Abstract
Background Over the last decade ocular involvement due to tuberculosis has re-emerged. In non-endemic areas the low frequency of active tuberculosis is at the origin of an underestimation of the disease. The purpose of this study is to report a group of patients with presumed tuberculous uveitis and to analyse the pre-diagnostic course, the diagnostic delay and the evolution of ocular inflammation after diagnosis and anti-tuberculous treatment.
Methods Criteria for presumed tuberculous uveitis included the presence of a hyperpositive tuberculin skin test with compatible uveitis and the exclusion of other possible etiologies.
Results Thirty-five patients fulfilled the diagnostic criteria for presumed tuberculous uveitis and were included in the study. The diagnosis was performed at presentation in only seven patients, while the correct diagnosis was delayed in the other 30 patients. The mean diagnostic delay was 5.7 ± 4 years. Anti-tuberculous therapy was given for a minimum of 6 to a maximum of 24 months. Post-diagnostic mean follow-up was 30.4 ± 13.4 months. Anti-tuberculous therapy resulted in a highly significant increase in visual acuity, from 0.53 to 0.78 (P < 0.001), a highly significant decrease of recurrences, from 100 to 10% (P < 0.001), with only three recurrences observed during the follow-up, and a highly significant decrease in intra-ocular pressure, from 18.3 to 13.7 (P < 0.001).
Conclusions Our study tends to confirm the existence of tuberculous uveitis and supports the validity of the proposed diagnostic criteria. Recognition of the correct diagnosis and specific therapy, even with substantial delay, avoids recurrences, improves visual acuity and intra-ocular inflammation and decreases intra-ocular pressure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Dye C, Scheele S, Dolin P, et al (1999) Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country: WHO Global Surveillance and Monitoring Project. JAMA 282:677–686
Global tuberculosis control: WHO report (2001) Geneva: World Health Organization, 2001. WHO/CDS/TB/2001.287
Dolin PJ, Raviglione MC, Kochi A (1994) Global tuberculosis incidence and mortality during 1990–2000. Bull World Health Organ 72:213–220
Geiter L (ed) (2000) Ending neglect: the elimination of tuberculosis in the United States. National Academy Press, Washington D.C., pp 86–121
Jasmer RM, Nahid P, Hopewell PC (2002) Latent tuberculosis infection. N Engl J Med 347:1860–1866
Alvarez S, McCabe WR (1984) Extra pulmonary tuberculosis revisited: a review of experience at Boston city and other hospitals. Medicine 63:25–55
Woods AC (1960) Modern concepts of the etiology of uveitis. Am J Ophthalmol 50:1170–1187
Tran VT, Auer C, Guex-Croiser Y, et al (1994) Epidemiology of uveitis in Switzerland. Ocul Immunol Inflamm 2:169–176
Helm CJ, Holland GN (1993) Ocular tuberculosis. Surv Ophthalmol 38:229–256
Bodaghi B, LeHoang P (2000) Ocular tuberculosis. Curr Opin Ophthalm 11:443–448
Helm CJ, Holland G (1993) Ocular tuberculosis. Surv Ophthalmol 38:229–256
Wolfensberger TJ, Piguet B, Herbort CP (1999) Indocyanine green angiographic features in tuberculous chorioretinitis. Am J Ophthalmol 127:350–353
Herbort CP, Probst K, Cimino L, Tran VT (2004) Differential involvement of retina and choroid in birdshot chorioretinopathy. Klin Montsbl Augenheilkd 211:351–356
Holden M, Dubin MR, Diamond PH (1971) Frequency of negative intermediate strength tuberculin sensitivity in patients with active tuberculosis. N Engl J Med 285:1506–1509
Nash DR, Douglass JE (1980) Anergy in active pulmonary tuberculosis: a comparison between positive and negative reactors and an evaluation of 5 TU and 250 TU skin test doses. Chest 77:32–37
Barondes MJ, Sponsel WE, Stevens TS, et al (1991) Tuberculous choroiditis diagnosed by chorioretinal endobiopsy. Am J Ophthalmol 112:460–461
Dye C, Williams BG (2000) Criteria for the control of drug-resistant tuberculosis. Proc Natl Acad Sci USA, 97:8180–8185
Gupta V, Arora S, Gupta A, et al (1998) Management of presumed intraocular tuberculosis: possible role of the polymerase chain reaction. Acta Ophthalmol Scand 76:679–682
Kotake S, Kimura K, Yoshikawa K, et al (1994) Polymerase chain reaction for the detection of Mycobacterium tuberculosis. In ocular tuberculosis. Am J Ophthalmol 117:805–806
Noordhoek GT, Kolk AH, Bjuneg, et al (1994) Sensitivity and specificity of PCR for detection of Mycobacterium tuberculosis: a blind comparison study among seven laboratories. J Clin Microbiol 32:277–284
Biswas J, Therese L, Madhavan HN (1999) Use of Polimerase chain reaction in detection of Mycobacterium tuberculosis complex DNA from vitreous sample of Eales’ disease. Br J Ophthalmol 83:994
Madhavan HN, Therese KL, Gunisha P, et al (2000) Polimerase chain reaction for detection of Mycobacterium tuberculosis in epiretinal membrane in Eales’ disease. Invest Ophthalmol Vis Sci 41:822–855
Biswas J, Madhavan HN, Gopal L et al. (1995) Intraocular tuberculosis. Clinic pathological study of five cases. Retina 15:461–468
Bowyer JD, Gormley PD, Seth R, et al (1999) Choroidal tuberculosis diagnosed by polymerase chain reaction. A clinicopathologic case report. Ophthalmology 106:290–294
Sarvananthan N, Wiselka M, Bibby K (1998) Intraocular tuberculosis without detectable systemic infection. Arch Ophthalmol 116:1386–1388
Sakai J, Matsuzawa S, Usui M (2001) New diagnostic approach for ocular tuberculosis by ELISA using the cord factor as antigen. Br J Ophthalmol 85:130–133
Gupta V, Gupta A, Arora S et al. (2003) Presumed tuberculous serpiginous like choroiditis. Ophthalmology 110:1744–1749
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cimino, L., Herbort, C.P., Aldigeri, R. et al. Tuberculous uveitis, a resurgent and underdiagnosed disease. Int Ophthalmol 29, 67–74 (2009). https://doi.org/10.1007/s10792-007-9071-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-007-9071-8