Tuberculosis and other causes of uveitis in Indonesia

Abstract

PurposeThe purpose of this study is to assess the causes of uveitis in Indonesia and determine the importance of tuberculosis (TB) as a cause of uveitis.Patients and methodsProspective cohort study examining 146 consecutive new human immunodeficiency virus-negative patients with active uveitis between June 2014 and May 2015. We assessed the anatomic locations and specific causes of uveitis, as well as associations with infectious and non-infectious systemic diseases. We determined the prevalence of positive QuantiFERON Tb Gold test (QFT) results in Indonesian patients with uveitis and calculated the number of patients with active systemic TB.ResultsPosterior and panuveitis were the most common anatomic entities (38% each). Infections represented the most frequent cause of uveitis (33%); the most prevalent were toxoplasmosis (19%) and active systemic TB (8%). The majority of patients were QFT positive (61%). A specific diagnosis could not be established in 45% of the patients. At first presentation to the ophthalmologist, the majority of patients (66%) had a visual acuity of less than finger counting at 3 m and already exhibited various complications of uveitis. When classifying the QFT-positive patients with unexplained uveitis into a TB-related group, the percentage of 'TB-associated' uveitis cases increased from 8-48%. Highly elevated QFT levels were observed in patients with uveitis of unknown cause and no signs of active systemic TB.ConclusionsIn Indonesia, infectious uveitis was the most common type of uveitis and the leading causes consisted of toxoplasmosis and TB. The association observed between highly elevated QFT results and uveitis of otherwise unexplained origins indicates that a link exists between the latent TB infection and the development of uveitis.

Type 1 interferon-inducible gene expression in QuantiFERON Gold TB-positive uveitis: A tool to stratify a high versus low risk of active tuberculosis?

“…The clinical part of the study has been recently published. [ 1 ] For the present study, we excluded 177 of these 247 uveitis patients for the following reasons: 72 had an incomplete screening workup, 29 were human immunodeficiency virus (HIV) positive, 53 were QuantiFERON-Gold TB (QFT)-negative, 2 had an indeterminate QFT value without evidence of clinically active TB, and 21 QFT-positive patients had another established cause of uveitis. In total, we included 12 cases with uveitis with clinically diagnosed active pulmonary TB (of whom two were Mtb sputum-positive and 10 were Mtb sputum-negative) and 58 patients with uveitis who were QFT-positive without any signs of active TB and in whom no alternative cause for uveitis could be established (Tables 1 and 2 ).…”

“…TB-associated uveitis represents a major cause of infectious uveitis in Indonesia and in other countries endemic for TB. [ 1 – 5 ] The diagnosis of TB uveitis is mainly based on microbiological proof of active TB infection in the eye or a positive culture in other organs, most frequently the lungs. However, the diagnosis TB uveitis is challenging in the absence of clinically apparent pulmonary disease because ocular tissue examinations are not readily available and biopsies are troublesome to perform.…”

Antinuclear and antiretinal antibodies in uveitis associated with active and latent tuberculosis

“…Blood samples from patients with uveitis associated with active (not yet treated) pulmonary TB (N = 10) and uveitis of unknown cause (N = 85) were collected from June 2014 until May 2015. Classification of patients was performed according to SUN classification, and specific diagnoses were determined after the basic work-up for uveitis as indicated in our previous publication (La Distia Nora et al 2017). The diagnosis of active pulmonary TB was based on clinical and/or microbiological and radiological findings (La Distia Nora et al 2017).…”

“…Classification of patients was performed according to SUN classification, and specific diagnoses were determined after the basic work-up for uveitis as indicated in our previous publication (La Distia Nora et al 2017). The diagnosis of active pulmonary TB was based on clinical and/or microbiological and radiological findings (La Distia Nora et al 2017). This study was performed with the approval of the local medical ethical committee.…”

No Evidence for Circulating Retina Specific Autoreactive T-cells in Latent Tuberculosis-associated Uveitis and Sarcoid Uveitis

“…Ocular infection with Mycobacterium tuberculosis (Mtb) is a very rare condition that may cause uveitis when Mtb-bacilli invade the eye and consequently elicit local granulomatous inflammation. [1][2][3] In support of local ocular infection by Mtb, anti-tuberculosis therapy (ATT) can be very effective in TB-associated uveitis patients without systemic signs of TB, higher response rates have been witnessed in patients with a high QuantiFERON-TB Gold test (QFT) score. 4 However, the results were often inconclusive, better responses to ATT in combination with corticosteroids have been shown and a significant number of patients still need corticosteroid treatment after ATT, which may point to the involvement of other pathophysiological mechanisms as well.…”