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Foreign-born patients more likely to be diagnosed with TB-associated uveitis, researchers find
Purified protein derivative tests should see continued use in high-risk groups in order to diagnose ocular tuberculosis, according to a new study.
Hong and colleagues reported in the British Journal of Ophthalmology that they reviewed the charts of 142 patients seen over a time period of 1 year at a uveitis clinic at Los Angeles County Hospital.
Researchers noted laterality of uveitis, purified protein derivative (PPD) test results, interferon γ release assays, chest x-rays, birthplace and treatment history as well as diagnosis. According to the study, patients who had a positive TB screening and a favorable response to anti-TB therapy were diagnosed with “presumed TB-uveitis.” Patients who had a definitive presence of Mycobacterium tuberculosis were diagnosed with “definite ocular TB.”
Results showed that six patients were diagnosed with TB-related uveitis. Researchers determined that foreign-born patients had a 30.3% chance of ocular TB while the entire group of patients had a 17.2% chance.
"PPD and IGRA provide supportive evidence in intraocular TB diagnosis, especially in patients from TB-endemic countries," the authors concluded. "Clinicians must be mindful of the quickening pace of globalization and use this knowledge in making informed decisions regarding pretest probability. Prudent use of TB tests is essential as false positives in a population with low pretest probability will confuse the clinical picture and may commit a patient to a course of TB drugs with a significant side-effect profile. Meanwhile, we do recommend the continued use of PPD in the diagnosis of ocular TB in at-risk populations."
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Br J Ophthalmol. 2014;doi: 10.1136/bjophthalmol-2013-303937.