior uveitis was also seen, suggesting that the ophthalmologist should not exclude the possibility of TB-associated uveitis from the differential diagnosis merely on the basis of clinical appearance. The recent description of 'atypical serpiginous choroiditis' secondary to TB 10 has been both reinforced by further studies 11 and widened to include more varied presentations including placoid-like retinitis 12 and this reminds us that our diagnostic net should be cast fairly widely.…”

Section: Discussionmentioning

confidence: 77%

“…In contrast, some countries have a high prevalence of TB and the approach to diagnosis will differ. 9 However, increasing immigration to the United Kingdom from high prevalence countries, commencing with those from the Indian sub-continent in the 1960s and followed by many from high-risk areas including Africa and Eastern Europe, have altered the population risk profile. 2 The type of uveitis exhibited may suggest TB to the ophthalmologist, although the reasons for this may be unreliable; observations made especially in the early twentieth century (when TB was endemic in the Western world) have taught generations of ophthalmologists to consider certain types of uveitis (particularly granulomatous anterior uveitis, choroiditis, and certain types of retinal vasculitis) more suggestive of TB than other forms of uveitis, an approach used for diagnosis in a recent study.…”

Section: Discussionmentioning

confidence: 99%

Presumed tuberculous uveitis: diagnosis, management, and outcome

Sanghvi

Bell

Woodhead

et al. 2011

Eye

View full text Add to dashboard Cite

Purpose To assess the effectiveness of anti-tuberculous treatment in patients with chronic uveitis and either active systemic or latent tuberculosis (TB) in a non-endemic community. Methods Retrospective study of patients with chronic uveitis, non-ocular evidence of latent or active TB and no other identified cause of uveitis who underwent a 6-month course of standard anti-tuberculous chemotherapy. Response to treatment was assessed at 6 and 12 months after initiation of treatment. Results A total of 27 patients were included of whom 59% were female. In all, 19 were Asian, 4 Caucasian, and 4 Black. More than half of patients had a history of contact with another person treated for TB. Inflammation resolved after chemotherapy in 70.3% of patients, 18.5% had a change in the nature of their inflammation and 11.1% had no benefit. Conclusions There were no uveitis features characteristic of TB uveitis and a wide range of manifestations was seen ranging from non-granulomatous anterior uveitis to occlusive retinal vasculitis. TB is not endemic in the United Kingdom, therefore consideration of ethnicity, immigration, and history of TB contact remain important to direct investigations. In a patient with uveitis and latent TB, a full 6-month course of antituberculous chemotherapy is recommended although it may not be curative of the uveitis.

show abstract

Mycobacterial Ocular Inflammation

Patel¹,

Saraiya²,

Tessler³

et al. 2013

JAMA Ophthalmol

View full text Add to dashboard Cite

The reported outcomes of ocular mycobacterial infection are commonly unfavorable. This study is among the first to elucidate factors associated with poor outcomes, as well as highlight the continued controversies in therapy, particularly the role of oral corticosteroids.Objective: To describe presentations and outcomes of mycobacterial ocular disease in the Midwestern United States.Design: Retrospective case series.Setting: A university-based uveitis clinic.Participants: Twenty-six eyes of 17 patients with mycobacterial ocular inflammatory disease seen at University of Illinois at Chicago from 1995 to 2010.Main Outcome Measures: Bivariate and regression analyses were performed to assess factors associated with delay in referral, relapse, and irreversible visual acuity loss (Յ20/200).Results: Of 17 patients, 13 had isolated ocular disease, 1 had miliary tuberculosis (TB), 2 had TB lymphadenopathy, and 1 had active pulmonary TB. Fourteen had Mycobacterium tuberculosis and 3 had nontuberculous my-cobacterial infection. Chest imaging was consistent with granulomatous disease in 46.7%. Average delay from ocular disease onset to uveitis service referral was 755.3 days. Posterior uveitis and non-Hispanic white race were associated with increased delay. A relapsing course was observed in posterior uveitis (odds ratio [OR], 20.0; 95% CI, 1.39-287; P=.03) and those treated with systemic steroids for eye disease (OR, 10.1; 95% CI,1.60-64.0; P=.01). Disease control was achieved in 81%, although 38.5% had profound visual loss, associated with age older than 50 years and delay in diagnosis. Patients diagnosed after 500 days from initial ocular symptoms were more likely to lose vision (OR, 20.0; 95% CI, 1.41-282; P =.03).Conclusions: Ocular mycobacterial infection occurs in nonendemic areas and cannot be ruled out with negative chest imaging. Tuberculosis and atypical mycobacterial infection should be in the differential diagnosis of ocular inflammation, regardless of patient ethnicity. Significant delays exist in instituting antimicrobial treatment, associated with increased morbidity. Early referral is necessary for patients not responding appropriately to anti-inflammatory therapy.

show abstract

Role of Anti-Tubercular Therapy in Uveitis With Latent/Manifest Tuberculosis

Cited by 193 publications

References 29 publications

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Presumed tuberculous uveitis: diagnosis, management, and outcome

Mycobacterial Ocular Inflammation

Contact Info

Product

Resources

About