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Ocular Tuberculosis in Immunocompromised Patients

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Ocular Tuberculosis

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Tuberculosis (TB) is a common opportunistic infection among immunocompromised patients and is a frequent cause of morbidity. Though pulmonary involvement is more common in tuberculosis, extra-pulmonary involvement has seen a recent rise due to increasing number of patients with immunodeficient conditions. The incidence of ocular tuberculosis reported by different authors is highly variable. Though systemic tuberculosis is quite common among HIV patients, ocular TB incidence is relatively rare, as compared to more common conditions like CMV retinitis. Ocular TB most commonly occurs due to secondary spread of bacterium to the eye from other distant foci via haematogenous route. HIV patients with ocular TB may present with choroidal tubercle, subretinal abscess, conjunctival mass, or panophthalmitis. In addition, these patients may show rapid progression due to defective immune function and can be complicated by the phenomenon of ‘immune reconstitution syndrome’. Choroidal tubercle in HIV patients in an endemic setting, even in the absence of visual symptoms, may be suggestive of disseminated tuberculosis. The absence of definitive diagnostic criteria makes the diagnosis of ocular TB a challenge. Currently, most ophthalmologists diagnose the condition on the basis of typical ocular features, evidence of tuberculosis elsewhere in the body, and response to antitubercular medications. The situation may be even more complex in immunocompromised patients due to atypical findings like negative Mantoux test. The treatment regime followed for TB in these patients is standard antitubercular treatment, with HAART preferably given a few weeks later.

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Pukhraj Rishi, Ekta Rishi, Sridevi Nair, Sridharan Sudharshan, and Sharanya Abraham declare that they have no conflict of interest. No human or animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Sankara Nethralaya, Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, TN, India

    Pukhraj Rishi MS, FRCS, Ekta Rishi MS & Sridevi Nair MD

  2. Uvea Department, Sankara Nethralaya, Chennai, TN, India

    S. Sudharshan MS & Sharanya Abraham MBBS, DO, DNB

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  1. Pukhraj Rishi MS, FRCS
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Correspondence to Pukhraj Rishi MS, FRCS .

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  1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

    Atul Kumar

  2. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

    Rohan Chawla

  3. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

    Namrata Sharma

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Rishi, P., Rishi, E., Nair, S., Sudharshan, S., Abraham, S. (2017). Ocular Tuberculosis in Immunocompromised Patients. In: Kumar, A., Chawla, R., Sharma, N. (eds) Ocular Tuberculosis. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-57520-9_11

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