Ocular inflammatory disease and ocular tuberculosis in a cohort of patients co-infected with HIV and multidrug-resistant tuberculosis in Mumbai, India: a cross-sectional study

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• 作者：Salil Mehta (15)
  Homa Mansoor (16)
  Samsuddin Khan (16)
  Peter Saranchuk (17)
  Petros Isaakidis (16)
  
• 关键词：HIV ; TB ; HIV ; Multidrug ; resistant tuberculosis ; Ocular inflammatory disease ; Ocular tuberculosis ; Operational research ; India
• 刊名：BMC Infectious Diseases
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：13
• 期：1
• 全文大小：178KB
• 参考文献：1. Biswas J, Badrinath SS: Ocular morbidity in patients with active systemic tuberculosis. / Int Ophthalmol 1995,19(5) 293-98. CrossRef
  2. Bouza E, Merino P, Munoz P, Sanchez-Carillo C, Yanez J, Cortes C: Ocular tuberculosis: A prospective study in a general hospital. / Medicine (Baltimore) 1997, 76:53-1. CrossRef
  3. Mehta S: Ocular lesions in acute disseminated tuberculosis. / Ocul Immunol Inflamm 2004,12(4) 311-15. CrossRef
  4. Beare NA, Kublin JG, Lewis DK, Schijffelen MJ, Peters RP, Joaki G, Kumwenda J, Zijlstra EE: Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa. / Br J Ophthalmol 2002,86(10) 1076-079. CrossRef
  5. Cochereau I, Mlika-Cabanne N, Godinaud P, Niyongabo T, Poste B, Ngayiragije A: AIDS related eye disease in Burundi, Africa. / Br J Ophthalmol 1999, 83:339-42. CrossRef
  6. Mehta S, Gilada IS: Ocular tuberculosis in acquired immune deficiency syndrome (AIDS). / Ocul Immunol Inflamm 2005,13(1) 87-9. CrossRef
  7. Banker AS, Chauhan R, Banker DA: HIV and Opportunistic Eye Diseases. / Exp Rev Ophthalmol 2009,4(2) 173-85. CrossRef
  8. Babu RB, Sudharshan S, Kumarasamy N, Therese L, Biswas J: Ocular tuberculosis in acquired immunodeficiency syndrome. / Am J Ophthalmol 2006,142(3) 413-18. CrossRef
  9. Isaakidis P, Cox HS, Varghese B, Montaldo C, Da Silva E: Ambulatory Multi-drug Resistant Tuberculosis Treatment Outcomes In A Cohort Of HIV-Infected Patients In A Slum Setting In Mumbai, India. / PLoS One 2011,6(12) e28066. CrossRef
  10. World Health Organization: / Guidelines for the programmatic management of drug-resistant tuberculosis, 2011 Update. Geneva, Switzerland; 2011.
  11. World Health Organization (WHO): / Antiretroviral therapy for HIV infection in adults and adolescents. Recommendations for a public health approach. 2010 revision. Geneva, Switzerland; 2010.
  12. Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group: Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. / Am J Ophthalmol 2005, 140:509-16. CrossRef
  13. Isaakidis P, Varghese B, Mansoor H, Cox HS, Ladomirska J, Saranchuk P: Adverse Events Among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral And Second Line Anti-TB Treatment In Mumbai, India. / PLoS One 2012,7(7) e40781. CrossRef
  14. Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH: Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. / Lancet Infect Dis 2009, 9:153-61. CrossRef
  15. Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM: Treatment Outcomes of Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis. / PLoS One 2009,4(9) e6914. CrossRef
  16. Henderly DE, Genstler AJ, Smith RE, Rao NA: Changing patterns of uveitis. / Am J Ophthalmol 1987, 103:131-36.
  17. Cimino L, Herbort CP, Aldigeri R, Salvarani C, Boiardi L: Tuberculous uveitis, a resurgent and underdiagnosed disease. / Int Ophthalmol 2009,29(2) 67-4. CrossRef
  18. Modorati G, Berchicci L, Miserocchi E, Scarpellini P, Mantegani P, Bandello F, Ortis C: Clinical application of an in-house ELISPOT assay in patients with suspicious tuberculous uveitis and no signs of active tuberculosis. / Eur J Ophthalmol 2012,22(5) 808-13. CrossRef
  19. Doycheva D, Deuter C, Hetzel J, Frick JS, Aschoff P, Schuelen E, Zierhut M, Pfannenberg C: The use of positron emission tomography/CT in the diagnosis of tuberculosis-associated uveitis. / Br J Ophthalmol 2011,95(9) 1290-294. CrossRef
  20. Sommer A: Global access to eye care. / Arch Ophthalmol 2007, 125:399-00. CrossRef
  21. Saranchuk P, Bedelu M, Heiden D: Retinal Examination Can Help Identify Disseminated Tuberculosis in Patients With HIV/AIDS. / Clin Infect Dis 2012,56(2) 310-12. CrossRef
  22. Tun N, London N, Kyaw MK, Smithuis F, Ford N, Margolis T, Drew WL, Lewallen S, Heiden D: CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar. / J Int AIDS Soc 2011, 14:41. CrossRef
  23. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/13/225/prepub
  
• 作者单位：Salil Mehta (15)
  Homa Mansoor (16)
  Samsuddin Khan (16)
  Peter Saranchuk (17)
  Petros Isaakidis (16)
  
  15. Ophthalmology Department, Lilavati Hospital and Research Centre, Mumbai, India
  16. Médecins Sans Frontières, Mumbai, India
  17. South African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
  

文摘

Background The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART). Methods Lilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation of HIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations. Results Between February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158-61). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of seven patients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). ‘These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%). Patients with extrapulmonary TB and patients <39 years old were at significantly higher risk of having ocular TB [Risk Ratio: 13.65 (95% CI: 2.4-78.5) and 6.38 (95% CI: 1.05-38.8) respectively]. Conclusions Ocular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai, India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.