Luis Anibarro1,2, Eliana Cortés3, Ana Chouza4, Alberto Parafita-Fernández5, Juan Carlos García4, Alberto Pena4, Carlos Fernández-Cid5, África González-Fernández6. 1. Unidad de Tuberculosis, Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo hospitalario universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, Rúa Loureiro Crespo, nº2, 36001, Pontevedra, Spain. luis.anibarro.garcia@sergas.es. 2. Inmunología, Centro de investigaciones Biomédicas, CINBIO, Centro Singular de Investigación de Galicia, Universidad de Vigo, Campus Universitario de Vigo, 36310, Vigo, Spain. luis.anibarro.garcia@sergas.es. 3. Servicio de Medicina Interna, Hospital universitario Ramón y Cajal, Carretera Colmenar Viejo km 9,100, 28034, Madrid, Spain. 4. Unidad de Tuberculosis, Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo hospitalario universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, Rúa Loureiro Crespo, nº2, 36001, Pontevedra, Spain. 5. Servicio de Oftalmología, Complexo hospitalario universitario de Pontevedra, 36001, Pontevedra, Spain. 6. Inmunología, Centro de investigaciones Biomédicas, CINBIO, Centro Singular de Investigación de Galicia, Universidad de Vigo, Campus Universitario de Vigo, 36310, Vigo, Spain.
Abstract
PURPOSE: Diagnosis of tuberculous uveitis (TBU) is often challenging and is usually made after excluding other causes of uveitis. We analysed the characteristics of TBU and variables associated with visual outcome. METHODS: A retrospective, observational analysis was performed in patients with presumptive TBU who were started on specific TB treatment between January 2006 and June 2016. Demographic, clinical, radiological, analytical and ophthalmic examination variables were studied. After completing TB treatment, a follow-up of at least 9 months was performed. A univariate and logistic regression analysis was applied to identify the variables associated with visual acuity and recurrences of uveitis. RESULTS: Forty affected eyes of 24 individuals were identified; 79% of patients were diagnosed during the last 3 years of the study period. Median delay from onset of symptoms to diagnosis was 12 weeks. Loss of visual acuity was the most frequent symptom (87.5%). Posterior uveitis was the most frequent localization (72.9%); 19 patients (79.2%) presented at least one of the Gupta signs predictive of TBU, but there were no confirmed diagnoses. OUTCOME: There was improvement in visual acuity in 74.4% of the eyes, but a complete response was achieved only in 56.4%. There was recurrence in two patients. The initiation of treatment ≥ 24 weeks after onset of symptoms was significantly associated with no improvement (p = 0.026). CONCLUSION: TBU can cause permanent damage to visual acuity, particularly in patients with delayed diagnosis. A prompt initiation of systemic TB treatment is essential to improve visual prognosis.
PURPOSE: Diagnosis of tuberculous uveitis (TBU) is often challenging and is usually made after excluding other causes of uveitis. We analysed the characteristics of TBU and variables associated with visual outcome. METHODS: A retrospective, observational analysis was performed in patients with presumptive TBU who were started on specific TB treatment between January 2006 and June 2016. Demographic, clinical, radiological, analytical and ophthalmic examination variables were studied. After completing TB treatment, a follow-up of at least 9 months was performed. A univariate and logistic regression analysis was applied to identify the variables associated with visual acuity and recurrences of uveitis. RESULTS: Forty affected eyes of 24 individuals were identified; 79% of patients were diagnosed during the last 3 years of the study period. Median delay from onset of symptoms to diagnosis was 12 weeks. Loss of visual acuity was the most frequent symptom (87.5%). Posterior uveitis was the most frequent localization (72.9%); 19 patients (79.2%) presented at least one of the Gupta signs predictive of TBU, but there were no confirmed diagnoses. OUTCOME: There was improvement in visual acuity in 74.4% of the eyes, but a complete response was achieved only in 56.4%. There was recurrence in two patients. The initiation of treatment ≥ 24 weeks after onset of symptoms was significantly associated with no improvement (p = 0.026). CONCLUSION:TBU can cause permanent damage to visual acuity, particularly in patients with delayed diagnosis. A prompt initiation of systemic TB treatment is essential to improve visual prognosis.
Authors: M S Tognon; M Fiscon; P Mirabelli; G Graziani; M Peracchi; A Sattin; S Marinello; F Vianello; D Sgarabotto Journal: Infection Date: 2013-11-26 Impact factor: 3.553