Ocular tuberculosis in Hospital Universiti Sains Malaysia - A case series

Abstract

IntroductionOcular tuberculosis (TB) encompasses a broad spectrum of clinical manifestations affecting different structures of the eye. It is caused by Mycobacterium tuberculosis, a great ancient organism that induces various types of diseases and unfavorable outcomes if unrecognized and not well treated.PurposeTo report the clinical profile of 34 ocular TB cases observed during 6 years period in Hospital Universiti Sains Malaysia (HUSM).MethodA retrospective review of medical records from 34 patients diagnosed with ocular TB in HUSM from January 2011 until December 2016.ResultsThe mean age was 43 ± 14.6 years old. Both male and female affected in about 1:1 ratio. The majority of subjects were local Malays (91.2%). Risk factors included previous contact with pulmonary TB patients (38.2%), and patients with underlying diabetes mellitus (26.5%). Most patients showed normal chest radiography (79.4%). However they had positive Mantoux test (94.1%) and raised erythrocyte sedimentation rate (ESR) value (58.8%). Uveitis was the most common ocular manifestation of ocular TB (70.6%) while the rare ocular manifestations included optic perineuritis and optic neuritis, orbital apex syndrome, orbital cellulitis, sclerokeratitis, corneal ulcer and conjunctival abscess. All patients responded well to anti-TB treatment, but visual outcome was variable.ConclusionsThis review shows the diverse entity of ocular TB spectrum in an endemic area. Good clinical response to anti-tuberculous therapy supported the presumed diagnosis of ocular TB in majority of the cases.

A clinical study of optic nerve involvement in patients with tuberculosis attending a tertiary health care center in North East

“…In another study in Malaysia by Shahidatul-Adha M et al with 1 case of tubercular optic neuritis were found. 21 In our study we found that 10 cases (47.61%) had bilateral involvement. In study conducted by Agrawal R et al, most patients had bilateral involvement (58.8%).…”

Feline Ocular Mycobacteriosis: Clinical Presentation, Histopathological Features, and Outcome

“…Similarly, the glaucoma observed in this study in 4 cats (6 eyes) was a likely sequel to mycobacterial uveitis. 11,22,45…”

Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 2

“…By contrast, multiple single-center studies highlighted the therapeutic role of ATT in patients diagnosed with TAU. 20,21,24,25,29,38,44,45,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] Based on overall scientific evidence and experience, uveitis specialists reached mostly moderate consensus for initiating ATT in recurrent TAU with any immunologic evidence of tuberculosis, along with radiologic signs suggestive of pulmonary tuberculosis infection, in both endemic and nonendemic regions when other possible causes have been ruled out. However, when it comes to the first episode of anterior uveitis, experts agreed to initiate ATT, regardless of endemicity, only when 2 immunologic and radiologic tests show positive results.…”

“…Evidence supported the efficacy of ATT in patients with TIU and TPU. 20e24, 26,30,31,38,44,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] Particularly in patients with TPU, any immunologic evidence of tuberculosis, along with positive radiologic signs, supports the initiation of ATT, regardless of endemicity. However, when comparing results from endemic and nonendemic regions, data confirmed once again that in an endemic area, where the pretest probability of TBU is higher, experts are more likely to treat patients with an isolated PPD test showing positive results, despite negative IGRA results.…”