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The utility of routine tuberculosis screening in county hospital patients with uveitis
  1. Bryan Kun Hong1,2,
  2. Hossein Nazari Khanamiri2,
  3. Simon R Bababeygy1,2,
  4. Narsing A Rao1,2
  1. 1Doheny Eye Institute, Los Angeles, California, USA
  2. 2Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
  1. Correspondence to Dr Narsing A Rao, Doheny Eye Institute, 1450 San Pablo Street, DVRC211, Los Angeles, CA 90033, USA; nrao{at}usc.edu

Abstract

Background/aim To evaluate the utility of tuberculosis (TB) screening in diagnosing ocular TB in uveitis patients in a government-funded hospital.

Methods The charts of 142 consecutive patients seen during August 2011–July 2012 at the Los Angeles County Hospital uveitis clinic were reviewed for manifestation/laterality of uveitis, purified protein derivative (PPD) test results, interferon γ release assay, chest x-ray, birthplace, treatment history and diagnosis. ‘Presumed TB-uveitis’ was diagnosed when patients had positive TB screening and favourable response to anti-TB therapy, and definite ocular TB when Mycobacterium tuberculosis’ presence was demonstrated. Post-test probabilities were determined.

Results TB screening was positive in 21.1%. Six patients were diagnosed with TB-related uveitis: one definite, four presumed and one systemic TB with uveitis. With regard to PPD positivity, being foreign-born was the only statistically significant factor with OR of 2.26 (95% CI 1.01 to 5.13; p<0.01) if born in Mexico and 4.90 (95% CI 1.74 to 13.83; p<0.01) if born in other foreign countries. The post-test probabilities of a positive PPD in a uveitis patient showed a 17.2% (overall) or 30.3% (foreign-born patients) chance of ocular TB.

Conclusions PPD skin test plays an important role in the diagnosis of TB-associated uveitis in high-risk groups, such as immigrants from TB endemic regions.

  • Diagnostic tests/Investigation
  • Infection
  • Public health

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