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Sarju Patel, Nehali Saraiya, Howard Tessler, Debra Goldstein; Presentation And Outcomes Of Mycobacterial Ocular Inflammatory Disease In The Mid-western United States. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2755.
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The diagnosis of ocular tuberculosis (TB) is difficult. Definitive diagnosis requires ocular tissue for acid-fast staining, mycobacterial culture, or polymerase chain reaction assays, which may be of low yield and associated with ocular morbidity. As such, the diagnosis of ocular TB is often presumptive, based on positive tuberculin skin test, interferon release assay and supportive clinical findings. However, it is often difficult to initiate multi-drug therapy in the absence of pulmonary TB, despite 18.7 % of TB being extrapulmonary (Peto H et al). The purpose of this study is to describe the presentation of ocular TB in the United States.
Retrospective review of patients from January 1995 to December 2010. All patients had ocular inflammation consistent with TB, and met at least one of the following criteria:1. Positive screening test (TST and/or quantiferon) AND response of eye disease to anti-TB therapy,2. Clinical/radiographic evidence of TB elsewhere in body AND response of eye disease to anti-TB therapy,3. Positive biopsy/culture diagnosis elsewhere in body AND response of eye disease to anti-TB, or4. Positive culture, PCR or histologic diagnosis from ocular tissue, regardless of response to therapy. Descriptive data were collected and presented as proportions and percentages.
15 cases of ocular TB were identified. Tissue diagnosis was achieved in 6 (40%) cases; 4 (27%) from ocular tissue with 2 (13%) being made after enucleation. 40% of patients were born in endemic TB countries, while 53% had spent significant time in endemic areas. 80% of patients were PPD+, 87% were Quantiferon+ (1 negative result had atypical mycobacteria). 1 case was HIV+, a total of 5 (33%) were immunosuppressed at time of diagnosis. 3 (20%) had evidence of active pulmonary/miliary TB, while 1 had changes consistent with prior TB on chest imaging. Per SUN criteria, 27% had posterior uveitis (predominately multifocal choroiditis), 27% had scleritis (83% necrotizing nodular), and 46% had granulomatous panuveitis. There was an average delay in anti-TB treatment from time of first symptoms of 858 days (82-1920).
Of the 15 patients with ocular TB, 11 had purely ocular disease. Absence of pulmonary TB should not dictate implementation of anti-TB therapy. Given variable clinical presentation and significant delay in time until treatment, new criteria must be established to ensure prompt diagnosis to improve clinical outcomes.
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