Presumed ocular tuberculosis in the United Kingdom: a British Ophthalmological Surveillance Unit (BOSU) study

Abstract

Introduction Ocular tuberculosis (TB) is an extrapulmonary manifestation of mycobacterium infection that most commonly presents as uveitis. This is the first prospective incidence study of presumed ocular tuberculosis performed in the United Kingdom (UK). Method New cases of ocular tuberculosis presenting to hospitals in the UK were prospectively ascertained between October 2016 and November 2017 with the aid of the British Ophthalmological Surveillance Unit (BOSU). Initial presentation data and 1-year follow-up data was collected using questionnaires. Results Forty-eight patients were recruited giving an overall incidence for ocular TB of 0.73 per million population per annum. The origin of birth for 71% of the patients was a non-UK country and 87.5% had their initial diagnosis of TB made by an ophthalmologist. The most common first line treatment was isoniazid, rifampicin, ethambutol and pyrazinamide which 71% of patients were treated with 60% of patients were commenced on a reducing course of oral steroids. At 1-year follow-up, 29 patients (83%) had complete resolution of active clinical signs. Mean best corrected visual acuity (BCVA) at presentation was +0.41 LogMAR(SD = 0.62), compared to +0.31 LogMAR (SD = 0.56) at 12-month follow-up. Discussion It is increasingly the responsibility of the ophthalmologist to diagnose ocular TB and although it remains a rare condition, consensus on diagnostic criteria and treatment is required. Increasing recognition and accessibility to gamma-interferon testing should enable earlier detection. Treatment with quadruple ATT treatment regimens for at least 6 months shows good clinical outcomes. However, it is still unclear whether steroid use is beneficial. Further large studies with longer follow-up would be warranted to answer these questions.

Clinics of ocular tuberculosis: A review

“…While nearly all epidemiological studies in the current literature report prevalence rates, a manuscript published in 2020 sought to elucidate the incidence rate of OTB in the general UK population. From October 2016 to November 2017, Shirley and colleagues 34 prospectively recorded new cases of OTB presenting to multiple hospitals in the United Kingdom, calculating an overall incidence for OTB of 0.73 per million population per annum. Interestingly, the origin of birth for 71% of the patients was a non‐UK country, with the majority from Pakistan, India or Africa, in line with the endemicity hypothesis.…”

“…Historically in the United Kingdom, there had been a lack of awareness of TB as a cause of uveitis as it is a non‐endemic region and hence rare. However, globalization and the influx of migrant populations, leading to the mixing of populations from endemic and non‐endemic regions, has prompted renewed consideration of TB as an aetiology in the patients presenting today 34,35 …”

“…However, globalization and the influx of migrant populations, leading to the mixing of populations from endemic and non-endemic regions, has prompted renewed consideration of TB as an aetiology in the patients presenting today. 34,35…”

Infektiöse posteriore Uveitis – Toxoplasmose, Treponema, Tuberkulose (TTT)

“…Europa gilt als nicht endemisch. Hier findet sich die Tuberkulose überwiegend bei Patienten mit Geburtsort außerhalb Europas 3 , 51 . Dementsprechend ist der Anteil an Patienten, die mit einer okulären Tuberkulose diagnostiziert werden, regional sehr unterschiedlich.…”

“…The disease is not considered endemic in Europe. Here, tuberculosis is predominantly found in patients born outside Europe 3 , 51 . Accordingly, the proportion of patients diagnosed with ocular tuberculosis varies greatly by region.…”