Ocular tuberculosis in acquired immunodeficiency syndrome.
OBJECTIVE
To present the clinical, histopathological, and molecular biologic findings in fifteen cases of ocular tuberculosis (TB) in patients with acquired immune deficiency syndrome (AIDS).


METHODS
Retrospective, observational, noncomparative case series of HIV-infected patients with ophthalmic complaints and/or with advanced disease (CD4+ cell count < 200), seen between the years 1993 to 2005 at tertiary care ophthalmic and AIDS care hospitals.


METHODS
Each patient underwent a complete ophthalmic examination and relevant laboratory and radiologic investigations and was treated accordingly. The study was carried out in this cohort to describe the ocular manifestations of TB. The main outcome measures were to describe the clinical course histopathologic and molecular biologic features of ocular lesions attributable to tuberculosis in AIDS patients in our center.


RESULTS
Ocular TB was seen in 15 (1.95%) out of 766 consecutive cases of HIV/AIDS. Nineteen eyes of 15 patients were affected. Four cases (26.66%) had bilateral presentation. Presentations of ocular TB included choroidal granulomas in 10 eyes (52.63%), subretinal abscess in seven eyes (36.84%), worsening to panophthalmitis in three eyes, conjunctival tuberculosis, and panophthalmitis each in one eye (5.26%). All cases had evidence of pulmonary tuberculosis. Coexistent central nervous system (CNS) tuberculosis was seen in two cases and one case had abdominal tuberculosis. CD4+ cell counts were done in 14 patients; the count ranged from 14 to 560 cells/microl--mean 160.85 cells/microl.


CONCLUSIONS
Ocular TB in AIDS is relatively rare and can occur even at CD4+ cell counts greater than 200 cells/microl. It can have varied presentations with severe sight-threatening complications.
Babu
Rajesh B
RB
Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India.
Sudharshan
Sridharan
S
Kumarasamy
Nagalingeswaran
N
Therese
Lily
L
Biswas
Jyotirmay
J
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000038:Abscess / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D003229:Conjunctival Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010202:Panophthalmitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D011718:Pyrazinamide / Q000627:therapeutic use; D012164:Retinal Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D020306:Tuberculosis, Central Nervous System / Q000150:complications / Q000175:diagnosis; D014392:Tuberculosis, Ocular / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis
D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin