Ocular tuberculosis in Hospital Universiti Sains Malaysia – A case series

Abstract

Introduction

Ocular tuberculosis (TB) encompasses a broad spectrum of clinical manifestations affecting different structures of the eye. It is caused by Mycobacterium tuberculosis, a great ancient organism that induces various types of diseases and unfavorable outcomes if unrecognized and not well treated.

Purpose

To report the clinical profile of 34 ocular TB cases observed during 6 years period in Hospital Universiti Sains Malaysia (HUSM).

Method

A retrospective review of medical records from 34 patients diagnosed with ocular TB in HUSM from January 2011 until December 2016.

Results

The mean age was 43 ± 14.6 years old. Both male and female affected in about 1:1 ratio. The majority of subjects were local Malays (91.2%). Risk factors included previous contact with pulmonary TB patients (38.2%), and patients with underlying diabetes mellitus (26.5%). Most patients showed normal chest radiography (79.4%). However they had positive Mantoux test (94.1%) and raised erythrocyte sedimentation rate (ESR) value (58.8%). Uveitis was the most common ocular manifestation of ocular TB (70.6%) while the rare ocular manifestations included optic perineuritis and optic neuritis, orbital apex syndrome, orbital cellulitis, sclerokeratitis, corneal ulcer and conjunctival abscess. All patients responded well to anti-TB treatment, but visual outcome was variable.

Conclusions

This review shows the diverse entity of ocular TB spectrum in an endemic area. Good clinical response to anti-tuberculous therapy supported the presumed diagnosis of ocular TB in majority of the cases.

Highlights

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  Tuberculosis (TB) causes significant morbidity and mortality and remains a major health problem despite medical advances.

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  Majority primary care givers and physicians are unaware of ocular TB and frequently misdiagnose ocular symptoms.

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  The spectrum of ocular TB is diverse, affecting different layers and contents of the orbit and the globe.

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  Good clinical response to anti-TB therapy supported the presumed diagnosis of ocular TB in majority of the cases.

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  Ocular tuberculosis is potentially blinding if unrecognized and poorly treated.