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J. Biswas, B.R. Babu, V.S. Prakash, S. Krishnakumar, T. Lily, N. Kumarasamy, S. Sunithi, H. Madhavan; Ocular Tuberculosis in AIDS Patients in India . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5073.
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Purpose: Tuberculosis is one of the most common systemic infections in AIDS patients in India. However, ocular lesions due to tuberculosis in AIDS patients have rarely been described. We describe the clinical features with histopathologic, microbiologic and molecular biologic correlation of ocular lesions of tuberculosis in AIDS patients in a tertiary ophthalmic center in India. Methods: Retrospective chart review of 683 cases of AIDS seen during 1993 to 2004 in a tertiary ophthalmic center in India was done. We analysed the clinical findings, course, and treatment of five patients of ocular tuberculosis. In 4 cases, ocular tuberculosis was confirmed by histopathologic, microbiologic and molecular biologic study. Results: 5 cases (0.73%) were found to have ocular tuberculosis. One patient had conjunctival mass; two patients had panophthalmitis, one patient each had subretinal abscess and miliary tuberculosis. CD4 cell count ranged from 34 to 233 cells per cubic mm. All patients had pulmonary tuberculosis. Subretinal abscess due to tuberculosis was the presenting manifestation of HIV infection in one case. One patient required excision of conjunctival mass, two patients of panophthalmitis required evisceration. Histopathology done in 3 cases showed caseation necrosis with acid fast bacilli. Microbiological study also showed Mycobacterium tuberculosis in direct smear and culture. Polymerase chain reaction using primer targeting MPB 64 gene showed amplification of Mycobacterium tuberculosis DNA in conjunctival tissue, eviscerated specimen and aqueous aspirate in 4 cases. Conclusions: Ocular tuberculosis in AIDS patients is rare, has protean manifestation and is often associated with pulmonary tuberculosis. Polymerase chain reaction is helpful in confirming the diagnosis of ocular tuberculosis in AIDS patients.
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