Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series
Abstract Background Ocular tuberculosis (TB) affects 1–2% of patients with TB, with TB uveitis being the most common. This series aims to look at different manifestations of tuberculosis associated uveitis and the different tests used to make a presumptive or definitive diagnosis. Methods Patients d...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | Tropical Diseases, Travel Medicine and Vaccines |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40794-023-00205-w |
| _version_ | 1797578015040864256 |
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| author | Jennifer KS Tsui Stephanie Hiu Ling Poon Nicholas Siu Kay Fung |
| author_facet | Jennifer KS Tsui Stephanie Hiu Ling Poon Nicholas Siu Kay Fung |
| author_sort | Jennifer KS Tsui |
| collection | DOAJ |
| description | Abstract Background Ocular tuberculosis (TB) affects 1–2% of patients with TB, with TB uveitis being the most common. This series aims to look at different manifestations of tuberculosis associated uveitis and the different tests used to make a presumptive or definitive diagnosis. Methods Patients diagnosed with TB related uveitis in Hong Kong SAR between 2017 and 2020 were reviewed. Demographics, clinical features, investigations and treatments of patients were collected. Results Fifteen eyes in 10 patients with a mean age 57.30 ± 10.17 years were included. The ocular manifestations on presentation included anterior uveitis (50%), posterior uveitis (40%) and panuveitis (10%), where 70% of them were unilateral and 30% were bilaterally infected; on subsequent visits the manifestations further developed into posterior uveitis (40%), panuveitis (40%) and anterior uveitis (20%), where 50% of them were unilateral and 50% bilateral infected. Tuberculosis tests were positive in 5 out of 7 Mantoux tests, 4 out of 4 T-SPOT TB tests, 3 out of 4 QuantiFERON-TB gold tests, 1 out of 1 lymph node biopsy, 0 out of 9 chest x-rays, and no aqueous fluid polymerase chain reaction (PCR) was tested. Vision impairing complications were seen in 6 patients where retinal vasculitis was most commonly seen. With anti-TB treatment prescribed in 9 patients, side effects occurred in 5 patients, including ocular hypertension, disc swelling, and hepatitis. Conclusions Ocular TB infections may manifest in various forms, and can involve different parts of the eye. Bilateral involvement of TB is commonly presented, and both eyes should be evaluated at every follow up. When TB is suspected in a patient, diagnostic confirmation requires multimodal investigations where a negative chest x-ray is not useful in ruling out ocular TB infections, especially in an endemic region like Hong Kong. In these patients, it is crucial to have a high index of suspicion for TB, even when they do not demonstrate classical respiratory signs and symptoms of TB. |
| first_indexed | 2024-03-10T22:17:04Z |
| format | Article |
| id | doaj.art-5978ef4b34e0412c9a0ec987958fd40f |
| institution | Directory Open Access Journal |
| issn | 2055-0936 |
| language | English |
| last_indexed | 2024-03-10T22:17:04Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Diseases, Travel Medicine and Vaccines |
| spelling | doaj.art-5978ef4b34e0412c9a0ec987958fd40f2023-11-19T12:24:32ZengBMCTropical Diseases, Travel Medicine and Vaccines2055-09362023-11-01911910.1186/s40794-023-00205-wOcular manifestations and diagnosis of tuberculosis involving the uvea: a case seriesJennifer KS Tsui0Stephanie Hiu Ling Poon1Nicholas Siu Kay Fung2Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong KongDepartment of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong KongDepartment of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong KongAbstract Background Ocular tuberculosis (TB) affects 1–2% of patients with TB, with TB uveitis being the most common. This series aims to look at different manifestations of tuberculosis associated uveitis and the different tests used to make a presumptive or definitive diagnosis. Methods Patients diagnosed with TB related uveitis in Hong Kong SAR between 2017 and 2020 were reviewed. Demographics, clinical features, investigations and treatments of patients were collected. Results Fifteen eyes in 10 patients with a mean age 57.30 ± 10.17 years were included. The ocular manifestations on presentation included anterior uveitis (50%), posterior uveitis (40%) and panuveitis (10%), where 70% of them were unilateral and 30% were bilaterally infected; on subsequent visits the manifestations further developed into posterior uveitis (40%), panuveitis (40%) and anterior uveitis (20%), where 50% of them were unilateral and 50% bilateral infected. Tuberculosis tests were positive in 5 out of 7 Mantoux tests, 4 out of 4 T-SPOT TB tests, 3 out of 4 QuantiFERON-TB gold tests, 1 out of 1 lymph node biopsy, 0 out of 9 chest x-rays, and no aqueous fluid polymerase chain reaction (PCR) was tested. Vision impairing complications were seen in 6 patients where retinal vasculitis was most commonly seen. With anti-TB treatment prescribed in 9 patients, side effects occurred in 5 patients, including ocular hypertension, disc swelling, and hepatitis. Conclusions Ocular TB infections may manifest in various forms, and can involve different parts of the eye. Bilateral involvement of TB is commonly presented, and both eyes should be evaluated at every follow up. When TB is suspected in a patient, diagnostic confirmation requires multimodal investigations where a negative chest x-ray is not useful in ruling out ocular TB infections, especially in an endemic region like Hong Kong. In these patients, it is crucial to have a high index of suspicion for TB, even when they do not demonstrate classical respiratory signs and symptoms of TB.https://doi.org/10.1186/s40794-023-00205-wOcular tuberculosisTB uveitisOcular uveitisMycobacterium tuberculosisExtra-pulmonary TB |
| spellingShingle | Jennifer KS Tsui Stephanie Hiu Ling Poon Nicholas Siu Kay Fung Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series Tropical Diseases, Travel Medicine and Vaccines Ocular tuberculosis TB uveitis Ocular uveitis Mycobacterium tuberculosis Extra-pulmonary TB |
| title | Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series |
| title_full | Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series |
| title_fullStr | Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series |
| title_full_unstemmed | Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series |
| title_short | Ocular manifestations and diagnosis of tuberculosis involving the uvea: a case series |
| title_sort | ocular manifestations and diagnosis of tuberculosis involving the uvea a case series |
| topic | Ocular tuberculosis TB uveitis Ocular uveitis Mycobacterium tuberculosis Extra-pulmonary TB |
| url | https://doi.org/10.1186/s40794-023-00205-w |
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