Jarisch–Herxheimer reaction: paradoxical worsening of tuberculosis chorioretinitis following initiation of antituberculous therapy

Cheung, Chui Ming Gemmy; Chee, Soon-Phaik

doi:10.1038/eye.2008.204

Cited by 50 publications

(41 citation statements)

References 4 publications

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“…Paradoxical reactions in the eye such as worsening of the inflammation or existing lesions, or appearance of new lesions have also been described. 26,27 However, we feel that standard full 6 months ATT is generally justified to minimize the risk of ocular damage. In our series, intraocular inflammation resolved without recurrence in all patients treated in this way.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Manousaridis

Ong

Stenton

et al. 2013

Eye

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Purpose To report the clinical manifestations and treatment outcomes of patients with presumed intraocular tuberculosis (TB) seen at the Newcastle Uveitis Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 10-year period. Methods Retrospective review of case notes. Results A total of 21 patients were identified. Occlusive retinal vasculitis was the commonest ophthalmological presentation (12 patients). Eight patients (38%) were found to have underlying active systemic TB (four with mediastinal lymphadenopathy, three with pulmonary TB, one with cutaneous TB). Constitutional or respiratory symptoms, elevated inflammatory markers, and an abnormal chest radiograph were poor indicators of active TB. Two patients had inactive intrathoracic TB. Eleven patients had latent TB. Eighteen patients received anti-tuberculous treatment. Final visual acuity was better than or equal to initial visual acuity in 14 out of 16 patients who completed at least 6 months of standard anti-tuberculous treatment. Conclusions Most patients with presumed intraocular TB have latent TB, but a significant minority has hitherto undetected active TB. Our series suggests that either proven or presumed intraocular TB occurs frequently in the absence of constitutional or respiratory symptoms, elevated inflammatory markers, or an abnormal chest radiograph. A minimum of 6 months standard anti-tuberculous treatment provides good visual outcomes in the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Manousaridis

Ong

Stenton

et al. 2013

Eye

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“…10 Paradoxical worsening in ocular TB has been described both in immunocompromised and immunocompetent patients. 5,[11][12][13] We have earlier described four cases of paradoxical worsening in the eye, two of which occurred following ATT for extra-ocular TB. 13 Gupta et al 5 reported 12 patients with SLC (14% of 84 patients in the study), who developed progressive inflammation following initiation of ATT.…”

Section: Site Of Progressive Inflammationmentioning

confidence: 99%

Progressive ocular inflammation following anti-tubercular therapy for presumed ocular tuberculosis in a high-endemic setting

Basu

Nayak

Padhi

et al. 2013

Eye

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“…[137][138][139][140][141] Yet symptom exacerbation resulting from an immunostimulative approach towards pathogens is paradoxical only because it defies previously held intuition.…”

Section: Discussionmentioning

confidence: 99%

“…96 Notably, both treatments may involve an immunopathological-style reaction. 97,98 However, isoniazid treatment is aimed at killing only one major pathogen whereas patients with autoimmune disease may be targeting multiple phyla of pathogenic microbes. By contrast, treatments like HAART in HIV patients target polymicrobial communities of opportunistic infections including viruses, fungi and bacteria.…”

Section: Potential Severity Of Immunopathologymentioning

confidence: 99%

Immunostimulation in the era of the metagenome

Proal

Albert

Blaney³

et al. 2011

Cell Mol Immunol

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Microbes are increasingly being implicated in autoimmune disease. This calls for a re-evaluation of how these chronic inflammatory illnesses are routinely treated. The standard of care for autoimmune disease remains the use of medications that slow the immune response, while treatments aimed at eradicating microbes seek the exact opposite-stimulation of the innate immune response. Immunostimulation is complicated by a cascade of sequelae, including exacerbated inflammation, which occurs in response to microbial death. Over the past 8 years, we have collaborated with American and international clinical professionals to research a model-based treatment for inflammatory disease. This intervention, designed to stimulate the innate immune response, has required a reevaluation of disease progression and amelioration. Paramount is the inherent conflict between palliation and microbicidal efficacy. Increased microbicidal activity was experienced as immunopathology-a temporary worsening of symptoms. Further studies are needed, but they will require careful planning to manage this immunopathology.

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Jarisch–Herxheimer reaction: paradoxical worsening of tuberculosis chorioretinitis following initiation of antituberculous therapy

Cited by 50 publications

References 4 publications

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Progressive ocular inflammation following anti-tubercular therapy for presumed ocular tuberculosis in a high-endemic setting

Immunostimulation in the era of the metagenome

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