The Collaborative Ocular Tuberculosis Study (COTS)-1 Report 3: Polymerase Chain Reaction in the Diagnosis and Management of Tubercular Uveitis: Global Trends

Agarwal, Aniruddha; Agrawal, Rupesh; Gunasekaran, Dinesh V.; Raje, Dhananjay; Gupta, Bhaskar; Aggarwal, Kanika; Murthy, Somasheila; Westcott, Mark; Chee, Soon Phaik; McCluskey, Peter; Ling, Ho Su; Teoh, Stephen C.; Cimino, Luca; Biswas, Jyotirmay; Narain, Shishir; Agarwal, Manisha; Mahendradas, Padmamalini; Khairallah, Moncef; Jones, Nicholas P.; Tuğal-Tutkun, İlknur; Babu, Kalpana; Basu, Soumayava; Carreño, Ester; Lee, Richard W.; Al-Dhibi, Hassan; Bodaghi, Bahram; Invernizzi, Alessandro; Goldstein, Debra A.; Herbort, Carl P.; Barisani-Asenbauer, Talin; González-López, Julio J.; Androudi, Sofia; Bansal, Reema; Moharana, Bruttendu; Mahajan, Sarakshi; Esposti, Simona Degli; Tasiopoulou, Anastasia; Nadarajah, Sengal; Agarwal, Mamta; Abraham, Sharanya; Vala, Ruchi; Singh, Ramandeep; Sharma, Aman; Sharma, Kusum; Zierhut, Manfred; Kon, Onn Min; Cunningham, Emmett T.; Nguyen, Quan Dong; Pavésio, Carlos; Gupta, Vishali

doi:10.1080/09273948.2017.1406529

Cited by 64 publications

(55 citation statements)

References 18 publications

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“…50 The report also demonstrated that PCR analysis may not influence management or treatment outcomes in the real-world scenario. 50 Regarding cost-effectiveness, previous studies looking at the diagnosis of pulmonary TB have demonstrated significant cost saving benefits of PCR versus mycobacterial culture. 51 From our study, no extrapolations can be made about the cost-effectiveness of those techniques for ocular fluid analysis.…”

Section: Discussionmentioning

confidence: 94%

“…The COTS-1 Report 3 studied the real-world evidence on the utility of PCR of ocular fluids in the management of ocular TB. 50 It showed that PCR analysis still needs significant advancement to gain wider acceptability worldwide. 50 The report also demonstrated that PCR analysis may not influence management or treatment outcomes in the real-world scenario.…”

Section: Discussionmentioning

confidence: 99%

“…50 It showed that PCR analysis still needs significant advancement to gain wider acceptability worldwide. 50 The report also demonstrated that PCR analysis may not influence management or treatment outcomes in the real-world scenario. 50 Regarding cost-effectiveness, previous studies looking at the diagnosis of pulmonary TB have demonstrated significant cost saving benefits of PCR versus mycobacterial culture.…”

Section: Discussionmentioning

confidence: 99%

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<p>Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series</p>

Antaki¹,

Javidi²,

Touma³

et al. 2020

OPTH

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To systematically review the characteristics of patients with endogenous tuberculous (TB) endophthalmitis and panophthalmitis in an effort to help clinicians with diagnosis and treatment. Patients and Methods: We conducted a systematic literature search in MEDLINE/ PubMed, EMBASE and Web of Science from inception to August 2020. References and abstracts were screened independently by two authors. Included studies were case reports and case series reporting endogenous TB endophthalmitis and panophthalmitis secondary to Mycobacterium tuberculosis complex (MTBC). Available-case analysis was employed to handle missing data. Results: A total of 1343 articles were found using the search strategy. Following abstract screening, 51 articles were selected for full text-review, from which 26 were deemed eligible for inclusion in the study. Forty-four cases from 26 articles were included in the quantitative analysis. The median age of presentation was 29.5 (range: 1 to 81), and 11/44 patients (25.0%) were pediatric. Immunosuppression was seen in 9/36 cases (25.0%). Most patients (24/38, 63.2%) had no prior history of tuberculosis. Systemic symptoms were absent in half of the patients (16/32, 50.0%). Visual acuity was poor, with 23/27 cases (85.2%) being 20/ 200 or worse at presentation. Poor organ and visual outcomes were reported: 36/43 cases (83.7%) resulted in enucleation/evisceration or exenteration. Intraocular tumors were suspected in 5/34 cases (14.7%). Pulmonary tuberculosis was seen in 15/35 cases (42.8%), and miliary tuberculosis was seen in 7/35 cases (20.0%). The earliest source of TB diagnosis was through histopathologic specimen after eye removal in 32/44 cases (72.7%), vitreous specimen in 6/44 cases (13.6%) and aqueous specimen in 3/44 cases (6.8%). Conclusion: TB endophthalmitis is a rare and sight-threatening manifestation of ocular tuberculosis. It can occur in apparently healthy individuals and can mimic intraocular tumors and other infectious etiologies. Diagnosis remains a significant challenge, which, often delayed, leads to profound visual loss. Early detection and treatment of intraocular tuberculosis may be associated with better ocular and systemic outcomes.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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<p>Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series</p>

Antaki¹,

Javidi²,

Touma³

et al. 2020

OPTH

View full text Add to dashboard Cite

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“…WHO currently recommends universal DST in its End TB Strategy [ 8 ]. Unfortunately, in 2016, only 26 of 48 surveyed countries reported a national policy and algorithms indicating universal access to DST, and globally, only 41% of bacteriologically confirmed new and previously treated cases were tested for at least rifampicin resistance [ 9 ]. Upon identifying resistance to rifampicin, recommended diagnostic algorithms assess susceptibility to additional drugs to determine whether the TB strain is multidrug resistant (i.e., MDR TB) or extensively drug resistant (i.e., XDR TB) [ 6 , 10 , 11 ].…”

Section: Patient Coveragementioning

confidence: 99%

“…Many countries conduct nationally representative drug resistance surveys for TB [ 6 ]. South Africa is one country that is transitioning away from TB drug resistance surveys after national scale-up of DST [ 9 , 18 ]. The continuous TB drug resistance surveillance system in Western Cape produced a rifampicin resistance estimate similar to that generated in a recent national survey (4.6% versus 4.3%, respectively) [ 19 ].…”

Section: Surveillance Approachesmentioning

confidence: 99%

Towards national systems for continuous surveillance of antimicrobial resistance: Lessons from tuberculosis

2018

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Validation of the Online Collaborative Ocular Tuberculosis Study Calculator for Tubercular Uveitis

Zhang,

Rojas-Carabali,

Choo

et al. 2024

JAMA Ophthalmol

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ImportanceThis was the first study, to the authors’ knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinically suspicious tubercular uveitis (TBU) in an international cohort.ObjectiveTo evaluate the accuracy of a score of 4 or greater on the online COTS calculator in recommending ATT initiation.Design, Setting, and ParticipantsThis study was an evaluation of a diagnostic test or technology. Data input required for the COTS calculator were extracted from the COTS-1 study dataset, which comprised retrospective, observational records of patients with TBU who were monitored for 12 months after treatment. Patients were recruited from international ophthalmic centers. In the absence of a traditional criterion standard, the 12-month treatment response to ATT was used to classify patients as disease positive or negative. The accuracy of clinicians at the ATT decision-making stage in the COTS-1 study was set against COTS calculator scores of 4 or greater. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), precision, recall, and F1 score, were computed. Data collected from January 2004 to December 2014 were analyzed.ExposuresCOTS calculator to guide initiation of ATT in patients with TBU.Main Outcomes and MeasuresComparison of accuracy between clinician judgment and the COTS calculator, analyzed at varying scores and further stratified by tuberculosis endemicity.ResultsOf the 492 participants (mean [SD] age, 42.3 [19.0] years; 233 male [47.3%]), application of the COTS calculator identified 225 (45.7%) with high or very high probability to start ATT (score = 4 or 5) and 111 (22.5%) with very high probability alone (score = 5). COTS-5 exhibited the highest specificity (88.7%; 95% CI, 81.4%-93.8%) compared with clinician judgment (29.6%; 95% CI, 21.4%-38.8%), and clinician judgment led in sensitivity (95.5%; 95% CI, 92.9%-97.4%) compared with COTS-5 (26%; 95% CI, 21.6%-30.7%). COTS-4 and COTS-5 balanced specificity (64.3%; 95% CI, 54.9%-73.1%) and sensitivity (48.8%; 95% CI, 43.7%-54%). PPV and sensitivity were consistently higher in the endemic group for all 3 tests.Conclusions and RelevanceResults of this diagnostic study suggest that the COTS calculator (score ≥4) was more specific than clinician judgment for ATT initiation. Although clinician judgment is a good first step to identify all potential true positives (with high sensitivity), a second consultation with COTS-5 (with high PPV) may lead to less false positives. This tool, apt for high-prevalence, low-resource settings, recommends ATT more selectively for genuine TBU cases. Large prospective studies are essential to explore potential improvements in the calculator’s sensitivity.

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The Collaborative Ocular Tuberculosis Study (COTS)-1 Report 3: Polymerase Chain Reaction in the Diagnosis and Management of Tubercular Uveitis: Global Trends

Cited by 64 publications

References 18 publications

<p>Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series</p>

<p>Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series</p>

Towards national systems for continuous surveillance of antimicrobial resistance: Lessons from tuberculosis

Validation of the Online Collaborative Ocular Tuberculosis Study Calculator for Tubercular Uveitis

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