rifampin and Choroiditis

Topics: Antitubercular Agents; Brain Mapping; Choroiditis; Confusion; Female; Humans; Isoniazid; Magnetic Resonance Imaging; Meningitis; Middle Aged; Optic Nerve Diseases; Pyrazinamide; Rifampin; Tuberculosis, Central Nervous System; Vision Disorders

To compare 3 different molecular techniques to detect the Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis (MSC).. Prospective, interventional case series.. Eleven patients (11 eyes) with active MSC in at least 1 eye underwent diagnostic pars plana vitrectomy (PPV) between October 2012 and December 2013.. Vitreous fluid samples were subjected to multitargeted polymerase chain reaction (PCR) for a M. tuberculosis assay, the Gene Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and a line probe assay (GenoType MTBDRplus; Hain Lifescience, GmbH, Nehren, Germany). The samples with positive results were subjected to rpoB gene sequencing to demonstrate rifampicin resistance. The clinical details, digital fundus imaging, and treatment details and outcomes also were noted.. Detection of the M. tuberculosis genome and rifampicin resistance in the vitreous samples.. Of the 11 eyes subjected to PPV, the multitargeted PCR results for tuberculosis were positive for 10 eyes, the MTBDRplus assay results were positive in 6 eyes, and the Gene Xpert MTB/RIF assay results were positive in 4 eyes. Rifampicin resistance was detected in 3 eyes by rpoB gene sequencing, in 3 eyes by the MTBDRplus assay, and in 1 eye by the Gene Xpert MTB/RIF assay.. We detected the M. tuberculosis genome in the vitreous fluid of eyes with MSC using 3 different molecular techniques. Rifampicin resistance was detected for the first time in eyes with MSC.

Topics: Adolescent; Adult; Antibiotics, Antitubercular; Antitubercular Agents; Choroiditis; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fluorescein Angiography; Genome, Bacterial; Humans; Male; Middle Aged; Molecular Diagnostic Techniques; Multifocal Choroiditis; Mycobacterium tuberculosis; Polymerase Chain Reaction; Prospective Studies; Rifampin; Tuberculosis, Multidrug-Resistant; Tuberculosis, Ocular; Vitrectomy; Vitreous Body; Young Adult

Choroidal tuberculosis (TB) infection may present itself as a diffuse choroiditis that resembles serpiginous choroiditis, usually treated with immunossupressants. Recent studies have demonstrated that patients with serpiginous-like choroiditis and evidence of systemic or latent TB are best treated with antituberculosis treatment (ATT) in addition to the corticosteroid therapy. The authors present a case of a 58-year-old man with decreased vision in his left eye. His best-corrected visual acuity was 20/20 right eye and 20/200 left eye. Funduscopic examination revealed a diffuse choroiditis. Mantoux skin test showed an area of induration measuring 30×35 mm and the patient started ATT with complete resolution of retinal lesions after 2 weeks of treatment. His final visual acuity was 20/25 in the left eye with no recurrences over a follow-up of 6 months. The use of ATT in these patients is likely to reduce active inflammation and eliminate future recurrences.

Topics: Antitubercular Agents; Choroiditis; Drug Combinations; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Ocular; Vision Disorders

A healthy 57 year-old woman with past untreated pulmonary tuberculosis, disclosed a bilateral uveitic syndrome characte rized by iritis, vitreitis, multiple peripheral retinal punched-out lesions, and cystoid macular edema. Systemic evaluation was unremarkable except for a 30 mm tuberculin skin test. Relapses occurred after oral and periocular corticosteroids were interrupted, but the inflammation completely disappeared after a 6 month course of isoniazid, rifampicin and pyrazinamide.. Intraocular tuberculosis should be considered as a treatable cause of peripheral multifocal choroiditis, after ruling out other etiologies.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Antitubercular Agents; Choroiditis; Drug Therapy, Combination; Female; Humans; Isoniazid; Macular Edema; Middle Aged; Pyrazinamide; Radiography; Rifampin; Tuberculin Test; Tuberculosis, Ocular; Tuberculosis, Pulmonary

Topics: Aged; Anti-Bacterial Agents; Choroiditis; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Prednisone; Pyrazinamide; Rifampin; Sputum; Tuberculosis, Ocular; Uveitis; Visual Acuity

A 32-year-old man developed unilateral visual loss. Disseminated large choroidal nodules and granulomatous optic neuropathy were observed in one eye and responded to antituberculous therapy with return of vision. There was no clinical evidence of extraocular tuberculosis. Disseminated choroiditis can be the presenting sign in tuberculosis and the single accessible yet non-invasive evidence for spread of the mycobacteria.

Topics: Adult; Choroiditis; Fundus Oculi; Humans; Isoniazid; Male; Rifampin; Tuberculosis, Ocular; Visual Acuity

Topics: Adult; Aged; Chorioretinitis; Choroiditis; Eye Diseases; Female; Humans; Male; Middle Aged; Optic Neuritis; Retinitis; Rifampin; Tuberculosis, Ocular; Uveitis; Uveitis, Anterior