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The spectrum of presumed tubercular uveitis in Tunisia, North Africa

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Abstract

The purpose of this study was to analyze the spectrum of presumed tubercular uveitis in Tunisia, North Africa. We retrospectively reviewed the clinical records of 38 patients (65 eyes) diagnosed with presumed tubercular uveitis at two referral centers in Tunisia, between January 2009 and December 2011. Mean age at presentation was 42.7 years. Twenty-four patients were women (63.2 %) and 14 (36.8 %) were men. Twenty-three eyes (35.4 %) had posterior uveitis, 21 eyes (32.3 %) had intermediate uveitis, 13 eyes (20 %) had panuveitis, and 8 eyes (12.3 %) had anterior uveitis. Ocular findings included vitritis in 67.7 % of eyes, posterior synechiae in 47.7 %, multifocal non-serpiginoid choroiditis in 23.1 %, multifocal serpiginoid choroiditis in 21.5 %, periphlebitis in 21.5 %, and mutton-fat keratic precipitates in 20 %. Anti-tubercular treatment was prescribed in 33 patients (86.8 %) and was associated with systemic corticosteroids in 20 patients (52.6 %) and periocular injections of corticosteroids in four patients (10.5 %). After a mean follow-up of 14.2 months (range, 10–58), inflammation was controlled, with a significant improvement in visual acuity (VA) (p = 0.028). However, recurrences developed in two patients (5.3 %). Final VA was better than 20/40 in 27 eyes (41.5 %) and less than 20/200 in five eyes (7.7 %). In Tunisia, all anatomic types are possible in tuberculosis-associated uveitis, but posterior and intermediate uveitis are more frequent. Vitritis, posterior synechiae, multifocal serpiginoid or non-serpiginoid choroiditis, and periphlebitis are the most common manifestations.

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References

  1. Gupta V, Gupta A, Rao NA (2007) Intraocular tuberculosis–an update. Surv Ophthalmol 52:561–587

    Article  PubMed  Google Scholar 

  2. Gupta A, Bansal R, Gupta V, Sharma A, Bambery P (2010) Ocular signs predictive of tubercular uveitis. Am J Ophthalmol 149:562–570

    Article  PubMed  Google Scholar 

  3. Al-Mezaine HS, Al-Muammar A, Kangave D, El-Asrar AMA (2008) Clinical and optical coherence tomographic findings and outcome of treatment in patients with presumed tuberculous uveitis. Int Ophthalmol 28:413–423

    Article  PubMed  Google Scholar 

  4. Sanghvi C, Bell C, Woodhead M, Hardy C, Jones N (2011) Presumed tuberculous uveitis: diagnosis, management, and outcome. Eye (Lond) 25:475–480

    Article  CAS  Google Scholar 

  5. Rosen PH, Spalton DJ, Graham EM (1990) Intraocular tuberculosis. Eye (Lond) 4:486–492

    Article  Google Scholar 

  6. Basu S, Das T (2010) Pitfalls in the management of TB-associated uveitis. Eye (Lond) 24:1681–1684

    Article  CAS  Google Scholar 

  7. Al-Mezaine HS, Kangave D, El-Asrar AMA (2010) Patterns of uveitis in patients admitted to a University Hospital in Riyadh, Saudi Arabia. Ocul Immunol Inflamm 18:424–431

    Article  PubMed  Google Scholar 

  8. Singh R, Gupta V, Gupta A (2004) Pattern of uveitis in a referral eye clinic in north India. Indian J Ophthalmol 52:121–125

    PubMed  Google Scholar 

  9. Wakabayashi T, Morimura Y, Miyamoto Y, Okada AA (2003) Changing patterns of intraocular inflammatory disease in Japan. Ocul Immunol Inflamm 11:277–286

    Article  PubMed  Google Scholar 

  10. Henderly DE, Genstler AJ, Smith RE, Rao NA (1987) Changing patterns of uveitis. Am J Ophthalmol 103:131–136

    Article  CAS  PubMed  Google Scholar 

  11. Khairallah M, Yahia SB, Ladjimi A, Messaoud R, Zaouali S, Attia S et al (2007) Pattern of uveitis in a referral centre in Tunisia, North Africa. Eye (Lond) 21:33–39

    Article  CAS  Google Scholar 

  12. Bansal R, Gupta A, Gupta V, Dogra MR, Bambery P, Arora SK (2008) Role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis. Am J Ophthalmol 146:772–779

    Article  CAS  PubMed  Google Scholar 

  13. Varma D, Anand S, Reddy AR, Das A, Watson JP, Currie DC et al (2006) Tuberculosis: an under-diagnosed aetiological agent in uveitis with an effective treatment. Eye (Lond) 20:1068–1073

    Article  CAS  Google Scholar 

  14. Bansal R, Gupta A, Gupta V, Dogra MR, Sharma A, Bambery P (2012) Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoid choroiditis. Ophthalmology 119:2334–2342

    Article  PubMed  Google Scholar 

  15. la Distia Nora R, van Velthoven ME, dam-van Loon NHT, Misotten T, Bakker M, van Hagen MP et al (2014) Clinical manifestations of patients with intraocular inflammation and positive QuantiFERON-TB gold in-tube test in a country non-endemic for tuberculosis. Am J Ophthalmol 157(4):754–761

    Article  Google Scholar 

  16. Manousaridis K, Ong E, Stenton C, Gupta R, Browning AC, Pandit R (2013) Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK. Eye (Lond) 27:480–486

    Article  CAS  Google Scholar 

  17. Vasconcelos-Santos DV, Rao PK, Davies JB, Sohn EH, Rao NA (2010) Clinical features of tuberculous serpiginous-like choroiditis in contrast to classic serpiginous choroiditis. Arch Ophthalmol 128:853–858

    Article  PubMed  Google Scholar 

  18. Nazari Khanamiri H, Rao NA (2013) Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis. Surv Ophthalmol 58:203–232

    Article  PubMed  Google Scholar 

  19. Gan WL, Jones NP (2013) Serpiginous-like choroiditis as a marker for tuberculosis in a non-endemic area. Br J Ophthalmol 97:644–647

    Article  PubMed  Google Scholar 

  20. Singh R, Toor P, Parchand S, Sharma K, Gupta V, Gupta A (2012) Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales’ disease. Ocul Immunol Inflamm 20:153–157

    Article  CAS  PubMed  Google Scholar 

  21. Babu K, Kini R, Mehta R, Philips M, Subbakrishna DK, Murthy KR (2012) Predictors for tubercular uveitis: a comparison between biopsy-proven cases of tubercular and sarcoid uveitis. Retina 32:1017–1020

    Article  PubMed  Google Scholar 

  22. Vasconcelos-Santos DV, Zierhut M, Rao NA (2009) Strengths and weaknesses of diagnostic tools for tuberculous uveitis. Ocul Immunol Inflamm 17:351–355

    Article  PubMed Central  PubMed  Google Scholar 

  23. Ball PM, Pernollet M, Bouillet L, Maurin M, Pavese P, Quesada JL et al (2010) Usefulness of an in vitro tuberculosis interferon-and; release assay (T-SPOT.TB) in the first-line check-up of uveitis patients. Ann Med 42:546–554

    Article  PubMed  Google Scholar 

  24. Mackensen F, Becker MD, Wiehler U, Max R, Dalpke A, Zimmermann S (2008) QuantiFERON TB-Gold—a new test strengthening long-suspected tuberculous involvement in serpiginous-like choroiditis. Am J Ophthalmol 146:761–766

    Article  PubMed  Google Scholar 

  25. Sudharshan S, Ganesh SK, Balu G, Mahalakshmi B, Therese LK, Madhavan HN et al (2012) Utility of QuantiFERON®-TB gold test in diagnosis and management of suspected tubercular uveitis in India. Int Ophthalmol 32:217–223

    Article  CAS  PubMed  Google Scholar 

  26. Kuznetcova TI, Sauty A, Herbort CP (2012) Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity). Int Ophthalmol 32:499–506

    Article  PubMed  Google Scholar 

  27. Ang M, Htoon HM, Chee SP (2009) Diagnosis of tuberculous uveitis: clinical application of an interferon-gamma release assay. Ophthalmology 116:1391–1396

    Article  PubMed  Google Scholar 

  28. Ang M, Wanling W, Chee SP (2012) Clinical significance of an equivocal interferon γ release assay result. Br J Ophthalmol 96:284–288

    Article  PubMed  Google Scholar 

  29. Balne PK, Modi RR, Choudhury N, Mohan N, Barik MR, Padhi TR, Sharma S, Panigrahi SR, Basu S (2014) Factors influencing polymerase chain reaction outcomes in patients with clinically suspected ocular tuberculosis. J Ophthalmic Inflamm Infect 4(1):10

    Article  PubMed Central  PubMed  Google Scholar 

  30. El-Asrar AMA, Al-Mezaine HS (2010) Anti-tuberculous therapy combined with systemic corticosteroids improves retinal sensitivity in patients with active presumed tuberculous choroiditis. Int Ophthalmol 30:567–576

    Article  PubMed  Google Scholar 

  31. Ang M, Hedayatfar A, Wong W, Chee SP (2012) Duration of anti-tubercular therapy in uveitis associated with latent tuberculosis: a case-control study. Br J Ophthalmol 96:332–336

    Article  PubMed  Google Scholar 

  32. Rao NA, Saraswathy S, Smith RE (2006) Tuberculous uveitis: distribution of Mycobacterium tuberculosis in the retinal pigment epithelium. Arch Ophthalmol 124:1777–1779

    Article  PubMed  Google Scholar 

  33. Gineys R, Bodaghi B, Carcelain G, Cassoux N, le Boutin TH, Amoura Z et al (2011) QuantiFERON-TB gold cut-off value: implications for the management of tuberculosis-related ocular inflammation. Am J Ophthalmol 152:433–440.e1

    PubMed  Google Scholar 

  34. Basu S, Nayak S, Padhi TR, Das T (2013) Progressive ocular inflammation following anti-tubercular therapy for presumed ocular tuberculosis in a high-endemic setting. Eye (Lond) 27:657–662

    Article  CAS  Google Scholar 

  35. Cheung CM, Chee SP (2009) Jarisch-Herxheimer reaction: paradoxical worsening of tuberculosis chorioretinitis following initiation of antituberculous therapy. Eye (Lond) 23:1472–1473

    Article  CAS  Google Scholar 

  36. Gupta V, Bansal R, Gupta A (2011) Continuous progression of tubercular serpiginous-like choroiditis after initiating antituberculosis treatment. Am J Ophthalmol 152:857–863.e2

    Article  PubMed  Google Scholar 

  37. Julian K, Langner-Wegscheider BJ, Haas A, de Smet MD (2013) Intravitreal methotrexate in the management of presumed tuberculous serpiginous-like choroiditis. Retina 33:1943–1948

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work has been supported by the Ministry of Higher Education and Research of Tunisia.

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Authors and Affiliations

  1. Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia

    Sana Khochtali, Nesrine Abroug, Imen Ksiaa, Sonia Attia & Moncef Khairallah

  2. Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia

    Salma Gargouri, Dorra Sellami & Jamel Feki

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  1. Sana Khochtali
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  2. Salma Gargouri
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Correspondence to Moncef Khairallah.

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Khochtali, S., Gargouri, S., Abroug, N. et al. The spectrum of presumed tubercular uveitis in Tunisia, North Africa. Int Ophthalmol 35, 663–671 (2015). https://doi.org/10.1007/s10792-014-9992-y

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  • DOI: https://doi.org/10.1007/s10792-014-9992-y

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