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Ramya N. Swamy, Hossein Nazari Khanamiri, Narsing A. Rao; Role Of Quantitative Polymerase Chain Reaction (qPCR) In Diagnosis Of Ocular Tuberculous Uveitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6224.
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To determine the diagnostic value of qPCR on ocular samples for tuberculous (TB) uveitis
Medical records of patients with presumptive TB uveitis and qPCR on ocular fluid or tissue for detection of mycobacterium tuberculosis (Mtb) DNA were reviewed retrospectively. The medical records were then analyzed to determine predictive value of qPCR in diagnosing ocular tuberculosis.
Twelve patients with either unilateral or bilateral uveitis were included. Eight patients (66.6%) were eventually diagnosed as ocular TB uveitis and underwent RIPE (rifampin, isoniazid, pyrazinamid and ethambutol) therapy. Of these individuals, 3 tested positive in qPCR. Final diagnosis in individuals who were not diagnosed with TB included toxoplasma, phacoanaphylactic endophthalmitis and HLA-B27 uveitis; qPCR in these patients was negative. All 8 individuals with a diagnosis of TB uveitis were PPD skin test positive, while 3 of 4 non-TB patients had positive skin test. Additionally, of presumptive TB uveitis patients, 1 of 3 with positive qPCR and 2 of 5 with negative qPCR had positive CXR. No differences were noted in presenting vision or degree of inflammation among the qPCR-positive and qPCR-negative TB uveitis groups. The positive predictive value based on this case series for qPCR was 37.5% and the negative predictive value was 44.4%.
Ocular TB can present as either unilateral or bilateral uveitis. qPCR would be most beneficial in diagnosis of TB uveitis in patients in whom there is a high index of suspicion and positive PPD. Data from this series suggests that the value of utilizing qPCR may be in negative prediction, where other data such as skin testing may be positive or equivocal. Further prospective studies are needed to identify those individuals in whom qPCR testing would be most beneficial and to determine when such testing would have the greatest yield.
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