Original articleProspective Head-to-Head Study Comparing 2 Commercial Interferon Gamma Release Assays for the Diagnosis of Tuberculous Uveitis
Section snippets
Overview of Management
We conducted a prospective study of consecutive patients presenting with new onset of uveitis to the Singapore National Eye Centre Ocular Inflammation and Immunology Service over a 2-year period (January 1, 2009, through December 31, 2010). Ethical approval was obtained from the Singapore Health Services Centralized Institutional Review Board, and our study adhered to the tenets of the Declaration of Helsinki. After we obtained informed consent, all patients underwent a full systemic review,
Patients’ demographics and clinical results
In this prospective study, we enrolled 120 patients (of whom 106 patients completed follow-up) with valid QuantiFERON-TB Gold In-Tube and T-SPOT.TB test results. The mean age of our patients was 48 ± 17 years, with an equal gender ratio (1:1, n = 53 males). The majority of the patients in our study were of Chinese ethnicity (65/106, 61.3%), followed by Indian (22/106, 20.8%) and Malay (7/106, 6.6%), reflecting the racial distribution in our Southeast Asian population. Of the 106 patients (152
Discussion
There is increasing evidence that suggests that IGRAs are more specific and accurate for the diagnosis of TB than is the tuberculin skin test.30, 31, 32, 33 The improved specificity of IGRAs over tuberculin skin testing has been shown to reduce unnecessary ATT.34 There have also been several studies that suggest that IGRAs are more useful than the tuberculin skin test in the diagnosis and management of patients with uveitis and TB infection.13, 15, 25, 35, 36, 37 However, there have been no
Dr Marcus Ang is currently an Associate Consultant at the Singapore National Eye Center and Singapore Eye Research Institute. His research interests include that of the cornea and anterior segment, infectious diseases affecting the eye, as well as ocular therapeutics and drug delivery for the anterior segment.
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Cited by (28)
Whitcup and Nussenblatt’s Uveitis: Fundamentals and Clinical Practice
2021, Whitcup and Nussenblatt's Uveitis: Fundamentals and Clinical PracticeContribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis)
2018, Autoimmunity ReviewsCitation Excerpt :Lab tests are even more important than imagery to establish the diagnosis [31]. Some studies [53,54] showed that TST is more sensible than T-SPOT.TB and Quantiferon® (69% vs 67% and 64% respectively). However, TST is less specific (74% vs 90.5% and 99.5% respectively), particularly in countries where the vaccination rate is higher.
Negative Mantoux test in a patient with definite pulmonary and ocular tuberculosis
2015, Taiwan Journal of OphthalmologyCitation Excerpt :Given that IGRAs enable differentiation between vaccinated and truly infected patients, IGRA is recommended as the first test to be performed in preference to T-SPOT.TB (Oxford Immunotech, Abingdon, Oxfordshire, UK) and the Mantoux test for the diagnosis of tuberculous uveitis.26 The guidelines for the diagnosis of ocular TB are as follows: (1) exclusion of other uveitis entities; (2) clinical history and signs consistent with ocular TB; (3) direct evidence from ocular investigations (such as positive acid-fast bacilli smear, MTB culture of ocular specimen, or ocular fluid PCR for MTB) so that a definite diagnosis can be made; (4) systemic investigations (including a positive Mantoux test, IGRA, or a healed or active tubercular lesion on a chest radiograph) are corroborative evidence and a presumed diagnosis can be made; (5) confirmed active extrapulmonary TB with microscopic examination or culture of the affected tissue for MTB; and (6) a therapeutic test with a positive response to four-drug treatment for TB over 4–6 weeks.4,6,12,24–26 Our patient was young and well-nourished and should therefore have been in an immunocompetent state at the time of presentation.
Systemic Investigations in Uveitis
2023, Uveitis Management: A Clinical HandbookDiagnosis and Treatment of Tubercular Uveitis in Taiwan - Consensus of Expert Panels
2023, Ocular Immunology and Inflammation
Dr Marcus Ang is currently an Associate Consultant at the Singapore National Eye Center and Singapore Eye Research Institute. His research interests include that of the cornea and anterior segment, infectious diseases affecting the eye, as well as ocular therapeutics and drug delivery for the anterior segment.
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