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Bryan Hong, Simon Bababeygy, Hossein Nazari Khanamiri, Narsing Rao, PPD in Uveitis; The utility of routine testing for tuberculosis in a county-hospital uveitis population. An analysis of predictive values. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5719. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize a county hospital-based uveitis population and to evaluate the utility of tuberculosis (TB) screening by means of calculated predictive values.
In this retrospective study, the charts of 142 patient seen between August 2011 and August 2012 at the uveitis subspecialty clinic at the Los Angeles County + University of Southern California Hospital were reviewed for birthplace, laterality and major manifestation of uveitis, TB-screening test (purified protein derivative and interferon-gamma release assay), chest X-ray, ophthalmic imaging, TB-treatment history and response to treatment, and final diagnosis. Uveitis was presumed TB-related when patients showed favorable response to anti-TB therapy within 2 to 4 months of initiation. Posttest probabilities were determined using numbers derived from our patient population and Bayes’ theorem.
Tuberculosis-screening test was positive in 30 of 142 patients (21.1% of total population). Six patients (20% of TB-screening positive population) received a final diagnosis of TB-related uveitis: 1 definite TB uveitis by PCR in setting of systemic TB (3.3%), 4 presumed TB uveitis by response to anti-TB therapy (13.3%), and 1 systemic TB with presumed TB uveitis (3.3%). Foreign place of birth was the only risk factor that reached statistical significance yielding an odds ratio of 2.26 (95% confidence interval [CI], 1.00-5.13; P<0.01) if born in Mexico and 4.90 (95%CI, 1.74-13.83; P<0.01) if born in other foreign countries versus 0.12 (95% CI, 0.04-0.38; P<0.01) for U.S.-born patients. Bayesian analysis yielded a posttest probability of 17.2% (all patients) and 30.3% (foreign-born patients) for TB-related uveitis among uveitis patients with positive TB-screening. Negative predictive values of 98.8% (all patients) and 97.5% (foreign-born patients) were calculated for those patients with negative TB-screening.
Tuberculosis screening plays an important role in high risk groups, such as immigrants from TB endemic regions.
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