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1.
Indian J Ophthalmol ; 67(8): 1362-1365, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31332144

RESUMO

A 47-year-old female presented with optic disc oedema, peripapillary subretinal fluid and scattered areas of choroiditis. Her ultrasound B-scan showed sclerochoroidal thickening with widening of sub-Tenon space. Subsequent investigations revealed a positive Mantoux test and high-resolution computed tomography of the chest was suggestive of pulmonary involvement. She responded well to antitubercular treatment and systemic corticosteroid. A review of the literature was conducted to identify additional reports on similar cases and discussed. A high index of suspicion and appropriate laboratory work-up can aid in the diagnosis of tuberculous posterior scleritis.


Assuntos
Infecções Oculares Bacterianas/diagnóstico , Esclerite/diagnóstico , Tuberculose Ocular/diagnóstico , Antituberculosos/uso terapêutico , Corioidite/diagnóstico , Corioidite/tratamento farmacológico , Corioidite/microbiologia , Corantes/administração & dosagem , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Verde de Indocianina/administração & dosagem , Pessoa de Meia-Idade , Papiledema/diagnóstico , Papiledema/tratamento farmacológico , Papiledema/microbiologia , Esclerite/tratamento farmacológico , Esclerite/microbiologia , Líquido Sub-Retiniano , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Acuidade Visual
2.
Indian J Ophthalmol ; 67(7): 1207-1209, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238468

RESUMO

The tuberculids are a group of distinct clinicopathological form of skin lesions representing hypersensitivity reaction to hematogenous dissemination of Mycobacterium tuberculosis or its antigen from an underlying active or a silent focus of tuberculosis elsewhere in the body in an individual with a strong antituberculous cell-mediated immunity and by definition do not show bacilli on special stains and are culture-negative. Ocular involvement can occur in tuberculosis, both due to direct invasion by the bacilli as well as an immune-mediated reaction; however, immune-mediated tuberculous uveitis occurring as a hypersensitivity response in association with PNT has hardly been reported in the literature. Here we report one such rare case.


Assuntos
Antígenos de Bactérias/imunologia , Infecções Oculares Bacterianas/imunologia , Mycobacterium tuberculosis/imunologia , Pele/patologia , Tuberculose Cutânea/complicações , Tuberculose Ocular/imunologia , Uveíte/imunologia , Adulto , Biópsia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/etiologia , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Necrose , Pele/microbiologia , Tuberculose Cutânea/diagnóstico , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/etiologia , Uveíte/diagnóstico , Uveíte/etiologia
3.
Indian J Ophthalmol ; 67(7): 1210-1212, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238469

RESUMO

Tuberculous optic neuropathy that includes papillitis, neuroretinitis, and optic nerve tubercle is a rare presentation of ocular tuberculosis. Though contagious spread from choroid following the hematogenous dissemination of the bacilli has been implicated in the optic nerve involvement, unlike neuroretinitis, optic nerve and choroidal involvement are usually considered as two separate clinical entities. We report a case of optic nerve involvement in a 33-year-old male who had concurrent choroidal involvement at present and also in the past. A strong history of contact with patients of pulmonary tuberculosis, positive tuberculin skin test, interferon gamma release assay, and high-resolution computed tomography helped us to clinch the diagnosis. Patients responded to systemic corticosteroid therapy and anti-tuberculosis treatment. Choroidal involvement in a case of inflammatory optic neuropathy should arise suspicion of tuberculous etiology.


Assuntos
Corioidite/complicações , Infecções Oculares Bacterianas/complicações , Disco Óptico/patologia , Doenças do Nervo Óptico/etiologia , Tuberculose Ocular/complicações , Adulto , Corioidite/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Doenças do Nervo Óptico/diagnóstico , Tuberculose Ocular/diagnóstico , Acuidade Visual
4.
J Fr Ophtalmol ; 42(8): 839-843, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31182251

RESUMO

INTRODUCTION: The diagnosis of neuroretinitis is clinical, with optic nerve involvement and a macular star. The most common etiology is cat scratch disease. MATERIALS AND METHODS: Study of 7 patients (7 eyes) with neuroretinitis. A complete ophthalmic examination, fluorescein angiography and optical coherence tomography were performed for all patients. A focused etiological work-up was conducted. RESULTS: The mean age of the patients was 41.6 years [27-51 years]. Decreased visual acuity was the most common reason for consultation. The neuroretinitis was unilateral in all cases. Subclinical serous retinal detachment was noted in 5 patients. The common etiologies were rickettsiosis (4 cases) and tuberculosis (1 case). Leber's idiopathic stellate neuroretinitis was concluded by the negativity of the etiological investigation. Doxycycline was the treatment of choice for rickettsiosis. CONCLUSION: Rickettsiosis appears to be more common than cat scratch disease as an etiology of neuroretinitis in the present study in southern Tunisia. Moreover, the clinical association of a serous retinal detachment, rarely reported in the literature, seems to be more frequent in our series.


Assuntos
Retinite/diagnóstico , Retinite/etiologia , Doença Aguda , Adulto , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Diagnóstico Diferencial , Exsudatos e Transudatos/diagnóstico por imagem , Infecções Oculares Bacterianas/complicações , Infecções Oculares Bacterianas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papiledema/diagnóstico , Papiledema/etiologia , Descolamento Retiniano/complicações , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Infecções por Rickettsia/complicações , Infecções por Rickettsia/diagnóstico , Tuberculose Ocular/complicações , Tuberculose Ocular/diagnóstico , Tunísia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia
7.
BMJ Case Rep ; 12(1)2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642860

RESUMO

Tubercular uveitis is a common manifestation of tuberculosis (TB) in TB-endemic countries. Due to lack of gold standard diagnostic tests for confirming intraocular TB, it is often either underdiagnosed or rarely over diagnosed. We report a case of a 28-year-old woman with diminution of vision in the left eye. She was started on antitubercular treatment (ATT) and steroids but she did not comply with the treatment. She developed progressive painful loss of vision consequently and was treated with vitrectomy and silicone oil tamponade. After a complete course of ATT, she recovered, salvaging of eye and restoration of some vision was possible. Mycobacterium tuberculosis is rarely demonstrated in the ocular fluid samples of the suspected cases of TB due to the paucibacillary nature of the disease. A vitreous sample can be obtained from these patients. Surgical intervention in the form of vitrectomy and silicone oil tamponade can help in avoiding enucleation/evisceration.


Assuntos
Oftalmopatias/microbiologia , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/microbiologia , Uveíte/microbiologia , Baixa Visão/etiologia , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Oftalmopatias/patologia , Feminino , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Cooperação do Paciente , Óleos de Silicone/administração & dosagem , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/patologia , Uveíte/diagnóstico , Uveíte/epidemiologia , Baixa Visão/diagnóstico , Vitrectomia/métodos
8.
Int Ophthalmol ; 39(2): 485-490, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29380185

RESUMO

INTRODUCTION: Tuberculosis-associated uveitis remains a diagnostic and therapeutic challenge. After diagnosis of tuberculosis and initiation of anti-tuberculosis therapy for tuberculosis uveitis, the clinical responses are favorable. However, at 4-6 weeks of the therapy, there commonly occurs paradoxical deterioration due to an increase in inflammation which is often accompanied by cystoid macular edema. Thus, adjuvant administration of anti-inflammatory regimen should be considered. For this purpose, systemic and periocular steroids, systemic and intravitreal immunosuppressive agents have been tested. Nevertheless, there is no report in the literature about intravitreal dexamethasone slow-release implants for the treatment of this inflammatory condition. METHODS: Case presentation. RESULTS: We presented a tuberculosis uveitis case whose ocular inflammation is partially modified by systemic and periocular steroid injections and then well controlled by the intravitreal dexamethasone implant. CONCLUSION: Intravitreal dexamethasone implant injection seems to be a safe and potent option for the treatment of macular edema secondary to tuberculosis uveitis.


Assuntos
Antituberculosos/uso terapêutico , Dexametasona/administração & dosagem , Infecções Oculares Bacterianas/tratamento farmacológico , Tuberculose Ocular/tratamento farmacológico , Uveíte/tratamento farmacológico , Adulto , Implantes de Medicamento , Quimioterapia Combinada , Infecções Oculares Bacterianas/diagnóstico , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Tomografia de Coerência Óptica , Tuberculose Ocular/diagnóstico , Uveíte/diagnóstico , Acuidade Visual
9.
Ocul Immunol Inflamm ; 27(4): 643-650, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29470929

RESUMO

Purpose: To assess the efficacy and tolerability of interferon (IFN) alpha-2a in post-infectious uveitis secondary to presumed intraocular tuberculosis (IOTB). Methods: Patients with chronic uveitis secondary to presumed IOTB who, after completing an antitubercular treatment, showed poor response to treatments or recurred after tapering oral corticosteroids to ≤7.5 mg/day were enrolled. All patients were treated with IFN alpha-2a subcutaneous injections. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and inflammatory signs were compared between baseline and follow-up visits up to six months. Results: Twelve eyes (six patients) were enrolled. Mean BCVA improved from 0.64 ± 0.55 logMAR at baseline to 0.32 ± 0.31 logMAR at 6 months (p = 0.03). Mean CRT decreased from 372 ± 132.2 µm to 274.66 ± 34.9 µm at six months (p = 0.01). Inflammatory signs (vitritis, vasculitis) also decreased overtime. No major complications or tuberculosis reactivations were recorded. Conclusions: IFN alpha-2a was efficacious and safe in treating chronic post-infectious uveitis secondary to presumed IOTB.


Assuntos
Infecções Oculares Bacterianas/complicações , Interferon alfa-2/administração & dosagem , Tuberculose Ocular/complicações , Uveíte/tratamento farmacológico , Acuidade Visual , Idoso , Doença Crônica , Relação Dose-Resposta a Droga , Infecções Oculares Bacterianas/diagnóstico , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Tuberculose Ocular/diagnóstico , Uveíte/diagnóstico , Uveíte/etiologia
10.
Int Ophthalmol ; 39(8): 1665-1667, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30022332

RESUMO

PURPOSE: To report patterns of uveitis in patients with systemic tuberculosis. METHODS: Records of patients presenting at uvea clinic of a tertiary eye care centre were evaluated retrospectively, and 47 cases with proven systemic tuberculosis were analyzed for patterns of uveitis. Tuberculosis had been proven with a combination of radio imaging and detection of acid fast bacilli in body fluids. All patients had been reviewed by a specialist as applicable before diagnosing tuberculosis. These patients had undergone a thorough ocular workup. Pattern of uveitis was the primary outcome measure. RESULTS: Mean age was 35.34 ± 15.56 years. Lung was the commonest systemic focus, seen in nearly 75% of the cases. Anterior uveitis was the most common presentation (48.9%), followed by posterior (25.5%), panuveitis (10.6%) and intermediate uveitis (10.6%). Multifocal serpiginoid choroidopathy (MSC) was seen in only one patient, while granulomatous choroiditis was the commonest type of posterior uveitis. CONCLUSIONS: Anterior uveitis is the most frequent type of uveitis seen in patients with proven systemic tuberculosis. Rarity of MSC in such patients indicates possibility of etiologies other than tuberculosis in causing MSC.


Assuntos
Infecções Oculares Bacterianas/complicações , Tuberculose Ocular/complicações , Tuberculose Pulmonar/complicações , Uveíte/etiologia , Adulto , Infecções Oculares Bacterianas/diagnóstico , Feminino , Humanos , Incidência , Índia , Masculino , Tuberculose Ocular/diagnóstico , Tuberculose Pulmonar/diagnóstico , Uveíte/diagnóstico , Uveíte/epidemiologia
11.
Orbit ; 38(4): 331-334, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30142013

RESUMO

Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy. Abbreviations: PCR: polymerase chain reaction; NAAT: nucleic acid amplification test.


Assuntos
Dacriocistite/diagnóstico , Obstrução dos Ductos Lacrimais/diagnóstico , Ducto Nasolacrimal/patologia , Tuberculose Ocular/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Biópsia , Sedimentação Sanguínea , Doença Crônica , Dacriocistite/microbiologia , Dacriocistite/terapia , Dacriocistorinostomia , Quimioterapia Combinada , Feminino , Humanos , Obstrução dos Ductos Lacrimais/microbiologia , Obstrução dos Ductos Lacrimais/terapia , Mycobacterium tuberculosis/isolamento & purificação , Ducto Nasolacrimal/efeitos dos fármacos , Ducto Nasolacrimal/microbiologia , Ducto Nasolacrimal/cirurgia , Teste Tuberculínico , Tuberculose Ocular/microbiologia , Tuberculose Ocular/terapia
12.
Int Ophthalmol ; 39(2): 317-333, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29318438

RESUMO

PURPOSE: To describe clinical characteristics and outcomes of treatment in patients with presumed tuberculous uveitis (PTU). METHODS: All patients diagnosed with PTU between January 1996 and March 2013 were reviewed. The diagnosis was made when clinical findings were consistent with possible intraocular tuberculosis, strongly positive purified protein derivative (PPD) skin test result, and response to anti-tuberculous therapy with no other cause of uveitis as suggested by history, symptoms, or ancillary testing. RESULTS: Ninety patients (141 eyes) were identified. There were 43 males (47.3%) and 47 females (52.7%). Mean age was 48.2 ± 14.4 years. Mean duration of symptoms prior to presentation was 6.7 ± 8.3 months. Ten eyes (7.1%) had anterior uveitis, 18 eyes (12.8%) had intermediate uveitis, 34 eyes (24.1%) had posterior uveitis, and 79 eyes (56%) had panuveitis. Macular edema was present in 33.3% of the eyes at presentation. All patients received anti-tuberculous therapy and systemic corticosteroids. Mean follow-up after completion of therapy was 36 ± 2.5 months. Only 2 eyes developed recurrent inflammation after treatment completion. At last follow-up, all eyes showed resolution of inflammation, associated with significant improvement in visual acuity. There was a significant positive correlation between initial and final VA. Eyes that had macular edema at presentation showed a significant reduction in central macular thickness at final follow-up. CONCLUSIONS: There is delay in presentation of patients with PTU. The most common anatomic diagnosis was panuveitis. Treatment with anti-tuberculous therapy combined with systemic corticosteroids resulted in resolution of inflammation and macular edema with significant improvement in visual acuity.


Assuntos
Antituberculosos/uso terapêutico , Infecções Oculares Bacterianas/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Tuberculose Ocular/epidemiologia , Universidades , Uveíte/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Quimioterapia Combinada , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Resultado do Tratamento , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológico , Uveíte/tratamento farmacológico , Uveíte/microbiologia , Adulto Jovem
13.
Eye (Lond) ; 33(1): 129-135, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30185832

RESUMO

PURPOSE: To analyze the serum cytokines profile in patients with tubercular multifocal serpiginoid choroiditis (TB MSC) receiving anti-tubercular therapy (ATT) and oral corticosteroids. METHODS: In this prospective longitudinal study, patients with active TB MSC were included. Serum levels of interferon (IFN)-γ, interleukin (IL)-10, and tumor necrosis factor (TNF)-α were analyzed using bead-based immunoassay. The levels of transforming growth factor (TGF)-ß were measured using cytokine bead array. Serial measurement was performed at baseline, 1, 3, and 6 weeks after initiation of therapy. Patients developing paradoxical worsening (PW) of TB MSC were identified and their serum levels of cytokines were compared with those patients who showed healing of lesions. Comparison of cytokine levels with baseline values was also performed. RESULTS: Twelve patients (three females) were included in the study. Four patients showed paradoxical worsening of TB MSC at 3.2 ± 1 weeks after initiation of therapy. Compared to patients who showed healing of lesions, patients with PW showed higher baseline IL-10 (not significant; p = 0.28). Among patients developing PW, levels of IFN-γ peaked at 1 week ((p = 0.01) and levels of TNF-α peaked at 3 weeks (p = 0.02) (coinciding with PW) compared to patients who showed healing. There was no significant difference in TGF-ß levels at any time point in either group (p > 0.47). CONCLUSIONS: Baseline and serial levels of inflammatory serum cytokines may help in predicting the response to ATT and corticosteroids in TB MSC. Patients with paradoxical worsening may show rise in pro-inflammatory cytokines after initiation of ATT indicating higher bacillary load.


Assuntos
Corioide/patologia , Corioidite/sangue , Citocinas/sangue , Tuberculose Ocular/sangue , Adulto , Antituberculosos/uso terapêutico , Biomarcadores/sangue , Corioidite/diagnóstico , Corioidite/tratamento farmacológico , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Glucocorticoides/uso terapêutico , Humanos , Masculino , Projetos Piloto , Prognóstico , Estudos Prospectivos , Tomografia de Coerência Óptica , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológico
14.
Ocul Immunol Inflamm ; 27(6): 998-1009, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29969330

RESUMO

Purpose: To describe tuberculous uveitis (TU) presenting as a bullous retinal detachment (RD) and to perform a comprehensive literature review on TU with similar features. Methods: Observational case report and systematic literature review. Results: An 84-year-old woman presented with bilateral granulomatous uveitis and bullous RD in the left eye. The interferon gamma release assay was strongly positive, but all other tests were unremarkable. The patient was diagnosed with TU and started on anti-tubercular therapy (ATT) and systemic steroids with excellent treatment response. Twenty-six articles (32 cases) reported TU with exudative RD. Choroidal tuberculoma was the most common clinical manifestation, followed by optic disc edema and retinal exudate. Systemic steroids with ATT improved vision in more patients (78.6%) than ATT alone (50.0%) or oral steroids followed by ATT (50.0%). Conclusion: Atypical presentations of TU make diagnosis and treatment difficult. A high level of suspicion for TU is needed to minimize ocular morbidity.


Assuntos
Descolamento Retiniano/diagnóstico , Tuberculose Ocular/diagnóstico , Uveíte/diagnóstico , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Feminino , Angiofluoresceinografia , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Granuloma/microbiologia , Humanos , Testes de Liberação de Interferon-gama , Mycobacterium tuberculosis/isolamento & purificação , Descolamento Retiniano/tratamento farmacológico , Descolamento Retiniano/microbiologia , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologia , Uveíte/tratamento farmacológico , Uveíte/microbiologia
15.
Ocul Immunol Inflamm ; 27(6): 995-997, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29543549

RESUMO

Purpose: To report our experience of using Endobronchial ultrasound-guided transbronchial lymph node aspiration (EBUS-TBNA) in assessing the etiology in uveitis from two tertiary eye-care centers in India. Materials & Methods: Retrospective interventional case series. Results: A total of 99 patients of uveitis who underwent EBUS-TBNA were included in the study. Mycobacterium tuberculosis (MTb) was detected on culture in 5 cases, 3 cases by polymerase chain reaction and caseating granulomas in 25 cases. None of these patients had any symptoms of systemic tuberculosis (TB). Biopsy was inconclusive in eight cases. Granulomatous inflammation was seen in 91 cases. In 51 cases, it was difficult to differentiate between sarcoidosis and TB on biopsy. None of the patients had any significant complications. There was a fair agreement between the biopsy diagnosis and the final ocular diagnosis. Conclusions: In high TB endemic countries, procedures like EBUS-TBNA are useful in obtaining tissue diagnosis of TB when ocular diagnosis may be inconclusive due to paucity of ocular tissue.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Granuloma/diagnóstico , Sarcoidose/diagnóstico , Tuberculose Ocular/diagnóstico , Uveíte/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Granuloma/microbiologia , Humanos , Índia , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoidose/microbiologia , Sensibilidade e Especificidade , Ultrassonografia de Intervenção , Uveíte/microbiologia , Adulto Jovem
16.
Ocul Immunol Inflamm ; 27(3): 465-473, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29261089

RESUMO

Purpose: To analyze the role of polymerase chain reaction (PCR) of ocular fluids in management of tubercular (TB) anterior, intermediate, posterior, and panuveitis. Methods: In Collaborative Ocular Tuberculosis Study (COTS)-1 (25 centers, n = 962), patients with TB-related uveitis were included. 59 patients undergoing PCR of intraocular fluids (18 females; 53 Asian Indians) were included. Results: 59 (6.13%) of COTS-1 underwent PCR analysis. PCR was positive for Mycobacterium TB in 33 patients (23 males; all Asian Indians). 26 patients were PCR negative (18 males). Eight patients with negative PCR had systemic TB. Anti-TB therapy was given in 18 negative and 31 PCR cases. At 1-year follow-up, five patients with positive PCR (15.15%) and three with negative PCR (11.54%) had persistence/worsening of inflammation. Conclusions: Data from COTS-1 suggest that PCR is not commonly done for diagnosing intraocular TB and positive/negative results may not influence management or treatment outcomes in the real world scenario.


Assuntos
Antituberculosos/uso terapêutico , Infecções Oculares Bacterianas/diagnóstico , Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase/métodos , Tuberculose Ocular/diagnóstico , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Adolescente , Adulto , Idoso , Humor Aquoso/microbiologia , Criança , DNA Bacteriano/análise , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Estudos Retrospectivos , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologia , Uveíte/microbiologia , Adulto Jovem
17.
Ocul Immunol Inflamm ; 27(3): 365-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29020501

RESUMO

Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional choroiditis lesions, PW and altering the course of therapy in TB MSC.


Assuntos
Antituberculosos/efeitos adversos , Corioide/patologia , Infecções Oculares Bacterianas/complicações , Angiofluoresceinografia/métodos , Tomografia de Coerência Óptica/métodos , Tuberculose Ocular/complicações , Adolescente , Adulto , Antituberculosos/uso terapêutico , Progressão da Doença , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológico , Adulto Jovem
18.
Pulmonology ; 24(5): 289-293, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30293580

RESUMO

INTRODUCTION: Ocular tuberculosis (OTB) is a rare form of tuberculosis. Diagnosis is usually presumptive based on epidemiology, clinical findings and positivity of immune response. The aim of the study was to characterize the OTB cases identified in Lisbon. METHODS: Retrospective study on OTB cases diagnosed in Lisbon from 2012 to 2015. The authors gathered data regarding demographic characteristics, diagnostic criteria, type of treatment as well as therapeutic results. RESULTS: There were 39 reported cases of presumed OTB which accounted for 12.2% of all reported TB cases. Patients had a mean age of 55.5 years. All had ocular manifestations (mainly uveitis). Diagnostic criteria included positive tuberculin skin test (TST) and/or Interferon Gamma Release Assay (IGRA). Culture testing or PCR could not be determined in any patient. Patients had OTB treatment for an average of 9.08 months. Clinical improvement was reported in 91.4% of treated patients. There were no relapses. CONCLUSION: This is the first published series about OTB in Lisbon. All cases had a presumptive diagnosis made through TST and/or IGRA testing. Most of treated patients improved, with no signs of relapse and a median 29.9-month follow up. OTB seems to be a growing diagnosis and treatment may be beneficial even in patients with a presumptive diagnosis.


Assuntos
Tuberculose Ocular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológico
20.
BMJ Case Rep ; 20182018 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-30171156

RESUMO

Tuberculosis treatment failure is not uncommon in patients with AIDS. Treatment failure is defined as a positive sputum smear or culture at month 5 or later in the course of the treatment. The clinical presentations in these patients show remarkable heterogeneity. In this report, we chronicle the case of a patient with treatment failure presenting as the disseminated disease, specifically ocular and renal tuberculosis. Additionally, we undertake here a brief literature review highlighting the increased resistance to tuberculosis treatment in patients with AIDS, the rarity of ocular tuberculosis and the importance of tailoring drug regimens on an individual basis in these coinfected patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/uso terapêutico , Tuberculose Ocular/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Renal/diagnóstico , Adulto , Feminino , Humanos , Falha de Tratamento
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