Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment

AimsFew studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate the value of the QuantiFERON test in a large cohort of patients with uveitis for both the diagnosis of tubercular uveitis and antituberculosis treatment (ATT) response prediction.MethodsA single-centre retrospective study including consecutive adult patients with uveitis who were prescribed a QuantiFERON test between January 2003 and December 2019 was performed. Adjusted ORs (aORs) were calculated between patients with uveitis responding and not responding to ATT according to the Collaborative Ocular Tuberculosis Study (COTS) group diagnostic criteria. Sensitivity (SE), specificity (Sp), and positive and negative predictive values of the QuantiFERON test were calculated.ResultsA total of 1075 patients were included in the study; 178 (16.5%) were found positive using the QuantiFERON test. Among the 178 positive patients, 62 (35%) had a diagnosis of tubercular uveitis according to the updated COTS classification; all received ATT for 6 months; and 44/62 (71%) responded to ATT. A QuantiFERON test value of >2 IU/mL was associated with a greater chance of responding to ATT (aOR=36.7, 95% CI 7.2 to 185.9, p<0.001). The optimal threshold to maximise both Sp and SE for diagnosis of TB uveitis was 4 IU/mL.ConclusionOne-sixth of the patients diagnosed with uveitis had a positive QuantiFERON test. The QuantiFERON threshold with the optimal SE and Sp for the diagnosis of tubercular uveitis was 4 IU/mL.Trial registration numberNCT03863782.

Choroidal Tubercles, an Ocular Presentation in Tuberculosis- a Retrospective Observational Hospital-based Study

Aim: To find the prevalence of choroidal tubercles in tuberculosis patients. Introduction: Tuberculosis is the most common cause of infectious cause of death especially in endemic countries. Tuberculosis infection spreads hematogenously from primary infection site to rest of the body. Ocular presentation manifests in the form of choroidal tubercles being the most common fundus change. Materials and Methods: It was a retrospective, observational hospital-based study. Total 100 tuberculosis patients were studied and their data were collected from Hospital record system from February 2020 to March 2021. Fundus examinations were reviewed and most common ocular presentation was found to be choroidal tubercles. Observations and Results: During the study period, out of 100 patients, 60% were females and 40% were males. Fundus changes were present in 14% patients and these were choroidal tubercles in 12% patients and papillitis in 2%. Choroidal tubercles were present in 7 females and 5 males. Conclusion: We concluded that choroidal tubercles is one of the most common form of ocular tuberculosis. Detection of choroidal inflammation can prevent visual loss as the ocular lesion resolves fully with timely management.

Clinical features and management of presumed ocular tuberculosis: A long-term follow-up cohort study in a tertiary referral center in Brazil

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.

Multifocal choroiditis and choroidal tuberculoma: Signs of presumed ocular tuberculosis

The diagnosis of OTB (Ocular tuberculosis) is usually difficult to make. Definitive diagnosis requires the identification of M. tuberculosis organisms in ocular tissues or fluids, but samples are often difficult to obtain, and biopsy may be hard to justify. We describe a 50-years-old Maghreb male, who presented a multifocal choroiditis associated with a choroidal tuberculoma on the left eye. Based on positive QuantiFERON-TB-Gold test and suggestive clinical and radiographic findings, a diagnosis of presumed ocular tuberculosis was made. Serial swept-source optical coherence tomography (SS-OCT) and widefield fundus retinographies during subsequent follow-up visits demonstrated the characterization of the atypical tuberculosis presentation and allowed the assessment of response to antitubercular therapy and oral steroids.

Need for a holistic approach to treat TB contacts and extrapulmonary (ocular) tuberculosis

We aim to highlight the ignorance and incidences of deliberate hiding of medical facts in society. The cause of it can be, the associated taboo with these diseases. The fear of social outcasts is the major barrier preventing diseased from accepting the diagnosis as well as treatment. Though the medical facility has improved significantly and has come up with a complete cure for these diseases, still these facilities are not able to trickle down to the lower socioeconomic group. The reason for facilities not reaching the lower socioeconomic strata is the self-made shield created by these people. The current case report tries to highlight the need to screen the family members and the contacts of patients with tuberculosis. The screening should be done holistically and thoroughly to rule out extrapulmonary pulmonary disease also.