Clinical characteristic and therapy results of presumed ocular tuberculosis and their relation to HIV status
DOI:
https://doi.org/10.13181/mji.v21i4.509Keywords:
HIV/AIDS, ocular tuberculosis, uveitisAbstract
Background: Ocular tuberculosis (TB) emerges as an important cause of intraocular inflammation, partly due to the increasing number of HIV/AIDS patients. This study attempts to identify ocular signs that are associated with ocular TB and assess the efficacy of the treatment and their relation to HIV status.
Methods: Medical records of all 56 patients diagnosed with presumed ocular TB in Cipto Mangunkusumo Hospital between January 2006 and December 2011 were reviewed. Demographic and clinical characteristics and HIV status were recorded as well as efficacy of treatments given.
Results: There were 39 patients included with mean age 35.38 ± 13.1 and male to female ratio was 2:1. Unilateral involvement was in 26 (66.7%) patients. From all, four (10.3%) had anterior uveitis, 14 (35.9%) posterior uveitis, 21 (53.8%) panuveitis, and none had intermediate uveitis. Most of them (32/82.1%) have concurrent other organ TB. Five out of 8 (62.5%) HIV positive patients had granulomatous inflammation and 3 (37.5%) had non-granulomatous inflammation and all eight of them had concurrent other organ TB. The other 7 known non-HIV patients, six (85.7%) have non-granulomatous inflammation. Treatment with anti-tubercular therapy (ATT), combination ATT and steroid or steroid alone increased visual acuity. However steroid alone was slightly have more frequent recurrences (1.4 ± 0.89 episodes of inflammation).
Conclusion: Ocular TB in our study had variable clinical manifestations and ocular inflammation was predominantly non-granulomatous in HIV negative patients and granulomatous in HIV infected patients. All HIV positive patients the ocular TB was always accompanied by manifestations in other organs. The treatment with steroids solely resulted in improved vision but was characterized by frequent recurrences. (Med J Indones. 2012;21:214-9)
Downloads
References
World Health Organization. Global tuberculosis control: WHO report 2011. France: World Health Organization; 2011.
Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005;72(9):1761-8.
Jones BE, Young SM, Antoniskis D, Davidson PT, Kramer F, Barnes PF. Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis. 1993;148(5):1292-7. https://doi.org/10.1164/ajrccm/148.5.1292
Nayak S, Basu S, Singh MK. Presumed tubercular retinal vasculitis with serpiginous-like choroiditis in the other eye. Ocul Immunol Inflamm. 2011;19(5):361-2. https://doi.org/10.3109/09273948.2011.590917
Gupta V, Gupta A, Arora S, Bambery P, Dogra MR, Agarwal A. Presumed tubercular serpiginouslike choroiditis: clinical presentations and management. Ophthalmology. 2003;110(9):1744-9. https://doi.org/10.1016/S0161-6420(03)00619-5
Rao NA, Albini TA, Kumaradas M, Pinn ML, Fraig MM, Karakousis PC. Experimental ocular tuberculosis in guinea pigs. Arch Ophthalmol. 2009;127(9):1162-6. https://doi.org/10.1001/archophthalmol.2009.220
Bansal R, Gupta A, Gupta V, Dogra MR, Bambery P, Arora SK. Role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis. Am J Ophthalmol. 2008;146(5):772-9. https://doi.org/10.1016/j.ajo.2008.06.011
Ang M, Hedayatfar A, Wong W, Chee SP. Duration of anti-tubercular therapy in uveitis associated with latent tuberculosis: a case-control study. Br J Ophthalmol. 2012;96(3):332-6. https://doi.org/10.1136/bjophthalmol-2011-300209
Gupta V, Bansal R, Gupta A. Continuous progression of tubercular serpiginous-like choroiditis after initiating antituberculosis treatment. Am J Ophthalmol. 2011;152(5):857-63.e2. https://doi.org/10.1016/j.ajo.2011.05.004
Gupta V, Gupta A, Rao NA. Intraocular tuberculosis--an update. Surv Ophthalmol. 2007;52(6):561-87. https://doi.org/10.1016/j.survophthal.2007.08.015
Zhang M, Zhang J, Liu Y. Clinical presentations and therapeutic effect of presumed choroidal tuberculosis. Retina. 2012;32(4):805-13. https://doi.org/10.1097/IAE.0b013e3182215b5e
Sudharshan S, Ganesh SK, Balu G, Mahalakshmi B, Therese LK, Madhavan HN, et al. Utility of QuantiFERON®-TB Gold test in diagnosis and management of suspected tubercular uveitis in India. Int Ophthalmol. 2012;32(3):217-23. https://doi.org/10.1007/s10792-012-9554-0
Davis EJ, Rathinam SR, Okada AA, Tow SL, Petrushkin H, Graham EM, et al. Clinical spectrum of tuberculous optic neuropathy. J Ophthalmic Inflamm Infect. 2012;2:183-9. https://doi.org/10.1007/s12348-012-0079-5
Wroblewski KJ, Hidayat AA, Neafie RC, Rao NA, Zapor M. Ocular tuberculosis: a clinicopathologic and molecular study. Ophthalmology. 2011;118(4):772-7. https://doi.org/10.1016/j.ophtha.2010.08.011
Ang M, Wong W, Ngan CC, Chee SP. Interferon-gamma release assay as a diagnostic test for tuberculosis-associated uveitis. Eye (Lond). 2012;26(5):658-65. https://doi.org/10.1038/eye.2012.1
Cordero-Coma M, Calleja S, Torres HE, del Barrio I, Franco M, Yilmaz T, et al. The value of an immune response to Mycobacterium tuberculosis in patients with chronic posterior uveitis revisited: utility of the new IGRAs. Eye (Lond). 2010;24(1):36-43. https://doi.org/10.1038/eye.2009.51
Goletti D, Sester M. Screening for latent infection with Mycobacterium tuberculosis: a plea for targeted testing in low endemic regions. Expert Rev Mol Diagn. 2012;12(3):231-4. https://doi.org/10.1586/erm.12.14
Mack U, Migliori GB, Sester M, Rieder HL, Ehlers S, Goletti D, et al. LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement. Eur Respir J. 2009;33(5):956-73. https://doi.org/10.1183/09031936.00120908
Gineys R, Bodaghi B, Carcelain G, Cassoux N, Boutin le TH, Amoura Z, et al. QuantiFERON-TB gold cut-off value: implications for the management of tuberculosis-related ocular inflammation. Am J Ophthalmol. 2011;152(3):433-40.e1. https://doi.org/10.1016/j.ajo.2011.02.006
Babu RB, Sudharshan S, Kumarasamy N, Therese L, Biswas J. Ocular tuberculosis in acquired immunodeficiency syndrome. Am J Ophthalmol. 2006;142(3):413-8. https://doi.org/10.1016/j.ajo.2006.03.062
Beare NA, Kublin JG, Lewis DK, Schijffelen MJ, Peters RP, Joaki G, et al. Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa. Br J Ophthalmol. 2002;86(10):1076-9. https://doi.org/10.1136/bjo.86.10.1076
Bouza E, Merino P, Munoz P, Sanchez-Carrillo C, Yanez J, Cortes C. Ocular tuberculosis. A prospective study in a general hospital. Medicine (Baltimore). 1997;76(1):53-61. https://doi.org/10.1097/00005792-199701000-00005
DiLoreto DA Jr, Rao NA. Solitary nonreactive choroidal tuberculoma in a patient with acquired immune deficiency syndrome. Am J Ophthalmol. 2001;131(1):138-40. https://doi.org/10.1016/S0002-9394(00)00622-X
Mehta S, Gilada IS. Ocular tuberculosis in acquired immune deficiency syndrome (AIDS). Ocul Immunol Inflamm. 2005;13(1):87-9. https://doi.org/10.1080/09273940490518702
Muccioli C, Belfort R Jr. Presumed ocular and central nervous system tuberculosis in a patient with the acquired immunodeficiency syndrome. Am J Ophthalmol. 1996;121(2):217-9. https://doi.org/10.1016/S0002-9394(14)70592-6
Shimakawa M. [Choroidal tuberculoma in a patient with acquired immunodeficiency syndrome]. Jpn J Ophthalmol. 2000;44(6):697. Japanese. https://doi.org/10.1016/S0021-5155(00)00267-7
Welton TH, Townsend JC, Bright DC, Anderson SF, Nguyen AT, Ilsen PF. Presumed ocular tuberculosis in an AIDS patient. J Am Optom Assoc. 1996;67(6):350-7.
Tuberculosis Coalition for Technical Assistance. International standards for tuberculosis care (ISTC). Standard 12. The Hague: Tuberculosis Coalition for Technical Assistance; 2006.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
