Factors associated with poor outcomes in mycobacterial inflammation

The results of this retrospective study suggest that tuberculosis (TB) must be considered in the differential diagnosis of ocular inflammation irrespective of patient ethnicity, country of origin or the results of chest imaging. Additionally, longer periods of multidrug therapy may be required to control ocular mycobacterial infection, systemic corticosteroids should? be used judiciously, and a reduction in the delay in diagnosis could improve clinical outcomes.

This paper reminds physicians that ocular mycobacterial infection often occurs without other systemic manifestations of TB, including pulmonary disease. 

The authors describe their experience with ocular mycobacterial disease in the Midwestern United States, evaluating treatment outcomes and factors that delay diagnosis. They reviewed the charts of 17 patients (26 eyes) with mycobacterial ocular inflammatory disease seen at the University of Illinois at Chicago from 1995 to 2010.

Of 17 patients, 13 had isolated ocular disease, 14 had mycobacterium TB, one had miliary TB, two had TB lymphadenopathy and one had active pulmonary TB. Three had nontuberculous mycobacterial infection.

Chest imaging was consistent with granulomatous disease in 46.7 percent of cases. The average delay from ocular disease onset to uveitis service referral was 755.3 days. Posterior uveitis and non-Hispanic white race were associated with increased delay. A relapsing course was observed in posterior uveitis and those treated with systemic steroids for eye disease.

Disease control was achieved in 81 percent, although 38.5 percent had profound visual loss, which was associated with age older than 50 years and delay in diagnosis. Patients diagnosed after 500 days from initial ocular symptoms were 20 times more likely to lose vision.

The authors write that it is reassuring that the clinical findings and outcomes found in this study are similar to those reported in other studies. Further, this study provides statistical evidence with large strengths of association for topics long observed, debated, and in need of further elucidation, such as the effect of systemic steroids and the nature of relapsing disease.