Commentary: Tuberculosis in neuro ophthalmology - How different it is?

[3] In practice, delineating tuberculosis related optic neuropathy[4] includes individualized work up on all the differentials such as infectives (syphilis, toxoplasmosis, cat scratch disease, Lyme disease, leptospirosis, systemic fungal infection, HIV-associated disease), systemic inflammatory dise...

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Bibliographic Details
Published in:Indian journal of ophthalmology 2019-07, Vol.67 (7), p.1212-1214
Main Authors: Murugan, Sivaraman, Sundaralakshmi, Priya
Format: Article
Language:English
Subjects:
Antigens
Bacilli
Bacterial infections
Behcet's syndrome
Care and treatment
Cat scratch disease
Choroiditis
Defects
Diagnosis
Drug dosages
Edema
Ethambutol
Etiology
Etiology (Medicine)
HIV
Human immunodeficiency virus
Humans
Infections
Inflammation
Inflammatory diseases
Isoniazid
Leptospirosis
Lyme disease
Multiple sclerosis
Neurology
Neuromyelitis
Ophthalmology
Optic nerve
Optic Nerve Diseases
Optic neuropathy
Pathogenesis
Polymerase chain reaction
Pyrazinamide
Retinitis
Rifampin
Sarcoidosis
Scleritis
Steroids
Syphilis
Toxoplasmosis
Tropical diseases
Tuberculosis
Uveitis
γ-Interferon
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Description
Summary:[3] In practice, delineating tuberculosis related optic neuropathy[4] includes individualized work up on all the differentials such as infectives (syphilis, toxoplasmosis, cat scratch disease, Lyme disease, leptospirosis, systemic fungal infection, HIV-associated disease), systemic inflammatory diseases (multiple sclerosis, neuromyelitis optica, sarcoidosis, Vogt-Koyanagi-Harada disease, Behçet's disease, other systemic vasculitidies) ocular inflammatory conditions (uveitis and posterior scleritis); and vascular, neoplastic, toxic and hereditary forms of optic neuropathy as well. The criteria for diagnosing ocular tuberculosis[1],[5] include: consistent ocular signs, positive Mantoux reaction or IFN-γ release assay, active or old tuberculous lesion on chest imaging; polymerase chain reaction (PCR) detection of M. tuberculosis DNA in ocular fluid samples; identification of acid-fast bacilli by microscopy or culture of ocular or other tissue samples; and/or positive response to four-drug anti-tuberculosis treatment (i.e., isoniazid, rifampicin, ethambutol and pyrazinamide). [...]of thumb, bilateral simultaneous neuroretinitis is uncommon and should suggest the clinician to rule out the possibility of malignant hypertension or increased intra cranial pressure before working up further on the lines of the above list.
ISSN:0301-4738
1998-3689
DOI:10.4103/ijo.IJO_531_19