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amelie Amara, Amelie Guihot, Salim Trad, Christine Fardeau, Phuc Lehoang, Valerie Touitou, Bahram Bodaghi; Interest of QuantiFERON®-TB Gold Plus as a diagnostic test in patients with ocular inflammation (OI). Invest. Ophthalmol. Vis. Sci. 2019;60(9):830. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the contribution of the QuantiFERON®-TB Gold Plus in patients with OI and identifiy the situations where its prescription is the most relevant.
We performed a retrospective monocentric study in patients with an active OI, included consecutively during a 5-month period and who underwent a QuantiFERON®-TB Gold Plus assay (standard assay combined with MHC Class II (CD4), Class I (CD8) and QFNTB gold in tube (threshold chosen at 0.35 IU/mL). Patients with active tuberculosis/PPD within 6 months were excluded. A complete ophthalmological evaluation and systemic assessment were performed for each patient. They were divided into three groups according to the QFN prescription indication: group 1 anterior uveitis/episcleritis (acute or chronic), group 2 for pretherapeutic assessment, group 3 uveitis with intermediate or posterior uveitis/optic neuritis. Patients were monitored for one year and the SUN Criteria (standardization of the Uveitis Nomenclature) were used to assess improvement.
Three hundred and sixteen patients were included in the study, of whom 255 had negative (81%) and 56 positive (19%) QFN. One hundred and twenty-nine patients belonged to group 1, the percentage of positive QFN in this group was 14%, 49 in group 2 with 18% positive QFN and 115 in group 3 of which 23% had a positive QFN. An increase although not significant in the percentage of positive QFN was observed in group 3 (p= 0.16). Of the 56 patients with a positive QFN, 80% had an endemic origin and 30% had a tuberculosis contagion. The most commonly found OI was uveitis (n=46) 85%, and 50% of the 56 patients belonged to group 3 (n=27), the median QFN was significantly higher in this group 6.21 (0.35-10) vs 3.34 (0.44-10) in group 2 and 1.65 (0.37-10) in group 1. When we analyzed the group 3 (n=27), there were 15% false positive results, so only 23 were susceptible to have a TB-related hypersensitivity. Complete antituberculosis treatment was administered in 11 patients, 8 of whom improved, representing 73% presumed tuberculosis vs 33% improvement in the 12 patients who remained untreated. The positive predictive value of QFN is 35% if it is tested in the case of an intermediate or posterior uveitis.
QFN has its place in the etiological assessment of TB-related uveitis. However, it should be analyzed together with other diagnostic tests before any therapeutic decision.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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