Longitudinal analysis of serum cytokine profile among patients with tubercular multifocal serpiginoid choroiditis: a pilot study

Agarwal, Aniruddha; Deokar, Ankit; Sharma, Ravi; Singh, Nirbhai; Aggarwal, Kanika; Sharma, Suryaprakash; Singh, Ramandeep; Sharma, Aman; Sharma, Kusum; Agrawal, Rupesh; Bansal, Reema; Gupta, Vishali

doi:10.1038/s41433-018-0157-5

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Paradoxical worsening can be predicted by various imaging biomarkers including optical coherence tomography angiography (OCTA) and inflammatory markers from the vitreous such as interleukins and tumor necrosis factor. 8,22 Studies have shown that early detection/prediction of paradoxical worsening can prevent permanent choriocapillaris/photoreceptor atrophy and help in superior visual outcomes 8,22 .…”

Section: Discussionmentioning

confidence: 99%

Automated lesion segmentation and quantification for prediction of paradoxical worsening in patients with tubercular serpiginous-like choroiditis

Kalra

Agarwal

Marchese

et al. 2022

Sci Rep

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To develop and evaluate a fully automated pipeline that analyzes color fundus images in patients with tubercular serpiginous-like choroiditis (TB SLC) for prediction of paradoxical worsening (PW). In this retrospective study, patients with TB SLC with a follow-up of 9 months after initiation of anti-tubercular therapy were included. A fully automated custom-designed pipeline was developed which was initially tested using 12 baseline color fundus photographs for assessment of repeatability. After confirming reliability using Bland–Altman plots and intraclass correlation coefficient (ICC), the pipeline was deployed for all patients. The images were preprocessed to exclude the optic nerve from the fundus photo using a single-shot trainable WEKA segmentation algorithm. Two automatic thresholding algorithms were applied, and quantitative metrics were generated. These metrics were compared between PW + and PW- groups using non-parametric tests. A logistic regression model was used to predict probability of PW for assessing binary classification performance and receiver operator curves were generated to choose a sensitivity-optimized threshold. The study included 139 patients (139 eyes; 92 males and 47 females; mean age: 44.8 ± 11.3 years) with TB SLC. Pilot analysis of 12 images showed an excellent ICC for measuring the mean area, intensity, and integrated pixel intensity (all ICC > 0.89). The PW + group had significantly higher mean lesion area (p = 0.0152), mean pixel intensity (p = 0.0181), and integrated pixel intensity (p < 0.0001) compared to the PW- group. Using a sensitivity optimized threshold cut-off for mean pixel intensity, an area under the curve of 0.87 was achieved (sensitivity: 96.80% and specificity: 72.09%). Automated calculation of lesion metrics such as mean pixel intensity and segmented area in TB SLC is a novel approach with good repeatability in predicting PW during the follow-up.

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Section: Discussionmentioning

confidence: 99%

Automated lesion segmentation and quantification for prediction of paradoxical worsening in patients with tubercular serpiginous-like choroiditis

Kalra

Agarwal

Marchese

et al. 2022

Sci Rep

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“…In MSC, the serum cytokine levels were studied at baseline and over a longitudinal follow up in patients who received oral corticosteroids and anti-tubercular therapy (ATT) [57]. Of 12 patients, four developed paradoxical worsening (PW) of choroiditis lesions.…”

Section: Tagirasa Et Al Identified Autoreactive T Cells In Eyesmentioning

confidence: 99%

Tubercular serpiginous choroiditis

Bansal

Gupta

2022

J Ophthal Inflamm Infect

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Tubercular association with serpiginous choroiditis, also called ‘serpiginous-like choroiditis’ or ‘multifocal serpiginoid choroiditis’ (MSC) is reported from world over, especially from endemic countries. Though the exact mechanism is not yet clear, a direct or indirect infectious trigger by Mycobacterium tuberculosis (MTB) is believed to cause choroiditis.The link of immune mechanisms with ocular inflammation caused by MTB is emerging, and has been supported by both experimental and human data. The molecular and histopathological findings of tubercular serpiginous-like choroiditis have been demonstrated in clinicopathological reports, as well as in animal models. Young to middle-aged healthy males are more frequently affected. The choroiditis lesions of tubercular serpiginous-like choroiditis evolve as multifocal lesions, affecting the retinal periphery as well as posterior pole. They begin as discrete lesions, and spread in a serpiginoid pattern to become confluent. Fundus imaging including autofluorescence is extremely helpful in monitoring patients for response to therapy. Its diagnosis is essentially clinical. Corroborative evidence is obtained by a positive tuberculin skin test, or a positive QuantiFERON-TB Gold (Cellestis, Carnegie, Victoria, Australia) test, and/or radiological (chest X-ray or chest CT scan) evidence of TB elsewhere in the body. Systemic corticosteroids are the mainstay of therapy to control active inflammation, while ATT helps to reduce recurrence of inflammatory attacks. Immunosuppressive agents are indicated in cases with relentless progression, paradoxical worsening, or recurrent choroiditis.

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“…The study concluded that patients with paradoxical worsening in TB-related uveitis may show a heightened immune response with higher baseline IL-10 values, early rising levels of interferon- ϒ (IFN-ϒ), progressive increase in transforming growth factor-β (TGF-β), and rising levels of TNF-α after initiation of ATT and corticosteroids. Patients with high IL-10 values have low bacilli clearance rates and more chance of persistence of infection [28]. Further, MTB is capable of stimulating the release of IL-10.…”

Section: Introductionmentioning

confidence: 99%

Paradoxical reactions in ocular tuberculosis

Ganesh

Abraham

Sridharan

2019

J Ophthal Inflamm Infect

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Paradoxical reactions following initiation of anti-tubercular therapy have been documented most often in extrapulmonary tuberculosis. A combination of factors such as delayed hypersensitivity, decreased suppressor mechanisms, and an increased response to mycobacterial antigens mediated by the host’s immune system have been implicated in the development of these reactions. Similar worsening in patients with ocular tuberculosis while on treatment has been described. It is therefore important for the clinician to be aware of this occurrence, as prompt recognition and timely institution of corticosteroids and immunosuppressants can lead to restoration of vision. In these patients, an alteration or discontinuation of anti-tubercular therapy may not be indicated.

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Longitudinal analysis of serum cytokine profile among patients with tubercular multifocal serpiginoid choroiditis: a pilot study

Abstract: 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.

Cited by 7 publications

References 18 publications

Automated lesion segmentation and quantification for prediction of paradoxical worsening in patients with tubercular serpiginous-like choroiditis

Automated lesion segmentation and quantification for prediction of paradoxical worsening in patients with tubercular serpiginous-like choroiditis

Tubercular serpiginous choroiditis

Paradoxical reactions in ocular tuberculosis

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