TB Gold Test Research Articles

Quantiferon-TB Gold Test in Diagnosis of Tubercular Uveitis

Background: Tuberculosis can occur in eye as a result of an active infection or immunological reaction to the tuberculosis antigen. One of the most accurate tests for suspected ocular tuberculosis is the Quantiferon TB Gold (QFT-G) test, which has a higher specificity than the Tuberculin Skin Test (TST) especially among persons vaccinated with bacillus Calmette-Guérin (BCG) and the fact that most environmental mycobacteria give TST positive results. Methods: We retrospectively reviewed thirty nine presumed ocular tuberculosis cases who had both TST and QFT-G test prior to anti-tuberculosis treatment (ATT) in the National Institute of Ophthalmology and Hospital and Vision Eye Hospital, Dhaka from January, 2019 to December, 2021. Patients who had concomitant pulmonary or other extra pulmonary tuberculosis were excluded from the study. Results: The most common anatomical type of uveitis was posterior uveitis 24(61.5%) and vasculitis retinae 8(20.5%) was the commonest form of specific pattern of uveitis. MT test was positive in 18(46.2%) and QFT-G test was positive in 17 (43.6%) patients. Multifocal choroiditis was commonest form of QFT-G positive uveitis 5(29.5%). There was no significant association of positive QFT-G test with any subset of uveitis (p>0.05). Conclusion: As our study found no significant association of positive QFT-G in patients with any anatomical variety of uveitis or specific variety of uveitis we should advice QFT-G judicially to patients of suspected TBU who have positive TST.

Low rate of seroconversion analyzing QuantiFERON TB-gold testing in patients with psoriasis and hidradenitis suppurativa taking biologic therapy at an academic center in New York City

Low rate of seroconversion analyzing QuantiFERON TB-gold testing in patients with psoriasis and hidradenitis suppurativa taking biologic therapy at an academic center in New York City

Performance of the QuantiFERON- TB gold test in children receiving immunosuppressive therapy for rheumatic diseases

ObjectivesThe mainstay of treatment for pediatric rheumatological disease is disease-modifying anti-rheumatic agents which are immunosuppressive in nature and increase the susceptibility to tuberculosis. The aims and objectives were to evaluate the performance of the QuantiFERON®-TB Gold test (QFT) and Tuberculin skin test (TST) to diagnose latent tuberculosis in children receiving immunosuppressive therapy for rheumatic diseases in a tertiary hospital in South India. MethodsThis was a prospective observational study. 60 consecutive children diagnosed with various rheumatic diseases attending the Paediatric Rheumatology clinic on immunosuppressive therapy were included. The QFT and TST were performed on the same day. Data regarding the demography, diagnosis, treatment received and test results were collected and analysed. ResultsAmong patients included (n = 60), two children had positive QFT and one child had positive TST. The agreement between tests was k = 0.85 and the proportion of latent tuberculosis was 5 %. All the children included were on conventional DMARDs and 3.3 % were on biological DMARDs. There was a significant decrease in the mitogen induced interferon level in children on treatment with hydroxychloroquine (p = 0.022) and a significant increase in the level in children on azathioprine (p = 0.006). Children on steroids had a lower range of mitogen-induced interferon levels. ConclusionQFT may be a more reliable test than TST for the detection of latent tuberculosis in children with rheumatic diseases receiving immunosuppressive treatment. The use of hydroxychloroquine and steroids might influence the mitogen-induced IFN-γ secretion and may interfere with the interpretation of the QFT test.

Polymerase chain reaction confirmed mycobacterium tuberculosis intermediate uveitis – analysis of 22 eyes of 14 cases from a tertiary care centre in South India: a retrospective study

BackgroundTo report the role of Polymerase Chain Reaction in confirming the diagnosis of presumed Mycobacterium Tuberculosis (MTB) Intermediate Uveitis.MethodRetrospective analysis of 22 eyes of 14 cases of presumed tubercular intermediate uveitis wherein intraocular fluid was tested for MTB DNA by Nested & Real-time PCR, based on clinical suspicion of tubercular aetiology. QuantiFERON TB gold test and High-Resolution CT Chest were done. Patients were treated with anti-tubercular therapy with oral steroids & immunomodulators. In the study, eleven were male (79%) and three female (21%). The median age was 34 years. Nested PCR for both IS 6110 & MPB 64 was positive in 64% of the cases, IS 6110 positive in 23% and MPB 64 positive in 15%. Real-time PCR was positive in 48% of the cases. Vision improved in 33% of cases, maintained in 57%, and worsened in 10% of cases.ConclusionPresumed Tubercular intermediate uveitis can be confirmed by PCR of intraocular fluids. Anti-tubercular therapy with immunosuppression can improve vision and prevent recurrences in such cases.

Could different aqueous humor and plasma cytokine profiles help differentiate between ocular sarcoidosis and ocular tuberculosis?

A cross-sectional single-center study was conducted to assess cytokine levels in aqueous humor (AH) and plasma of three different uveitis entities: definite ocular sarcoidosis (OS), definite OS associated with QuantiFERON®-TB Gold test positivity (Q + OS) and presumed tubercular uveitis (TBU). Thirty-two patients (15 OS, 5 Q + OS, 12 TBU) were included. Quantification of selected cytokines was performed on blood and AH samples collected before starting any treatment. Statistical analysis was conducted using the Kruskal-Wallis test, the Mann-Whitney or Fisher test and the Principal Component Analysis (PCA). IL-6, IL-8 and IP-10 levels were higher in AH samples than in peripheral blood. In AH samples, BLC, IL-8 and IP-10 were significantly higher in definite OS than in presumptive TBU. There were no statistically significant differences in terms of cytokine levels between Q + OS and presumptive TBU. PCA showed a similar cytokine pattern in the latter two groups (IFNγ, IL-15, IL-2, IP-10, MIG), while the prevalent expression of BLC, IL-10 and MIP-3 α was seen in definite OS. The different AH and plasma cytokine profiles observed in OS compared to Q + OS and TBU may help to differentiate OS from TBU in overlapping clinical phenotypes of granulomatous uveitis (Q + OS).

Treatment in Latent Tuberculosis Uveitis-Is Immunosuppression Effective or Is Conventional 3- or 4-Drug Antituberculosis Therapy Mandatory?

Background/Aims: Controversy exists regarding 3- or 4 drug antituberculosis therapy (conventional ATT) in uveitis patients having latent tuberculosis (LTB), especially while initiating therapy with corticosteroids and/or other immunosuppressants. Methods: We performed a monocentral retrospective analysis of posterior uveitis patients with latent TB. Latent TB was diagnosed, in case of a positive QuantiFERON®-TB-Gold test and normal chest imaging, after ruling out other causes of infectious and noninfectious uveitis. Patients with active TB were excluded. From 2016 to 2020 we included 17 patients. Ophthalmological evaluation consisted of Best corrected visual acuity (BCVA), slit lamp examination, fundoscopy, OCT, and fluorescein- and indocyaningreen- angiography before and at months 3, 6, 12, 24, and the last follow-up after treatment. Results: Initially, all patients had active posterior uveitis with occlusive (n = 5 patients) and nonocclusive retinal vasculitis (n = 12 patients). Mean follow up was 28 ± 15 months. Therapy was started with systemic corticosteroids (mean prednisolone equivalent 71.3 mg/d) and already after 3 months it could be tapered to a mean maintenance dosage of 8.63 mg/d. Additional immunosuppressive treatment with cs- or bDMARDs was initiated in 14 patients (82%) due to recurrences of uveitis while tapering the corticosteroids <10 mg per/day or because of severe inflammation at the initial visit. While being on immunosuppression, best corrected visual acuity increased from 0.56 logMAR to 0.32 logMAR during follow-up and only three patients had one uveitis relapse, which was followed by switch of immunosuppressive treatment. As recommended, TB prophylaxis with 300 mg/d isoniazid was administered in 11 patients for at least 9 months while being on TNF-alpha-blocking agents. No patient developed active tuberculosis during immunosuppressive therapy. Conclusion: Mainly conventional ATT is strongly recommended—as monotherapy or in combination with immunosuppressives—for effective treatment in patients with uveitis due to latent TB. Although in our patient group no conventional ATT was initiated, immunosuppression alone occurred as an efficient treatment. Nevertheless, due to possible activation of TB, isoniazid prophylaxis is mandatory in latent TB patients while being on TNF-alpha blocking agents.

Clinical profile, multimodal imaging, and treatment response in macular serpiginous choroiditis.

Purpose:To describe the clinical profile, multimodal imaging, and treatment response in macular serpiginous choroiditis (MSC).Methods:Clinical records of 16 eyes (14 patients) with MSC presenting to a tertiary eye care institute between 2015 and 2019 were analyzed retrospectively.Results:Mean age of 14 patients presenting with MSC was 33 ± 13 yrs with 64% males and 36% females. Mean visual acuity of the eyes with MSC at presentation was 0.43 ± 0.46 (logMAR) improving to 0.16 ± 0.28 (logMAR) at final visit. Thirteen eyes (81.3%) had active lesion at presentation. Mantoux test was positive in seven patients (50%) and QuantiFERON TB gold test positive in 10 patients (71%). HRCT chest showed latent tuberculosis in seven patients (50%). All patients underwent multimodal imaging. All patients received oral steroids as treatment therapy; 11 patients also received immunosuppressives, nine patients received additional anti-tubercular therapy (ATT). Mean duration of follow-up for the patients was 18 ± 10 months. A total of eight (50%) eyes had recurrence of lesions after an average duration of 14 ± 14 (3-36) months and were restarted on the treatment as per the requirement. At final follow-up, all eyes showed a good response to treatment and had healed lesions. Comparing the final BCVA to the initial BCVA, 38% (n = 6) showed improvement, 56% (n = 9) remained stable, and 6% (n = 1) eyes worsened at the final follow-up.Conclusion:Clinical profile and presentation of MSC is similar to that of CSC, and combination treatment with intravenous methyl prednisolone (IVMP), steroids, immunosuppressives, and ATT can salvage vision. A high suspicion of associated tuberculosis in endemic regions should be kept in mind.

Heme oxygenase-1 and neopterin plasma/serum levels and their role in diagnosing active and latent TB among HIV/TB co-infected patients: a cross sectional study

BackgroundTuberculosis (TB) diagnosis in the context of HIV co-infection remains challenging. Heme oxygenase 1 (HO-1) and neopterin have been validated as potential biomarkers for TB diagnosis. Latent TB infection (LTBI) is diagnosed using tuberculin skin test (TST) and interferon gamma release assays (T-Spot and QuantiFERON TB gold tests, respectively). However, these tests have shown challenges and yet diagnosing LTBI is important for the overall control of TB. This study was conducted to determine the levels of H0–1 and neopterin, and their role in the diagnosis of TB among individuals enrolled in the Community Health and Social Network of Tuberculosis (COHSONET) study and the Kampala TB Drug Resistance Survey (KDRS).MethodsThis was a nested cross-sectional study. Plasma and serum samples collected from 140 patients at Mulago National Referral Hospital, Kampala Uganda were used. M.tb culture was performed on sputum to confirm active TB(ATB) and QuantiFERON TB gold test to confirm latent TB infection (LTBI). ELISAs were performed to determine the levels of HO-1 and neopterin. Data analysis was done using t-test and Receiver Operating Characteristic curves to determine the diagnostic accuracy.ResultsHO-1 levels among active tuberculosis (ATB)/HIV-infected patients and LTBI/HIV-infected patients were 10.7 ng/ml (IQR: 7.3–12.7 ng/ml) and 7.5 ng/ml (IQR: 5.4–14.1 ng/ml) respectively. Neopterin levels among ATB/HIV-positive patients and LTBI/HIV-positive patients were 11.7 ng/ml (IQR: 5.2.4 ng/ml) and 8.8 ng/ml (IQR: 2.4–19.8 ng/ml), respectively. HO-1 showed a sensitivity of 58.57% and a specificity of 67.14% with area under the curve (AUC) of 0.57 when used to discriminate between ATB and LTB. Neopterin showed an AUC of 0.62 with a sensitivity of 57.14% and a specificity of 60.0% when used to distinguish ATB from LTB.ConclusionThere was no in significant difference in HO-1 concentration levels of ATB individuals compared to LTB individuals. There was a significant difference in neopterin concentrations levels of ATB individuals compared to latently infected individuals. Findings from this study, show that HO-1 and neopterin have poor ability to distinguish between ATB and LTB.

Abstract 14442: Tuberculosis-Specific Cell-Mediated Immune Responses Are Associated With Coronary Artery Atherosclerosis Among Persons With and Without HIV in Uganda

Introduction: Latent tuberculosis infection (LTBI) has been associated with increased odds of acute myocardial infarction. Here we assessed the relationship between subclinical coronary atherosclerosis, LTBI status, and Mycobacterium tuberculosis ( Mtb )-specific cell-mediated responses. Hypothesis: LTBI and the magnitude of Mtb -specific cell-mediated responses are associated with increased rates of subclinical coronary artery disease (CAD). Methods: Cross-sectional study within a cohort of HIV-infected and -uninfected participants enrolled at the Joint Clinical Research Centre in Kampala, Uganda. Participants were ≥45 years with at least one risk factor for cardiovascular disease. Persons living with HIV (PLWH) were on stable antiretroviral therapy with HIV viral load ≤1,000 copies/mL within the 6 months prior to study entry. Participants underwent QuantiFERON®-TB Gold (QFT) testing to define LTBI status. Interferon-γ (IFN-γ) cell-mediated responses to Mtb antigens contained in the QFT TB tube were extracted. Participants underwent coronary computed tomography angiography (CCTA) utilizing a 128-slice Siemen’s scanner. Obstructive CAD was defined as having at least one coronary segment with plaque causing ≥ 50% luminal stenosis (CAD-RADS ≥3). Results: Of 138 participants, 66 (48%) had LTBI (17 PLWH and 49 HIV-uninfected), and 72 (52%) were non-LTBI (38 PLWH and 34 HIV-uninfected). Median age was 57 years; 91 (66%) were female; 120 (87%) had hypertension, 45 (33%) had diabetes mellitus, 24 (17%) had dyslipidemia, and 7 (5%) used tobacco. Median CD4 count was 569 cells/uL in PLWH. Prevalence of obstructive CAD was 9% in LTBI vs. 3% in non-LTBI; p =0.152. Mtb -specific responses were higher in persons with obstructive CAD compared to those without it (IFN-γ IU/mL median [IQR]; 5 [0.4 - 9.6] vs. 0.3 [0.1 - 2.9]; p =0.04). Mtb -specific responses remained associated with obstructive CAD after adjusting for age, sex, HIV status, cholesterol, hypertension, tobacco use, and diabetes mellitus (adjusted OR, 1.33; 95% CI; 1.04 - 1.7). Conclusions: Higher Mtb -specific cell-mediated responses were associated with obstructive CAD. Our findings suggest that Mtb contributes to coronary plaque burden independently of HIV and cardiovascular risk factors.

Lichen planus and multifocal choroiditis - A diagnostic dilemma.

A 24-year-old gentleman had a right headache and MFC; for 1 year [Fig. 1a]; being on AKT for 3 weeks with further worsening. Fundus fluorescein angiography (FFA) [Fig. 1b]; optical coherence tomography (OCT), [Fig. 1c] and B-Scan [Fig. 1d] had been done. Serum angiotensin-converting enzyme (ACE), serum uric acid, and QuantiFERON TB Gold Test were normal. Mantoux was 19 mm [48 h/5 tuberculin units (TU)]. Oculus sinister (OS) was normal. On presentation to us, OD had finger counting close to face with congestion; mild relative afferent pupillary defect (RAPD); painful movements; disc edema; peripapillary sub-retinal exudation, and MFC [Fig. 1e]. We did contrast magnetic resonance imaging (MRI) brain/orbit, venereal disease research laboratory (VDRL), antinuclear antibody (ANA), antineutrophil cytoplasmic autoantibody (ANCA), and HIV, which were normal. Paradoxical worsening of TB choroiditis (3 weeks AKT) was considered and intravenous methylprednisolone was used. Repeat history-taking, caused him to recall having skin biopsy-proven LP; treated with oral prednisolone; just prior to ocular symptoms; 1 year back. Pursuing the possibility of flare-up of occult systemic TB; after the use of oral steroids to treat LP, a contrast chest CT was done, which was normal. A previously reported; LP associated intraocular inflammation[1] led us to use of azathioprine. One of the treatment protocols could have been the continuation of AKT, but our physician stopped AKT to avoid hepatotoxicity. Intraocular inflammation resolved within 2 months of azathioprine, [Fig. 1f]; which was continued for 9 months. At 16 months post cessation of azathioprine; he stays in remission.Figure 1: (a) Fundus showing fulminant MFC on treatment with tapering oral steroids for one year. (b) FFA showing late hyperfluorescence; pooling; disc leakage. (c) OCT showing choroidal elevation with macular thickening. (d) B-Scan showing grossly thickened choroid with sub-tenons fluid in macular area. (e) Fundus showing disc edema with peripapillary sub retinal exudation and MFC. (f) Fundus showing resolution of inflammation; 2 months on azathioprineDiscussion Ocular LP is largely extraocular and involves conjunctiva, cornea, and lacrimal drainage system.[2] The role of cellular immunity in LP and retinal vasculitis[34] was believed to be the cause of their once previously reported association.[1] In our patient; there is a diagnostic dilemma of the mere coexistence of LP and MFC with a temporal dissociation (LP occurring just prior to the onset of ocular symptoms) vs possible association between these two otherwise separate immune-mediated clinical entities. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement The authors wish to acknowledge Dr. Avinash Pathengay, for his technical help in the management of this patient.

Ethambutol-resistant Mycobacterium kansasii cervical lymphadenitis in an immunocompetent adult patient: A case report and literature review

Mycobacterium kansasii extrapulmonary infections are infrequent in immunocompetent adults. Rifampin (RIF), clarithromycin (CLR), isoniazid (INH) and ethambutol (EMB) are included in all the standard regimens against M.kansasii. We report a case of a healthy 65-year-old male farmer who presented with isolated right supraclavicular lymphadenopathy. The lymph node FNA showed acid-fast-bacilli and granulomatous inflammation. Quantiferon TB Gold test, HIV serology, and functional immunological studies were all negative or normal. He was put on a standard 4 drugs anti-tuberculous regimen that was switched to RIF + CLR+ INH after the Microbiology lab demonstrated an EMB–resistant Mycobacterium kansasii isotype I strain. The patient was cured after 12 months of therapy. This is the 6th reported case of M. kansasii extrapulmonary lymphadenitis in an immunocompetent adult and the 2nd showing EMB resistance in the world literature. Antimycobacterial regimens against M. kansasii, classically resistant to pyrazinamide (PZA) might also exclude EMB due to its increasing resistance in Europe. A 612 months therapy with at least 2 effective antimycobacterial drugs including RIF + CLR might be enough to treat extrapulmonary M. kansasii infections in immunocompetents.

Comparison of IFN-γ Levels in Children with Tuberculosis Disease (TB) and Latent Tuberculosis Infection (LTBI).

AIM:This study aimed to evaluate the importance of IFN-γ in the diagnosis of pediatric TB and LTBI and to compare the IFN-γ levels.METHODS:We analysed 100 patients examined for possible M. tuberculosis infection or disease at the Institute of Respiratory Diseases in Children, Kozle, Skopje. Patients were divided into 2 groups: TB disease and LTBI. The following parameters were analyzed: demographic characteristics, history of previous exposure to active TB, BCG vaccination and presence of BCG scar, lung X-ray findings, tuberculin skin test by the Monteux method and the value of INF-γ according to the Quantiferon TB gold test, direct samples of acid-alcohol-resistant bacilli of sputum and Löwenstein Jensen cultures. Informed parental consent was obtained for each child included in the study.RESULTS:In the LTBI group 60.9% had a scar from the vaccination while in the TB group 50% had BCG scar. TST induration diameters in children with or without BCG scar were significantly larger in patients with active TB. Children with active TB had significantly higher IFN-γ levels than children with LTBI. The IFN-γ for the cut-off of 0.35 IU/ml, has 64% sensitivity for detection of LTBI, versus 80.6% sensitivity for active disease. Children with close TB contact had significantly higher IFN-γ levels. Correlation between TST induration diameter and IFN-γ levels was stronger in the TB group.CONCLUSION:IFN-γ levels are significantly higher in children with active TB, and children with close contact with TB patient. It has better sensitivity in active TB. Using both tests (IFN-γ and TST) can improve the diagnose of LTBI and TB in countries where vaccination with BCG is widespread.

Stratification by interferon-γ release assay level predicts risk of incident TB

IntroductionTargeted testing and treatment of latent TB infection (LTBI) are priorities on the global health agenda, but LTBI management remains challenging. We aimed to evaluate the prognostic value of the...

Real life experience of a screening strategy for latent tuberculosis before treatment with biologicals in indian patients with rheumatic diseases

Objective: The objective of the study was to study the effectiveness of a recommended screening strategy for latent tuberculosis infection (LTBI) in patients with systemic inflammatory rheumatic diseases (SIRDs) treated with biological disease-modifying antirheumatic drugs (bDMARDs). Methods: The study included patients being considered for bDMARD treatment. Screening strategy included screening with “4S symptom complex (current cough, fever, weight loss, and night sweats) for TB,” augmented Mantoux test using ten tuberculin unit (TU) strength simultaneously with QuantiFERON®-TB Gold (QFTG) test. Those with a Mantoux test reading of ≥10 mm induration at 48–72 h and/or with a positive QFTG test, were given TB prophylaxis before initiating bDMARDs. They were followed and monitored for any features of tuberculosis flare. Results: A total of 730 patients (265 rheumatoid arthritis, 400 axial spondyloarthritis [axSpA], 34 psoriatic arthritis, and 31 others) were considered for bDMARDs. Two hundred and sixty-seven (36.6%) were positive for LTBI. They were treated either with isoniazid monotherapy for 6 months or with rifampicin + isoniazid for 4 months. bDMARDs were started 1 month after initiating chemoprophylaxis. Five (0.68%) patients developed active TB disease in the follow-up. In a total of 2930 “control” patients with the same diseases but never having taken bDMARDs, 18 (0.61%) developed active TB disease. The proportion of patients developing active TBI during the same period of follow-up did not differ between those who were and those who were not treated with bDMARDs. None of the study participants had “4S” symptoms. Conclusion: The strategy of clinical screening for active TBI with “4S complex,” standard chest radiograph, and an augmented Mantoux testing (10 TU purified protein derivative, [PPD]) simultaneously with QFTG test for the screening of LTBI, was successful in identifying active TBI in patients treated with bDMARDs.

Latent tuberculosis in patients with hepatitis C infection before receiving antiretroviral drugs

Aim of the work Studying the prevalence of latent TB infection among people infected with hepatitis C virus for preventing emergence of active tuberclous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. Patients and method The study was performed on 75 patients who were divided into two groups ; group A (hepatitis C group) which was 45 patients and group B (control group) which was 30 patients. A written consent was taken from patents who underwent the study. Patients underwent: 1. History taking. 2. Examination: general and local chest examination. 3. Radiology: chest x-ray. 4. tuberculin skin test with (PPD) 5. QuantiFERON TB testing (interferon gamma release assay {IGRA}). Results The mean age of (54.9±10.23) in group A (hepatitis C group) and (61.1±9.2) in group B (control group). In group A there are 30 males (66.7%) and 15 females (33.3%) while in group B there are 16 males (53.3%) and 14 females (46.7%) with no significance difference between the two groups. In group A there are 9 patients (20%) with positive tuberculin test and 36 patients with negative test while in group B there are 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test . there is no significant difference between the two groups regarding tuberculin test. Regarding QuantiFERON TB Gold test, In group A there are 15 patients (33.3%) with positive test and 30 patients (66,7%) with negative test while in group B there is 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test. There is significant difference between the studied groups regarding QuantiFERON TB gold test. Summary and conclusion People infected with hepatitis C virus should undergo testing for latent TB for preventing emergence of active tuberculous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. QuantiFERON test is preferred more than tuberculin test in detecting latent TB in patient with hepatitis C because tuberculin test may be falsely negative in patient with immunosuppression and hepatic patients which may give unreliable results.

Tuberculosis and other causes of uveitis in Indonesia.

PurposeThe purpose of this study is to assess the causes of uveitis in Indonesia and determine the importance of tuberculosis (TB) as a cause of uveitis.Patients and methodsProspective cohort study examining 146 consecutive new human immunodeficiency virus-negative patients with active uveitis between June 2014 and May 2015. We assessed the anatomic locations and specific causes of uveitis, as well as associations with infectious and non-infectious systemic diseases. We determined the prevalence of positive QuantiFERON Tb Gold test (QFT) results in Indonesian patients with uveitis and calculated the number of patients with active systemic TB.ResultsPosterior and panuveitis were the most common anatomic entities (38% each). Infections represented the most frequent cause of uveitis (33%); the most prevalent were toxoplasmosis (19%) and active systemic TB (8%). The majority of patients were QFT positive (61%). A specific diagnosis could not be established in 45% of the patients. At first presentation to the ophthalmologist, the majority of patients (66%) had a visual acuity of less than finger counting at 3 m and already exhibited various complications of uveitis. When classifying the QFT-positive patients with unexplained uveitis into a TB-related group, the percentage of 'TB-associated' uveitis cases increased from 8-48%. Highly elevated QFT levels were observed in patients with uveitis of unknown cause and no signs of active systemic TB.ConclusionsIn Indonesia, infectious uveitis was the most common type of uveitis and the leading causes consisted of toxoplasmosis and TB. The association observed between highly elevated QFT results and uveitis of otherwise unexplained origins indicates that a link exists between the latent TB infection and the development of uveitis.

The Role of QuantiFERON®-TB Gold and Tuberculin Skin Test as Diagnostic Tests for Intraocular Tuberculosis in HIV-Positive and HIV-Negative Patients in South Africa

ABSTRACTPurpose: To compare QuantiFERON®-TB Gold and tuberculin skin testing as diagnostic tests for intraocular tuberculosis in HIV positive and negative patients.Methods: A prospective study evaluating two different tests to help diagnose intraocular tuberculosis.Results: Thirty-five of 106 patients (33.0%) were diagnosed with intraocular tuberculosis including 11 (31.4%) with HIV infection. Patients were 6.95 times more likely to have intraocular tuberculosis if TST alone was positive (p < 0.001) versus 2.19 times more likely if Quantiferon alone was positive (p = 0.04). Tuberculin skin testing showed superior specificity (60.3% vs 33.3%) (p = 0.001) but similar sensitivity (90.3% vs 85.7%), positive (54.9% vs 40.5%) and negative predictive values (92.1% vs 81.5%) compared to Quantiferon. Specificity did not increase significantly if both skin testing and Quantiferon were positive.Conclusions: In South Africa, with its high HIV burden and limited public health resources, Quantiferon testing should not replace tuberculin skin testing as it provides little additional diagnostic information.

Management of long-term therapy with biological drugs in psoriatic patients with latent tuberculosis infection in real life setting.

Psoriatic patients with latent tuberculosis infection (LTBI) need a prophylaxis before starting a treatment with biological drugs. The aim of this study is to investigate the safety and efficacy of prophylaxis of LTBI in psoriatic patients receiving long-term biological drugs. The study included 56 patients (42 male and 14 female) affected by moderate-to-severe psoriasis (mean PASI: 12.8 ± 6.9 SD) treated with anti-TNF-α and/or anti IL 12, 23 and/or anti-CD11 drugs with a diagnosis of LTBI. LTBI diagnosis was based on tuberculin skin test and/or QuantiFERON TB Gold test positivity and chest X-ray suggestive, without clinical, or microbiological evidence of active disease. All patients received prophylactic therapy for 9 months with isoniazid (INH) 300 mg/day, starting 3 weeks before the beginning of biological treatment. Fifty-four patients completed prophylaxis with INH without any adverse events or intolerance; they continue the biological treatment without appearance of active tuberculosis. One patient developed tuberculosis pleurisy in course of treatment with etanercept. The infection has been treated and after a stable remission, treatment was restarted without tuberculosis reactivation. In this retrospective analysis, the prophylaxis of LTBI whit INH was effective and safe in longer follow-up period.

Primary nasal tuberculosis with lacrimal drainage involvement

Abstract Primary tuberculosis of the nasolacrimal system is a rare entity. We report two cases of nasal tuberculosis from an endemic area who presented with epiphora as the only symptom. Both cases had no nasal symptoms, no cervical lymph nodes involvement and no evidence of pulmonary tuberculosis. Histopathology of biopsy from nasal mucosa in both cases was consistent with tuberculosis. Tuberculin test and Quantiferon TB-Gold test were positive. The patients were treated with anti tubercular therapy along with endoscopic dacryocystorhinostomy. At three months post-operative follow up epiphora resolved and patients were asymptomatic.

Looking for Ocular Tuberculosis: Prevalence and Clinical Manifestations of Patients with Uveitis and Positive QuantiFERON®-TB Gold Test

ABSTRACTPurpose: To report on the prevalence of ocular TB and positive QuantiFERON®-TB Gold (QFT-G) test in uveitis patients and describe their clinical manifestations.Methods: We performed a prospective study of 108 new human immunodeficiency virus-negative uveitis patients. All patients underwent a tailored screening protocol for uveitis and received QFT-G test and tuberculin skin tests (TST).Results: QFT-G test was positive in 39/108 (36%) of patients, while TST ≥15 mm was positive in 16/108 (15%) patients. None of the patients were identified with active systemic TB. Out of 39 QFT-G-positive patients, 25 (64%) were of unknown cause, which represents a higher proportion than encountered in QFT-G-negative cases (29/69; 42%; p<0.03). Retinal occlusive vasculitis was frequently observed in patients with positive QFT-G outcomes (10/39 vs 3/69; p = 0.001) and was commonly associated with high QFT-G levels, young age, and male gender.Conclusions: Out of all patients with uveitis, none had active systemic TB but 36% were positive for QFT-G test. QFT-G-positive patients frequently had uveitis of unknown cause and exhibited clinical features of occlusive retinal vasculitis.