The efficacy of latent tuberculosis treatment for immunocompetent uveitis patients with a positive T-SPOT.TB test: 6-year experience in a tuberculosis endemic region

• DOI: 10.1007/s10792-017-0716-y
• Publication Date: 2017-09-25T01:54:50Z
• Authors: Chung Yee Chung; Kenneth K. W. Li
• Keywords: Adult; Aged, 80 and over; Male; Antitubercular Agents; Sputum; Mycobacterium tuberculosis; Tuberculosis, Ocular; Middle Aged; 3. Good health; Aqueous Humor; Uveitis; Vitreous Body; Young Adult; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Latent Tuberculosis; Humans; Female; Child; Glucocorticoids; Interferon-gamma Release Tests; Aged

To assess the efficacy of latent tuberculosis (TB) treatment for immunocompetent uveitis patients with a positive T-SPOT.TB test.This is a consecutive case series of all T-SPOT.TB positive latent TB patients with presumed tuberculous uveitis managed with anti-tuberculous therapy (ATT) from 1 January 2000 to 31 December 2015. Patients with active TB or other known causes of uveitis, immunocompromised states and those followed up < 12 months were excluded. Descriptive statistics and hypothesis testing were performed, with a significance level of p < 0.05 taken.Among the 75 T-SPOT.TB tests performed for uveitis, 14 cases were enrolled. Mycobacterium tuberculosis was isolated in none of the sputum and intraocular samples. Most cases had posterior uveitis (10/14 cases, 71.4%) and/or intermediate uveitis (9/14 cases, 64.3%). Vasculitis was predominantly occlusive. The mean presenting best-corrected visual acuity (BCVA) was 0.18, improving to 0.44 at 6 months (p = 0.03) and 0.40 at 12 months. (p = 0.03). At 1 year, remission of uveitis was achieved in 92.9%, in which none of them recurred at the last follow-up. High-dose systemic steroid was required in 50% of patients. Only 1 patient was steroid dependent at 18 months. The BCVA improvement in patients treated with or without steroid was comparable.In a TB-endemic region with wide Bacille Calmette-Guerin vaccination coverage, ATT for immunocompetent uveitis patients with latent TB identified from T-SPOT.TB test can improve vision, induce long-term steroid-free remission, and prevent recurrence and systemic reactivation of TB in those who require steroid.