title: Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS.
abstract: Choroidal tuberculosis is present in 5-20% of patients with disseminated tuberculosis, and point-of-care dilated binocular indirect ophthalmoscopy eye examination can provide immediate diagnosis. In geographical areas of high tuberculosis prevalence and in susceptible patients (CD4 counts less than 200 cells per μL) detection of choroidal granulomas should be accepted as evidence of disseminated tuberculosis. With training and proper support, eye screening can be done by HIV/AIDS clinicians, allowing early tuberculosis treatment. In regions with a high burden of tuberculosis, we recommend that eye screening be a standard part of the initial assessment of susceptible patients, including at a minimum all patients with HIV/AIDS with CD4 less than 100 cells per μL with or without eye symptoms, and with or without suspicion of disseminated tuberculosis.
authors.affiliation: Seva Foundation, Berkeley, California, USA. Electronic address: dheidenpea@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Heiden
authors.affiliation: Southern Africa Medical Unit, Operational Centre Brussels, Médecins Sans Frontières, Cape Town, South Africa.
authors.forename: Peter
authors.initials: P
authors.lastname: Saranchuk
authors.affiliation: Francis I Proctor Foundation, University of California, San Francisco, CA, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Lowinger
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Yen
authors.affiliation: Division of Experimental Medicine, University of California, San Francisco, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: McCune
authors.affiliation: Ophthalmic Pathology Laboratory and Uveitis Service, USC Eye Institute, Keck School of Medicine, University of Southern California, CA, USA.
authors.forename: Narsing A
authors.initials: NA
authors.lastname: Rao
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000382:microbiology; D015862:Choroid Diseases / Q000175:diagnosis* / Q000382:microbiology; D042241:Early Diagnosis; D005123:Eye / Q000382:microbiology; D006099:Granuloma / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000473:pathology; D019095:Point-of-Care Systems; D015995:Prevalence; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D014392:Tuberculosis, Ocular / Q000150:complications / Q000175:diagnosis / Q000382:microbiology