What are the treatment guidelines for ocular tuberculosis (TB)?
Ocular TB is generally treated under the same guidelines for active pulmonary and extrapulmonary TB Standard anti-TB treatment (ATT): 6 months of therapy based on WHO recommendations ( Figure 8)
What does ocular TB stand for?
Ocular Tuberculosis (TB) - Asia Pacific. Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis, which can cause disease in multiple organs throughout the body, including the eye. The term “ocular TB” describes an infection by the M. tuberculosis species that can affect any part of the eye (intraocular, superficial,...
What is the relationship between ocular tuberculosis (TB) and pulmonary TB?
Ocular TB may not be associated with clinical evidence of pulmonary TB; up to 60% of patients with evidence of extrapulmonary TB may not have diagnosed pulmonary TB Ocular TB may be an initial presentation of extrapulmonary dissemination of infection Posterior uveitis is the most common presentation of intraocular TB.
What is the prevalence of tuberculosis of the eye?
The overwhelming majority of patients with eye tuberculosis (97.4%) identify by treatment. In this case, a high proportion of specific processes diagnosed in the late stages of development - 43.7%. This fact indirectly indicates that. That at the beginning of manifestations of a common tuberculosis infection, specific eye lesions were missed.
How is ocular tuberculosis treated?
In general, the treatment of ocular tuberculosis is the same as for pulmonary TB. Treatment consists of a four-drug regimen, administered in two phases: rifampicin, isoniazid, pyrazinamide, and ethambutol daily for two months, followed by rifampicin and isoniazid for four months.
Can ocular TB cause blindness?
Tuberculosis is a cause of ocular morbidity, visual impairment and blindness. Prevention, early diagnosis and early treatment of TB may prevent avoidable visual loss.
How do you get TB of the eye?
Tuberculosis of the retina most commonly results from the direct extension from the underlying uvea but may also be caused by hematogenous spread. Retinal lesions may take the form of either focal tubercles or diffuse retinitis.
What are the symptoms of ocular tuberculosis?
Blurry vision, and light sensitivity may be the only reported symptoms. Other complaints may include headache, redness of the eye, floaters, or flashes. Patients may also be asymptomatic.
Can TB medicines cause eye problems?
It is generally well tolerated, but known to cause optic neuritis, more specifically retro bulbar neuritis causing blurred vision, decreased visual acuity, central scotomas, and loss of red-green color vision.
Does TB medication cause eye problems?
A study, jointly conducted by Medecins Sans Frontiers (MSF) and Lilavati Hospital in Mumbai, has shown that some anti-tuberculosis drugs can have adverse effects on the eye, and can even lead to compromised vision in patients.
How common is ocular TB?
Ocular TB is still an important cause of uveitis. Prevalence of TB as an etiology of uveitis has varied from 0.5% in the USA,12 4% in the People's Republic of China,13 6.31% in Italy,14 6.9% in Japan,15 9.86% in north India,16 10.5% in Saudi Arabia,17 and 11.4% in Iraq where TB is endemic.
How common is ocular TB?
Ocular TB is still an important cause of uveitis. Prevalence of TB as an etiology of uveitis has varied from 0.5% in the USA,12 4% in the People's Republic of China,13 6.31% in Italy,14 6.9% in Japan,15 9.86% in north India,16 10.5% in Saudi Arabia,17 and 11.4% in Iraq where TB is endemic.
Can tuberculous meningitis cause blindness?
Blindness and vision impairment are unpredictable complications of tuberculous meningitis (TBM) that are often unrecognized in the acute stages of illness due to inability to assess vision in patients with depressed levels of consciousness or confusion.
What is a multifocal choroidal lesions?
Multifocal, discrete choroidal lesions that are initially noncontiguous and later progress to form diffuse lesions with an active edge resembling serpiginous choroiditis
What is secondary ocular TB?
“Secondary ocular TB” is defined as ocular involvement as a result of seeding by hematogenous spread from a distant site or direct invasion by ...
What is the most common presentation of intraocular TB?
Posterior uveitis is the most common presentation of intraocular TB.
What are the symptoms of uveitis?
SIGNS/SYMPTOMS. In general, blurred vision and light sensitivity are the most common symptoms and may be the only reported symptoms. Patients can also be asymptomatic or have other complaints, such as headache, flashes, floaters, or redness of the eye. Anterior Uveitis ( Figure 1) Unilateral or bilateral.
What is TB in Asia?
Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis, which can cause disease in multiple organs throughout the body, including the eye. The term “ocular TB” describes an infection by the M. tuberculosis species that can affect any part of the eye (intraocular, superficial, ...
How long does it take to get anti-TB treatment?
Standard anti-TB treatment (ATT): 6 months of therapy based on WHO recommendations ( Figure 8)
How many people in the world have TB?
Nearly one-third of the world’s population is latently infected with TB, and more than 9 million new cases are diagnosed each year, 95% in developing countries.
What is paradoxical worsening of TB?
Paradoxical worsening is observed due to a combination of multiple factors, including increased type IV hypersensitivity, increased exposure to Mycobacterium antigen such as tubercular proteins and the eye’s response to them, and decreased suppressor mechanisms. The rate of detection of this worsening has increased significantly since the introduction of ultra-wide-field retinal imaging. UWF imaging detects 36 percent cases of worsening after two to six weeks of initiation of ATT versus only 14 percent with conventional imaging. 17 OCTA, too, has proven to be very useful in detecting paradoxical worsening by showing the alteration in choriocapillaris. 24 When detected, these patients require a higher dose of steroids or additional methylprednisolone pulses intravenously. In cases of anterior uveitis, topical steroids can be administered. The addition of steroid-sparing immunosuppressants is based on the patient’s need for them, as well as the discretion of the uveitis specialist. 25-30
What is the cots 1 study?
A recently completed multicenter retrospective collaborative study (the Collaborative Ocular Tuberculosis Study [COTS-1]) collected data from 40 uveitis experts around the world in order to address the current controversies related to the diagnosis and management of intraocular tuberculosis. 9-12 The study had 945 subjects, 74 percent of whom were Asian. The study showed a higher prevalence of intraocular tuberculosis in the Asian population, in both native residents and immigrants. Among the Asian patients, the most common manifestation was TB serpiginous-like choroiditis (SLC), which was far less common in the Western population. 9 This study highlighted the variations in practice guidelines and lack of consensus among the experts about the diagnosis and management of this disease.
What are the three types of choroiditis?
Serpiginous-like choroiditis has three distinct patterns: multifocal; placoid; and mixed. 14,15 The multifocal pattern is characterized by multiple discrete, yellowish lesions with well-defined margins. The placoid pattern appears as a large plaque with yellowish edges and pigmentary changes in the center. When both features are present, the disease is characterized as mixed.
How to detect TB SLC?
Several newer imaging techniques like ultra widefield imaging can play a significant role in identifying peripheral lesions in SLC that may be otherwise missed by conventional imaging.17 OCT also helps detect retinochoroidal changes in TB SLC. OCT B-scans passing the active edge of TB SLC during the active stage show an area of hyper-reflectivity in the outer retinal layers with no increased backscattering from the inner choroid. As the lesions heal, the hyper-reflective fuzzy areas disappear and are replaced by irregular, hyper-reflective knobby elevations of the outer retinal layers and other retinal layers, including RPE, ellipsoid and myoid zones; the ELM can’t be identified at this stage.13 Choroidal vascularity index measurement of the active SLC on OCT will show a relative decrease in choroidal vascularity, with choriocapillaris atrophy and the remodeling of the choroid during the healing stage.18 OCT angiography has demonstrated novel findings that show voids in areas of choriocapillaris flow during the active stage of SLC that also correlate well with indocyanine green angiography.19 ICGA is also very useful for detecting choroidal neovascular membranes that may otherwise be missed.20
Why is mycobacterium a paradoxical ailment worsening?
Paradoxical worsening is observed due to a combination of multiple factors, including increased type IV hypersensitivity, increased exposure to Mycobacterium antigen such as tubercular proteins and the eye’s response to them, and decreased suppressor mechanisms.
Where are choroidal tubercles located?
Choroidal tubercles are mostly located in the posterior pole or mid-periphery , and they show initial hypofluorescence in the early phases of FA, followed by hyperfluorescence in the later phases. These tubercles can also be seen as focal areas of choroidal elevation on OCT.
What is the standard treatment for iotb?
The standard therapy for IOTB consists of isoniazid, rifampicin, ethambutol, pyrazinamide and pyridoxine. The therapy is initiated with 5 mg/kg/day of isoniazid, 10 mg/kg/day of rifampicin, 15 mg/kg/day of ethambutol, 20 to 25 mg/kg/day of pyrazinamide, and 10 mg/day of pyridoxine. The treatment should be started after carefully weighing ...
Why is ocular TB uncertain?
The incidence of ocular TB is uncertain due to difficulties in ocular sampling for microbiology and lack of definitive diagnostic criteria [1,4].
What is the disease that affects the eye?
Tuberculosis ( TB) is an infectious disease caused byMycobacterium tuberculosisthat can affect many organs, including the eye. Ocular TB can involve any part of
Is TB an infectious disease?
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosisthat can affect many organs, including the eye [1-3]. Ocular TB can involve any part of the eye and can occur with or without evidence of systemic TB. It generally develops following hematogenous spread from a primary focus but, in rare cases, ...
Is TB a communicable disease?
TB is an airborne communicable disease of major public health significance in many countries. General issues related to epidemiology of TB are discussed separately. (See "Epidemiology of tuberculosis"and "Epidemiology and pathology of miliary and extrapulmonary tuberculosis"and "Epidemiology and molecular mechanisms of drug-resistant tuberculosis".)
How many groups are there in tubercular uveitis?
By primary localization, tubercular uveitis can be divided into 4 groups:
How much did the incidence of eye tuberculosis decrease between 1975 and 1984?
Between 1975 and 1984, the incidence of eye tuberculosis declined by more than 50%.
How often is chorioretinitis detected?
Also, it should be noted that at a young age, tubercular chorioretinitis is detected more often (more than 2.5 times) - in this case, as a rule, in the early stage of the disease, and after 50 years - the anterior uveitis, and among them more often noted far-gone processes.
What are the diseases of the lungs, bronchi and pleura?
Diseases of the lungs, bronchi and pleura (pulmonology) Diseases of the ear, throat and nose (otolaryngology) Diseases of the endocrine system and metabolic disorders (endocrinology) Sexually transmitted infections (sexually transmitted diseases) Gynecological diseases (gynecology)
What is the medical term for the mammary gland?
Diseases of the mammary glands (mammology) Diseases of the joints, muscles and connective tissue (rheumatology) Cancer (oncology) Diseases of the immune system (immunology) Diseases of the blood (hematology) Diseases of the heart and blood vessels (cardiology) Mental health (psychiatry) Injuries and poisonings.
Is hematogenic tuberculosis uveitis a symptom?
The onset of the disease, as a rule, is rarely noticeable without symptom. The inflammatory process proceeds sluggishly, torpidly, without severe pain syndrome, but may acquire a more acute course in cases of accession of the allergic component (which is more often observed in adolescents and young people) and / or secondary infection. The clinical picture of hematogenic tuberculosis uveitis is characterized by pronounced polymorphism, so it is difficult to single out strictly pathognomonic signs of the disease.
Where do tubercular lesions occur?
Tubercular lesions of the organ of vision occur in most cases in young and middle-aged people, more often in women, in towns or in a large village, with satisfactory living conditions, with moderate income, from employees or skilled workers, without bad habits, with concomitant diseases.
