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Eye exam with indirect ophthalmoscopy for diagnosis of disseminated tuberculosis in patients with HIV/AIDS
  1. David Heiden1,2,
  2. Todd P Margolis3,
  3. Alan Lowinger4,
  4. Peter Saranchuk5
  1. 1 Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
  2. 2 Seva Foundation, Center for Innovation in Eye Care, Berkeley, California, USA
  3. 3 Francis I. Proctor Foundation, UCSF Medical School, University of California San Francisco, San Francisco, California, USA
  4. 4 Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
  5. 5 South African Medical Unit (SAMU), Operational Centre Brussels (OCB), Médecins Sans Frontières (MSF), Cape Town, South Africa
  1. Correspondence to Dr David Heiden, Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA; Seva Foundation, Center for Innovation in Eye Care, Berkeley, CA, USA; 641 Clayton Street, San Francisco, CA 94117, USA; davidheiden{at}gmail.com

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To the Editor The choroidal tubercle (figure 1) may be the most common manifestation of ocular tuberculosis (TB), and one of the earliest signs of disseminated infection.1 Fuchs described the value of eye examination for detection of choroidal tubercles and diagnosis of disseminated tuberculosis in his textbook over a century ago. About half a century later, an autopsy study of miliary tuberculosis in children found that eye examination exceeded chest radiography in diagnostic sensitivity: choroidal tubercles were found in 25/48 (52.1%) of children; positive chest radiography in 18/52 (34.6%).2

Figure 1

Retinal photograph of a choroidal tubercle from a patient with HIV/AIDS who died of disseminated tuberculosis. This figure is only reproduced in colour in the online version.

In the AIDS era, there have been conflicting reports about ocular TB. For instance, in India, a retrospective AIDS case series from a tertiary care eye referral centre in Chennai reported it occurring rarely, in under 2% of patients,3 whereas, a prospective cross-sectional study from an AIDS clinic in Mumbai reported ocular TB in 23.5% of patients.4 …

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