RESUMEN
PURPOSE: To assess the quality of life in patients diagnosed as having tuberculous uveitis and its association with sociodemographic, clinical, and psychosocial aspects. METHOD: By conducting standardized interviews, clinical and demographic data were collected using a measure developed in this study. This measure was applied in addition to other measures, namely SF-12, Hospital Anxiety and Depression Scale, and NEI-VFQ-39, which were used to assess health-related quality of life, anxiety and depression symptoms, and visual functioning. RESULTS: The study included 34 patients [mean age: 46.5 ± 15.1 years, female patients: 21 (61.8%)]. The mean of the VFQ-39 score was 74.5 ± 16.6 and that of SF-12 physical and mental component scores were 45.8 ± 10.1 and 51.6 ± 7.5, respectively, for the health-related quality of life. Anxiety symptoms were the most prevalent compared with depression symptoms and were found in 35.3% of the participants. CONCLUSION: Tuberculous uveitis affects several scales of quality of life, thereby affecting a population economically active with a social, psychological, and economic burden.
Asunto(s)
Ansiedad , Depresión , Calidad de Vida , Factores Socioeconómicos , Tuberculosis Ocular , Uveítis , Humanos , Femenino , Masculino , Persona de Mediana Edad , Uveítis/psicología , Uveítis/epidemiología , Adulto , Tuberculosis Ocular/psicología , Tuberculosis Ocular/epidemiología , Tuberculosis Ocular/diagnóstico , Ansiedad/epidemiología , Depresión/epidemiología , Depresión/psicología , Encuestas y Cuestionarios , Estudios Transversales , Brasil/epidemiología , Adulto Joven , AncianoRESUMEN
INTRODUCCIÓN: El tratamiento de la tuberculosis (TB) ocular es un tema que genera controversia en el mundo. Para el correcto manejo de estos pacientes, es necesario el desarrollo de guías que consideren la epidemiología de la TB ocular en cada nación. El objetivo de este consenso fue discutir de forma interdisciplinaria la epidemiología, fisiopatología, clínica, diagnóstico, estudio y tratamiento de los pacientes con TB ocular, para establecer un algoritmo de tratamiento y proponer qué pacientes deben ser tratados en Chile y con qué tratamiento. Además, se establecieron acuerdos para efectuar quimioprofilaxis de los pacientes con TB latente que tienen indicación de tratamiento inmunosupresor por enfermedades inflamatorias oculares.
The treatment of ocular tuberculosis (TB) remains controversial worldwide. The development of guidelines for ocular TB can facilitate the approach and management of these patients. These guidelines should be developed regionally, considering the local TB epidemiology. The objectives of this consensus are: to initiate an interdisciplinary discussion about the epidemiology, pathophysiology, clinical presentation, diagnosis, workup and treatment of patients with ocular TB, to establish a treatment algorithm and define which patients should be treated in Chile and how and, to analyze and discuss the published data regarding chemoprophylaxis for patients with latent TB who need to start immunosuppressive treatment due to inflammatory ocular conditions.
Asunto(s)
Humanos , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/terapia , Tuberculosis Ocular/epidemiología , Fenotipo , Uveítis/diagnóstico , Chile/epidemiología , Escleritis/diagnóstico , Tuberculosis Ocular/fisiopatología , Factores de Riesgo , Quimioprevención , Vasculitis Retiniana/diagnóstico , Consenso , Diagnóstico DiferencialRESUMEN
PURPOSE: To assess the performance of interferon-gamma release assay (IGRA) associated with tuberculosis skin test (TST) for ocular tuberculosis (OTB) diagnosis and therapeutic decision making. METHOD: One hundred and ninety-one patients with ocular inflammation were prospectively followed-up. Patients with clinical signs highly suspected of OTB, TST≥10 mm, and/or IGRA≥0.35 IU/mL received antitubercular therapy (ATT). Sensitivity (Se), specificity (Sp), and area under the curve (AUC) were assessed. RESULTS: Seventy-two (37.7%) patients received ATT for presumed OTB. Combining TST and IGRA had Se=89.6%, Sp=99.2%, and AUC (0.98) significantly higher compared to TST (0.85, Z=6.3, p<.001) or IGRA (0.95, Z=2.5, p=.01). Prior history of corticosteroids or immunosuppressant with concomitantly oral prednisone and baseline IGRA> 2.0 IU/mL was associated significantly with more recurrences in ATT patients (p=.01) . CONCLUSION: Considering TST and IGRA together was more effective in assessing OTB diagnosis. The real value of the IGRA test to predict recurrences needs further studies.
Asunto(s)
Tuberculosis Latente , Tuberculosis Ocular , Tuberculosis , Humanos , Ensayos de Liberación de Interferón gamma , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/complicaciones , Estudios de Seguimiento , Prueba de Tuberculina , Tuberculosis/complicaciones , Antituberculosos/uso terapéutico , Recurrencia , Tuberculosis Latente/diagnósticoRESUMEN
PURPOSE: To evaluate the clinical features and management of presumed ocular tuberculosis (OTB). METHOD: A prospective 3-year follow-up study of patients with ocular inflammation that performed Interferon-gamma release assay (IGRA) and tuberculin skin test (TST) was conducted in a tertiary referral center in Brazil. Patients with clinical signs highly suspect of OTB with a positive TST and/or IGRA with other causes ruled out were prescribed anti-tuberculosis therapy (ATT) during 9 months. Clinical features and treatment outcomes were recorded. RESULTS: Seventy-two patients (mean age 48.3 ± 15.7 years) were included in the study, and most were female (65.3%, n = 47). Posterior uveitis (43.1%, n = 31) was the main clinical feature. Multifocal choroiditis (25%, n = 18) was the most common choroidal involvement. Concomitant oral prednisone (45.8%, n = 33) during ATT was associated with more recurrences (p = 0.04). A significant difference (p < 0.001) between initial and final best-corrected visual acuity after ATT conclusion was observed. Cure or remission was observed in 58 (85.3%) patients that completed follow-up (n = 68). CONCLUSION: In our cohort some variation in demographics and ocular phenotypes of presumed OTB was observed. The high rates of cure or remission of our patients strongly support the ATT in presumed OTB. Oral corticosteroids during ATT were associated with higher recurrences rates.
Asunto(s)
Tuberculosis Ocular , Uveítis , Antituberculosos/uso terapéutico , Brasil/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Centros de Atención Terciaria , Tuberculosis Ocular/complicaciones , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológico , Uveítis/diagnóstico , Uveítis/tratamiento farmacológico , Uveítis/etiologíaRESUMEN
PURPOSE: To report unique retinal fundus lesions and treatment outcomes of intraocular tuberculosis in patients under anti-tumor necrosis factor treatment. METHODS: Retrospective review of two patients with laboratorial evidence of tuberculosis who had bilateral ocular signs and symptoms not attributable to other diseases. Multimodal imaging was analyzed at the time of presentation and after the treatment initiation. The study patients underwent standard treatment for tuberculosis. RESULTS: Clinical and laboratory findings were consistent with the diagnosis of presumed tuberculosis. Color fundus photograph revealed the presence of multifocal yellowish retinal spots in the study eyes. On fluorescein angiography, the retinal lesions seen on color fundus photograph showed early hypofluorescence with progressive staining of its edges. Occlusive vasculitis with peripheral nonperfusion was also observed in both cases. Spectral domain optical coherence tomography demonstrated increased reflectivity and thickness on the topography of retinitis lesions. After specific antibiotic treatment for tuberculosis, there was complete disappearance of the retinal lesions in all study eyes. CONCLUSION: We report two unique cases of bilateral presumed intraocular tuberculosis presenting as multifocal retinitis in patients under biologic agent treatment. Anti-tumor necrosis factor agents may be related to unusual fundus manifestations of tuberculosis.
Asunto(s)
Factores Biológicos/uso terapéutico , Infecciones Virales del Ojo/tratamiento farmacológico , Mycobacterium tuberculosis/aislamiento & purificación , Retina/patología , Retinitis/tratamiento farmacológico , Tuberculosis Ocular/tratamiento farmacológico , Agudeza Visual , Adulto , Diagnóstico Diferencial , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/microbiología , Angiografía con Fluoresceína/métodos , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal , Retina/microbiología , Retinitis/diagnóstico , Retinitis/microbiología , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/microbiologíaRESUMEN
Purpose: To describe the approach of Brazilian specialists in the diagnosis and treatment of tuberculosis-associated uveitis (TBU).Methods: Members of the Brazilian Uveitis Society received an electronic invitation to participate in an online questionnaire.Results: Of the 169 invited specialists, 78 answered the questionnaire. Specialists evaluated 5.6 patients with TBU annually. Tuberculin skin test (TST, 81%) was primarily used for diagnosis. Patients with presumed TBU should always be tested for syphilis and HIV according to 51 (88%) and 47 (81%) of respondents, respectively. Chest computed tomography (CT, 72%) was preferable to chest radiography (CXR) for diagnosis. A positive TST (81%) and CXR (60%) were the main indicators of anti-tuberculous therapy, with 34%, 39%, and 14% of specialists treating for 6, 9, and 12 months, respectively.Conclusions: TST remains the preferred method for TBU diagnosis and prompt treatment by Brazilian specialists, though there is no consensus regarding disease treatment and management.
Asunto(s)
Antituberculosos/uso terapéutico , Consenso , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Tuberculosis Ocular/diagnóstico , Uveítis/tratamiento farmacológico , Adulto , Brasil/epidemiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Encuestas y Cuestionarios , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/epidemiología , Uveítis/diagnóstico , Uveítis/epidemiologíaRESUMEN
Resumo Objetivo: Descrever aspectos clínicos e esquema terapêutico dos pacientes com tuberculose ocular presumida tratados em um centro de referência em tuberculose de São Paulo. Métodos: Estudo retrospectivo descritivo. O teste exato de Fisher foi realizado quando apropriado. Resultados: A queixa mais comum foi baixa acuidade visual (83,1%), seguida por dor ocular generalizada (25,3%) e visão turva (22,8%). A uveíte posterior foi a apresentação mais comum (35,7%). O tratamento consistiu no esquema atualmente recomendado de rifampicina, isoniazida, pirazinamida e etambutol (RHZE). A prednisona oral foi incluída no tratamento de 37 pacientes, para tratamento da inflamação aguda, embora não tenha diminuído a prevalência de complicações crônicas, em comparação com a recuperação completa (p = 0,1). O diagnóstico precoce (<70 dias) foi associado a maiores taxas de recuperação total (p = 0,005). Não houve significância estatística quando se comparou a terapia de 6 a 9 meses (p = 0,7). Conclusão: A uveíte tuberculosa pode ser tratada por uma terapia com duração de seis meses. Um breve curso de esteroides melhora os sintomas agudos, embora não reduza as complicações a longo prazo.
Abstract Purpose: To analyze and describe the therapy used in presumed ocular tuberculosis in a referral center in São Paulo, Brazil. Methods: Retrospective, descriptive study. Fisher's exact test was performed when appropriate. Results: The most common complaint was low visual acuity (83.1%), followed by generalized ocular pain (25.3%) and blurred vision (22.8%). Posterior uveitis was the most common presentation (35.7%). Treatment consisted of the currently recommended association of rifampin, isoniazid, pyrazinamide, ethambutol (RHZE) regimen. Oral prednisone was included in the treatment of 37 patients for acute inflammation, although it did not significantly decrease the prevalence of chronic complications compared to full recovery (p = 0,1). Early diagnosis (< 70 days) was associated with higher rates of full recovery (p = 0.005). No statistical significance was observed when comparing 6 to 9-month therapy (p = 0.7). Conclusion: Tuberculous uveitis can be treated with a 6-month duration RHZE therapy. A brief course of steroids may improve acute symptoms, although it did not reduce long-term disabilities.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológico , Uveítis/diagnóstico , Uveítis/tratamiento farmacológico , Prednisona/uso terapéutico , Prueba de Tuberculina , Agudeza Visual , Registros Médicos , Estudios Retrospectivos , Técnicas de Diagnóstico Oftalmológico , Mycobacterium tuberculosis/efectos de los fármacos , Antituberculosos/uso terapéuticoRESUMEN
ABSTRACT A 27-year-old man presented with a complaint of decreased visual acuity in the right eye. Best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Right eye fundoscopy revealed mild vitritis, multifocal yellowish lesions, and macular serous retinal detachment. Left eye evaluation was normal. Acute posterior multifocal placoid pigment epitheliopathy was diagnosed in the right eye. Complementary exams revealed a strong reaction to the Mycobacterium tuberculosis purified protein derivative test, thus treatment for tuberculosis was initiated. Baseline fluorescein angiography of the right eye revealed early hypofluorescence and late staining of the lesions. Optical coherence tomography of the right eye demonstrated the accumulation of subretinal and intraretinal fluid associated with cystoid macular edema. During follow-up, the retinal fluid and cysts disappeared, which was followed by disorganization of foveal interdigitation and ellipsoid zones. This is the second described case of unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strong positive result to the M. tuberculosis purified protein derivative test.
RESUMO Um homem de 27 anos apresentou uma queixa de diminuição da acuidade visual no olho direito. A acuidade visual melhor corrigida foi 20/60 no olho direito e 20/20 no olho esquerdo. A fundoscopia do olho direito revelou vitreíte leve, lesões amareladas multifocais e descolamento seroso da retina em região macular. A avaliação do olho esquerdo foi normal. Epiteliopatia pigmentar placóide multifocal posterior aguda foi diagnosticada no olho direito. Os exames complementares revelaram forte reação ao teste do derivado proteico purificado Mycobacterium tuberculosis, iniciando terapia antibiótica contra tuberculose. A angiografia fluoresceínica basal do olho direito revelou hipofluorescência precoce e tardia das lesões. A tomografia de coerência óptica do olho direito demonstrou fluído sub- e intrarretiniano associado a edema macular cistóide. Durante o seguimento, os fluídos e cistos retinianos desapareceram, seguido da desorganização das zonas de interdigitação e elipsóide em região foveal. Este é o segundo caso descrito de epiteliopatia pigmentar placóide multifocal posterior aguda unilateral em um paciente com um forte resultado positivo para o teste tuberculínico.
Asunto(s)
Humanos , Masculino , Adulto , Epitelio Pigmentado Ocular/diagnóstico por imagen , Enfermedades de la Retina/diagnóstico , Tuberculosis Ocular/diagnóstico , Enfermedades de la Retina/tratamiento farmacológico , Prednisona/uso terapéutico , Angiografía con Fluoresceína , Agudeza Visual , Tuberculosis Ocular/tratamiento farmacológico , Enfermedad Aguda , Tomografía de Coherencia Óptica , Antiinflamatorios/uso terapéutico , Antibióticos Antituberculosos/uso terapéuticoRESUMEN
A 27-year-old man presented with a complaint of decreased visual acuity in the right eye. Best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Right eye fundoscopy revealed mild vitritis, multifocal yellowish lesions, and macular serous retinal detachment. Left eye evaluation was normal. Acute posterior multifocal placoid pigment epitheliopathy was diagnosed in the right eye. Complementary exams revealed a strong reaction to the Mycobacterium tuberculosis purified protein derivative test, thus treatment for tuberculosis was initiated. Baseline fluorescein angiography of the right eye revealed early hypofluorescence and late staining of the lesions. Optical coherence tomography of the right eye demonstrated the accumulation of subretinal and intraretinal fluid associated with cystoid macular edema. During follow-up, the retinal fluid and cysts disappeared, which was followed by disorganization of foveal interdigitation and ellipsoid zones. This is the second described case of unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strong positive result to the M. tuberculosis purified protein derivative test.
Asunto(s)
Epitelio Pigmentado Ocular/diagnóstico por imagen , Enfermedades de la Retina/diagnóstico , Tuberculosis Ocular/diagnóstico , Enfermedad Aguda , Adulto , Antiinflamatorios/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Angiografía con Fluoresceína , Humanos , Masculino , Prednisona/uso terapéutico , Enfermedades de la Retina/tratamiento farmacológico , Tomografía de Coherencia Óptica , Tuberculosis Ocular/tratamiento farmacológico , Agudeza VisualRESUMEN
Resumo A detecção precisa da infecção latente por tuberculose está se tornando cada vez mais importante devido ao aumento do uso de medicamentos imunossupressores e da epidemia do vírus da imunodeficiência humana, o que aumentou o risco de reativação à tuberculose ativa (TB). O Teste IGRA QuantiFERON® TB Gold apresenta vantagens frente ao teste de PPD como por exemplo, requer somente uma coleta de amostra sanguínea ; não há necessidade que o paciente retorne ao laboratório para leitura e interpretação dos resultados; Os resultados são objetivos, não requerem interpretação do leitor ou interferência de critérios subjetivos; trata-se de um teste in vitro, portanto não há "efeito booster" (potenciação da reação tuberculínica); o teste não é afetado por vacinação prévia por BCG ou infecção por outras espécies de micobactérias. Limitações são descritas, apesar de raras, como reações cruzadas deste método com infecções por algumas espécies de micobactérias não-tuberculosis (incluindo Mycobacterium kansasii, Mycobacterium szulgai e Mycobacterium marinum). Ainda há poucos dados sobre o teste IGRA em certas populações, como por exemplo, em crianças, pacientes imunocomprometidos e mulheres grávidas. Nestes grupos, a interpretação do teste pode ser difícil e mais estudos se fazem necessários.
Abstract Precise detection of latent tuberculosis infection is becoming increasingly important due to increased use of immunosuppressive drugs and the human immunodeficiency virus epidemic , which increased the risk of reactivation to active tuberculosis (TB).The QuantiFERON® TB Gold IGRA Test has advantages over the skin test for TB, otherwise known as a Mantoux tuberculin test, for example, requires only a blood sample collection; there is no need for the patient to return to the laboratory for reading and interpretation of the results; The results are objective, do not require interpretation of the reader or interference of subjective criteria; it is an in vitro test, so there is no "booster effect" (potentiation of the tuberculin reaction); the test is not affected by prior BCG vaccination or infection with other species of mycobacteria. Limitations are described, although rare, as cross-reactions of this method with infections by some species of non-tuberculosis mycobacteria (including Mycobacterium kansasii, Mycobacterium szulgai and Mycobacterium marinum). There is still little data on the IGRA test in certain populations, such as in children, immunocompromised patients and pregnant women. In these groups, the interpretation of the test can be difficult and more studies are needed.
Asunto(s)
Humanos , Uveítis/diagnóstico , Prueba de Tuberculina , Tuberculosis Ocular/diagnóstico , Ensayos de Liberación de Interferón gamma/métodos , Tuberculina/análisis , Estudio Comparativo , Interferón gamma/análisis , Mycobacterium tuberculosis/aislamiento & purificaciónRESUMEN
ABSTRACT Tuberculosis (TB) is an infectious disease of great magnitude in the world. Of patients with extrapulmonary disease, ocular manifestations are rare but among reported cases the most common ocular manifestation is uveitis. The diagnosis of ocular TB should be made as early as possible so that treatment is initiated and the risks of ocular complications are minimized. The objective of this study is to report an ocular TB case that presented as anterior uveitis. A 52-year-old female patient, a nursing technician at a large hospital, presented a history of low visual acuity associated with myiodesopsia for 4 days. Her ophthalmologic history included an iridotomy due to narrow angle in both eyes. On examination, the best corrected visual acuity was 20/100, right eye, and 20/80, left eye. Among the most significant ocular alterations were granulomatous keratic precipitates, anterior chamber reaction, flare and light vitreitis, corresponding to anterior uveitis. Based on clinical history and ophthalmologic examination, tests were ordered that corroborated the diagnosis of ocular TB. Thereafter, antituberculous therapy was instituted with a good response in 15 days, including improvement in visual acuity. The patient was followed-up by ophthalmology and infectology. Intraocular TB should be considered in the differential diagnosis of any type of intraocular inflammation. The diagnosis of presumed ocular TB is a clinical challenge with the diagnosis modalities currently available. The faster the onset of treatment, the better the visual prognosis of the affected patient.
RESUMO A tuberculose (TB) é uma doença infecciosa de grande magnitude no mundo. Dos pacientes com doença extrapulmonar, as manifestações oculares são raras, mas entre os casos relatados, a manifestação ocular mais comum é a uveíte. O diagnóstico de TB ocular deve ser feito o mais precoce possível para que o tratamento seja iniciado e os riscos de complicações oculares sejam minimizados. O objetivo deste estudo é relatar um caso de TB ocular que se apresentou como uveíte anterior. Uma paciente do sexo feminino, 52 anos, técnica de enfermagem de um hospital de grande porte, apresentou história de baixa acuidade visual associada à miodesopsia por 4 dias. Sua história oftalmológica incluía uma iridotomia devido ao ângulo estreito em ambos os olhos. No exame, a melhor acuidade visual corrigida foi 20/100, olho direito, e 20/80, olho esquerdo. Dentre as alterações oculares mais significativas, destacam-se precipitados ceráticos granulomatosos, reação de câmara anterior, flare e vitreíte leve, correspondendo à uveíte anterior. Com base na história clínica e no exame oftalmológico, foram solicitados exames que corroboram o diagnóstico de TB ocular. Posteriormente, a terapia antituberculosa foi instituída com uma boa resposta em 15 dias, incluindo melhora na acuidade visual. A paciente foi acompanhada pelas especialidades: oftalmologia e infectologia. A TB intraocular deve ser considerada no diagnóstico diferencial de qualquer tipo de inflamação intraocular. O diagnóstico presumível de tuberculose ocular é um desafio clínico com as modalidades de diagnóstico atualmente disponíveis. Quanto mais rápido o início do tratamento, melhor o prognóstico visual do paciente afetado.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Tuberculosis Ocular/complicaciones , Uveítis Anterior/etiología , Rifampin/uso terapéutico , Agudeza Visual , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológico , Uveítis Anterior/diagnóstico , Uveítis Anterior/tratamiento farmacológico , Etambutol/uso terapéutico , Isoniazida/uso terapéuticoRESUMEN
PURPOSE: To characterize the clinical features in patients with presumed ocular tuberculosis (TB) and determine prognostic factors of visual outcomes and complications in this disease. MATERIAL AND METHODS: Retrospective case series of 35 patients (29 females, 6 males) with presumed ocular TB from referral centers in Chile and Spain between 2002 and 2012. Medical records were reviewed, and data regarding clinical features, complications, best-corrected visual acuity (BCVA), duration of disease, extraocular manifestations, and therapy were retrieved. Prognostic factors for low vision (BCVA 20/50 or less), legal blindness (BCVA 20/200 or less), and complications (cataract, glaucoma, and macular lesion) were evaluated. To calculate correlations, we used Spearman's rank correlation test. To determine clinical predictors, we used the binary logistic regression test. RESULTS: Anterior and non-granulomatous uveitis was the most common types of inflammation. Only 2 (5.7%) patients had respiratory symptoms, and 6 (17.1%) patients had an abnormal chest X-ray at diagnosis. All patients received combined antitubercular therapy with a mean duration of 6.9 ± 2.3 months. A longer duration of symptoms at diagnosis was associated with both low vision and legal blindness. Older patients had a higher risk of legal blindness. A longer duration of symptoms as well as anterior inflammation demonstrated an increased risk for cataract formation. The duration of the symptoms and baseline BCVA had a positive correlation with the final BCVA. Prognostic factors of macular lesions were not found. CONCLUSIONS: The diagnosis of ocular TB can be difficult due to the lack of extraocular manifestations and the broad spectrum of ocular features. A longer duration of symptoms at diagnosis was associated with poorer visual outcomes and cataracts. Therefore, efforts should be made to avoid a delay in the diagnosis of ocular TB and to identify prognostic factors for visual outcomes and complications.
Asunto(s)
Antituberculosos/uso terapéutico , Catarata/etiología , Tuberculosis Ocular/diagnóstico , Agudeza Visual , Catarata/diagnóstico , Diagnóstico Tardío , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tuberculosis Ocular/complicaciones , Tuberculosis Ocular/tratamiento farmacológicoRESUMEN
PURPOSE: To determine the performance of T-SPOT.TB, an interferon gamma release assay test, in patients with ocular tuberculosis (TB) in a BCG-vaccinated, non-endemic population. METHODS: We employed a nested case-control design. In total, 45 subjects were enrolled (23 patients with ocular tuberculosis and 22 patients with other causes of uveitis). A blood sample was collected from each subject, and T-SPOT.TB was executed. Laboratory professionals were blinded to the disease status of each subject. RESULTS: Five patients were excluded because of indeterminate results. The calculated sensitivity and specificity were 0.80 and 0.85, respectively. The positive likelihood ratio was 5.33 and the negative likelihood ratio was 0.23. The overall accuracy of the test was 0.83. CONCLUSIONS: T-SPOT.TB adequately diagnosed ocular TB. This technique is particularly useful in populations where BCG vaccinations are still mandatory.
Asunto(s)
Vacuna BCG/administración & dosificación , Ensayos de Liberación de Interferón gamma/normas , Interferón gamma/sangre , Tuberculosis Ocular/diagnóstico , Vacunación , Antígenos Bacterianos/inmunología , Estudios de Casos y Controles , Reacciones Falso Positivas , Femenino , Humanos , Funciones de Verosimilitud , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/inmunología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Linfocitos T/inmunología , Tuberculosis Ocular/prevención & controlRESUMEN
Ocular tuberculosis (TB) is considered to be rare, although its incidence has varied widely over time and in different populations. Latent TB is diagnosed when a person is infected with Mycobacterium tuberculosis but does not have active TB. During the last decade, interferon-gamma release assay tests have been developed that allow identification of patients with latent TB infection with better specificity than the tuberculin skin test and can differentiate between infection and prior vaccination. Although rare, tuberculous scleritis should be considered in the differential diagnosis of posterior scleritis. Here we describe a patient with posterior scleritis and severe visual loss associated with latent TB without uveitis, anterior scleritis, keratitis, or any other previous ocular disease history. The patient responded well to a combined treatment of antitubercular therapy and oral corticosteroids.
Asunto(s)
Escleritis/diagnóstico , Tuberculosis Ocular/diagnóstico , Corticoesteroides/uso terapéutico , Adulto , Antituberculosos/uso terapéutico , Femenino , Humanos , Ensayos de Liberación de Interferón gamma/métodos , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/tratamiento farmacológico , Escleritis/tratamiento farmacológico , Escleritis/etiología , Resultado del Tratamiento , Tuberculosis Ocular/complicaciones , Tuberculosis Ocular/tratamiento farmacológicoRESUMEN
ABSTRACT Ocular tuberculosis (TB) is considered to be rare, although its incidence has varied widely over time and in different populations. Latent TB is diagnosed when a person is infected with Mycobacterium tuberculosis but does not have active TB. During the last decade, interferon-gamma release assay tests have been developed that allow identification of patients with latent TB infection with better specificity than the tuberculin skin test and can differentiate between infection and prior vaccination. Although rare, tuberculous scleritis should be considered in the differential diagnosis of posterior scleritis. Here we describe a patient with posterior scleritis and severe visual loss associated with latent TB without uveitis, anterior scleritis, keratitis, or any other previous ocular disease history. The patient responded well to a combined treatment of antitubercular therapy and oral corticosteroids.
RESUMO A tuberculose (TB) ocular foi considerada rara, embora a sua incidência tenha variado significativamente ao longo do tempo e nas diferentes populações. A TB latente é diagnosticada quando alguém é infetado com Mycobacterium tuberculosis sem possuir doença ativa. Durante a última década, testes tendo por base interferon gamma release assay foram desenvolvidos, permitindo a identificação de pacientes com infeção por tuberculose latente com maior especificidade que o teste tuberculínico e diferenciar infeção e vacinação prévia. Embora rara, a esclerite tuberculosa deve ser tida em consideração no diagnóstico diferencial de esclerite posterior. Reportamos um paciente com esclerite posterior e baixa grave de acuidade visual associada a TB latente, sem uveíte, esclerite anterior, ceratite ou história de doença ocular prévia. O paciente respondeu favoravelmente a um tratamento combinado de fármacos antituberculose e corticoides orais.
Asunto(s)
Humanos , Femenino , Adulto , Escleritis/diagnóstico , Tuberculosis Ocular/diagnóstico , Escleritis/etiología , Escleritis/tratamiento farmacológico , Tuberculosis Ocular/complicaciones , Tuberculosis Ocular/tratamiento farmacológico , Resultado del Tratamiento , Corticoesteroides/uso terapéutico , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/tratamiento farmacológico , Ensayos de Liberación de Interferón gamma/métodos , Antituberculosos/uso terapéuticoAsunto(s)
Enfermedades de la Coroides/diagnóstico , Tuberculosis del Sistema Nervioso Central/diagnóstico , Tuberculosis Miliar/diagnóstico , Tuberculosis Ocular/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Antituberculosos/uso terapéutico , Niño , Enfermedades de la Coroides/tratamiento farmacológico , Enfermedades de la Coroides/microbiología , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológico , Tuberculosis del Sistema Nervioso Central/microbiología , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/microbiología , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiologíaRESUMEN
Tuberculose é uma doença infecciosa causada pelo Mycobacterium tuberculosis, também conhecido como bacilo de Koch. O principal sítio de acometimento é o pulmonar, porém o bacilo pode disseminar-se por via linfo-hematogênica para outros órgãos, dentre eles o olho. A incidência de tuberculose ocular é de 1 a 2% dos casos extrapulmonares. Os autores apresentam um caso clínico de um paciente do sexo feminino de 28 anos que procura atendimento médico devido à redução da acuidade visual em olho esquerdo há 7 dias. Apresentava a melhor acuidade visual corrigida no olho acometido de 20/200 e no olho contralateral de 20/20. Na fundoscopia era evidenciado um granuloma em área macular do olho esquerdo, com edema e hemorragia intrarretiniana adjacente. Após investigação diagnóstica, a paciente foi tratada com esquema antibiótico para tuberculose durante 6 meses, obtendo regressão do granuloma e melhora da acuidade visual deste olho para 20/50.
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis.The main site of involvement is the lung, but the bacillus may spread by hematogenous/lymph systems to other organs, including the eye.The incidence of ocular TB is 1-2% of extra-pulmonary cases. The authors present a case of a 28 years old female patient seeking medical care due to reduction of visual acuity in the left eye for 8 days. She had the best corrected visual acuity in the affected eye of 20/200, and the opposite eye was 20/20. At fundoscopy was shown a granuloma in the macular area of the left eye, with retinal edema and hemorrhage. After diagnostic investigation the patient was treated with antibiotic therapy for tuberculosis during 6 months, obtaining lesion regression and visual acuity improvement to 20/50.
Asunto(s)
Humanos , Femenino , Adulto , Antiinflamatorios/uso terapéutico , Dexametasona/uso terapéutico , Granuloma , Mácula Lútea/patología , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológico , Agudeza VisualRESUMEN
A 59-year-old Hispanic woman presented with a 3-year history of floaters associated with bilateral reduced visual acuity. Her best-corrected visual acuity (BCVA) was 20/40. Both anterior segments were without inflammation, but fundoscopy showed mild vitreous inflammation and multiple inflammatory choroidal lesions. Tests for inflammatory and infectious diseases were negative except for human leucocyte antigen A29. The patient was diagnosed with birdshot choroidoretinopathy, and treatment was initiated with cyclosporine A 2.5â mg/kg/day. One year after treatment, the patient reported systemic symptoms with no improvement in visual acuity. Fundus findings remained with vitreal inflammation. QuantiFERON-TB Gold In-Tube Test was positive, and a diagnosis of presumed latent ocular tuberculosis (TB) was made. We initiated anti-TB treatment for 9â months. At 6â months of anti-TB therapy, there was no active inflammation. The patient was followed for 2â years with no medications and no active inflammation. Her final BCVA was 20/25.
Asunto(s)
Fondo de Ojo , Antígenos HLA-A/metabolismo , Tuberculosis Latente/diagnóstico , Tuberculosis Ocular/diagnóstico , Uveítis/diagnóstico , Cuerpo Vítreo/patología , Femenino , Oro , Humanos , Inflamación/diagnóstico , Inflamación/tratamiento farmacológico , Inflamación/etiología , Tuberculosis Latente/tratamiento farmacológico , Tuberculosis Latente/metabolismo , Persona de Mediana Edad , Prueba de Tuberculina , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/metabolismo , Uveítis/tratamiento farmacológico , Uveítis/etiología , Agudeza VisualRESUMEN
Fundamento: el síndrome de inmuno deficiencia adquirida constituye una enfermedad de distribución mundial, aproximadamente un tercio de la población con esta patología presentan una coinfección con tuberculosis. Objetivos: argumentar el tema de la tuberculosis ocular en los pacientes con síndrome de inmunodeficiencia adquirida para contribuir en el conocimiento en esta forma de presentación atípica la enfermedad. Conclusiones: el diagnóstico de la tuberculosis ocular en coinfección con síndrome de inmunodeficiencia adquirida constituye un reto para los oftalmólogos, incluyendo las particularidades en los medios diagnósticos y la respuesta terapéutica en este grupo poblacional(AU)
Background: The AIDS syndrome constitutes a worldwide disease; approximately one third of the population with this pathology shows a tuberculosis co-infection. Objectives: To argue the item of the ocular tuberculosis in AIDS patients to contribute to the knowledge of this way of atypical presentation of the disease. Conclusions: The diagnosis of ocular TB in co-infection with AIDS constitutes a challenge for the ophthalmologists including the peculiarities in the diagnostic kits and the therapeutical response in this population(AU)
Asunto(s)
Humanos , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Tuberculosis Ocular/diagnóstico , AntirretroviralesRESUMEN
Fundamento: el síndrome de inmuno deficiencia adquirida constituye una enfermedad de distribución mundial, aproximadamente un tercio de la población con esta patología presentan una coinfección con tuberculosis. Objetivos: argumentar el tema de la tuberculosis ocular en los pacientes con síndrome de inmunodeficiencia adquirida para contribuir en el conocimiento en esta forma de presentación atípica la enfermedad. Conclusiones: el diagnóstico de la tuberculosis ocular en coinfección con síndrome de inmunodeficiencia adquirida constituye un reto para los oftalmólogos, incluyendo las particularidades en los medios diagnósticos y la respuesta terapéutica en este grupo poblacional(AU)