title: Role of the Infectious Disease Consultant in Management of Patients With Tuberculosis-Associated Ocular Inflammation.
abstract: Background.  Tuberculosis is a disease with continued worldwide prevalence, morbidity, and mortality. Tuberculosis-associated ocular inflammation (TB-AOI) is a manifestation that can occur with pulmonary or extrapulmonary TB. Evaluation of these ocular presentations and treatment in the United States are limited. Our objective was to describe cases in an urban area and assess the role of the infectious diseases specialist in managing these complex patients. Methods.  We performed a retrospective case series of all patients referred to our infectious disease clinic for presumed TB-AOI from 2005 through 2013. Patients with ocular inflammation were determined to have presumed TB-AOI based on clinical presentation with correlative positive tuberculin skin test and/or QuantiFERON-TB Gold. Attempts were made to exclude other diagnoses. Data were collected and analyzed with respect to demographics, ocular manifestations, and treatment. Results.  Sixty eyes of 42 patients were included in the study; anterior uveitis was the most common site of involvement. The median age was 46 years, and 33 patients (79%) were foreign born. Forty patients (95%) received a course of antituberculous therapy with 38% experiencing treatment-related side effects. A 6-month duration was recommended in 78% cases. There was improvement or stability of the vision in 42 eyes (74%) of those treated. Conclusions.  Ocular involvement is an uncommon but important manifestation of TB. Our data further characterize TB-AOI cases in the United States. Treatment provides significant benefit to properly selected patients. A multidisciplinary approach, with care provided by ophthalmology and infectious disease providers, should be used to allow for the most efficacious treatment.
authors.affiliation: Division of Infectious Diseases, Rush University; Division of Infectious Diseases, John Stroger Hospital of Cook County and Ruth Rothstein CORE Center.
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Conant
authors.affiliation: Department of Internal Medicine.
authors.forename: Chuck R
authors.initials: CR
authors.lastname: Vrasich
authors.affiliation: Division of Ophthalmology , John Stroger Hospital of Cook County , Chicago, Illinois.
authors.forename: Jeff V
authors.initials: JV
authors.lastname: Wongskhaluang
authors.affiliation: Division of Ophthalmology , John Stroger Hospital of Cook County , Chicago, Illinois.
authors.forename: Kevin
authors.initials: K
authors.lastname: Ferenchak
authors.affiliation: Division of Ophthalmology , John Stroger Hospital of Cook County , Chicago, Illinois.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Asano
authors.affiliation: Division of Ophthalmology , John Stroger Hospital of Cook County , Chicago, Illinois.
authors.forename: Norbert
authors.initials: N
authors.lastname: Becker
authors.affiliation: Division of Infectious Diseases , John Stroger Hospital of Cook County and Ruth Rothstein CORE Center.
authors.forename: Patricia
authors.initials: P
authors.lastname: DeMarais
keywords: Mycobacterium; ocular infections; tuberculosis; uveitis
references.citation: JAMA Ophthalmol. 2013 Jun;131(6):752-8
references.pmid: 23579549
references.citation: Ophthalmology. 2009 Jul;116(7):1391-6
references.pmid: 19576501
references.citation: Acta Ophthalmol. 2013 Mar;91(2):e99-e107
references.pmid: 23039176
references.citation: J Multidiscip Healthc. 2013;6:41-3
references.pmid: 23450761
references.citation: Am J Ophthalmol. 2005 Sep;140(3):509-16
references.pmid: 16196117
references.citation: Infection. 2014 Apr;42(2):335-42
references.pmid: 24277596
references.citation: Am J Ophthalmol. 2010 Apr;149(4):562-70
references.pmid: 20149341
references.citation: Ocul Immunol Inflamm. 2010 Aug;18(4):281-91
references.pmid: 20662660
references.citation: Ocul Immunol Inflamm. 2009 Sep-Oct;17(5):351-5
references.pmid: 19831571
references.citation: AAPS J. 2010 Sep;12(3):348-60
references.pmid: 20437123
references.citation: Surv Ophthalmol. 2004 Jan-Feb;49(1):78-89
references.pmid: 14711441
references.citation: Chest. 1997 Jul;112(1):63-70
references.pmid: 9228359
references.citation: MMWR Recomm Rep. 2005 Nov 4;54(RR-12):1-81
references.pmid: 16267499
references.citation: Tuber Lung Dis. 1999;79(4):229-33
references.pmid: 10692991
references.citation: Drug Discov Today. 2011 Mar;16(5-6):270-7
references.pmid: 21167306
references.citation: Ann Acad Med Singapore. 2006 Mar;35(3):203-9
references.pmid: 16625271
references.citation: Surv Ophthalmol. 2007 Nov-Dec;52(6):561-87
references.pmid: 18029267
references.citation: Curr Opin Ophthalmol. 2012 Nov;23(6):551-6
references.pmid: 23047173
references.citation: Ophthalmology. 2002 May;109(5):851-7
references.pmid: 11986087
references.citation: Int Ophthalmol Clin. 2007 Summer;47(3):45-62
references.pmid: 17667275