Tuberculose

QuantiFERON-TB gold cut-off value: implications for the management of tuberculosis-related ocular inflammation

Américan Journal of Ophtalmology

Informations

Gineys R, Bodaghi B, Carcelain G, Cassoux N, Boutin LTH, Amoura Z, Lehoang P, Trad S.

Am J Ophthalmol. 2011 Sep;152(3):433-440

Purpose

To evaluate the accuracy of QuantiFERON-TB Gold testing in patients with presumptive tuberculosis-ocular inflammation.

Design

Prospective nonrandomized case series and clinical laboratory investigation.

Methods

Ninety-six consecutive patients presenting with ocular inflammation between January and October 2007 were tested using QuantiFERON-TB Gold. Positive patients received a 6-month anti-tuberculosis treatment. Patient follow-up ranged from 12 months to 24 months. Treatment was considered effective at the end of follow-up, in cases of no or a 2-point decrease of ocular inflammation (SUN criteria) and systemic corticosteroids stopped or tapered to 10 mg/day.

Results

Mean age was 51 ± 17 years. Types of ocular inflammation included scleritis (n = 7), panuveitis (n = 34), and posterior (n = 15), intermediate (n = 14), and anterior uveitis (n = 15). QuantiFERON-TB Gold was positive in 42 cases (44%), negative in 51 cases (53%), and undetermined in 3 cases (3%). Among positive QuantiFERON-TB Gold patients, 25 received a full anti-tuberculosistreatment, which was effective in 15 cases (60%). Associated systemic steroids were given to 6 patients and tapered to 10 mg/day or less in all cases. Median QuantiFERON-TB Gold value was significantly higher in the group with a successful therapeutic response (7.67 IU/mL [0.46 to 33.37]) compared to the group with treatment failure (1.22 IU/mL [0.61 to 4.4]), P = .026.

Conclusion

Results of anti-tuberculosis treatment were encouraging in QuantiFERON-TB Gold-positive ocular inflammation, especially with values over 2 IU/mL in our study, suggesting that a higher cut-off value than that given by the manufacturer should be considered to better identify ocular inflammation that can benefit from full anti-tuberculosis treatment.

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Update on Immunological Test (Quantiferon-TB Gold) Contribution in the Management of Tuberculosis-Related Ocular Inflammation

Informations

Trad S, Bodaghi B, Saadoun D.

Ocul Immunol Inflamm. 2017 Jul 12:1-8. doi: 10.1080/09273948.2017.1332232.

Purpose

To clarify interferon-gamma release assay (IGRA) contributions to intraocular tuberculosis management, according to related TB endemic prevalence.

Methods

Despite extensive investigations, including IGRA, the diagnosis of intraocular tuberculosis (TB) is still challenging and remains mostly presumptive. According to the literature, it appears that management of suspected ocular TB differs significantly based on whether patients are from areas of high TB prevalence or from non-TB-endemic countries. The accuracy and final contribution of chest X-rays, tuberculin skin test and IGRA differ significantly according to low or high endemic TB areas. This work aims to review IGRA test outcomes in the light of these clinical and epidemiological settings. We therefore focused our analysis and its subsequent guidelines proposal based on the TB prevalence where the patient lives.

Conclusion

We believe that distinct guidelines should be determined for managing patients with suspected ocular TB, first taking into consideration the relative TB prevalence.

Pour obtenir la version PDF, contacter le CMIO :  salim.trad@aphp.fr

Ocular Tuberculosis

Informations

Trad S, Saadoun D, Errera MH, Abad S, Bielefeld P, Terrada C, Sène D, Bodaghi B, Sève P

Rev Med Interne. 2018 Mai (in press)

Résumé

Les immunosuppresseurs conventionnels, les anticorps anti-TNF alpha et d’autres biothérapies ont étoffé ces dernières années l’arsenal thérapeutique permettant de mieux contrôler les uvéites antérieures, les uvéites.
Le diagnostic de tuberculose oculaire demeure difficile malgré l’avènement, depuis plus de 10 ans, de nouveaux tests immunologiques. Dans les pays à faible endémie pour la tuberculose, la mise en évidence intraoculaire de Mycobacterium tuberculosis est exceptionnelle et le diagnostic de tuberculose oculaire est principalement présomptif. Cette mise au point a pour but :
  • de souligner les principales formes cliniques évocatrices de tuberculose intraoculaire, et les dernières classifications proposées pour poser le diagnostic de tuberculose oculaire.
  • de clarifier la contribution et la pertinence des tests immunologiques, type IGRA (interferon-gamma release assay), dans la prise en charge diagnostique de la tuberculose intraoculaire ainsi que leur place parmi les autres outils diagnostiques disponibles, à savoir ; clinique, immunologique (intradermoréaction à la tuberculine), bactériologique, histologique (prélèvement(s) intra/extra oculaire), et radiologique.
  • de comparer les stratégies diagnostiques  réalisées en pays de forte ou de faible endémie pour la tuberculose.
  • et de rappeler les principes de la prise en charge thérapeutique des atteintes inflammatoires intraoculaires d’origine tuberculeuse.
    Il ressort de cette mise au point, qu’il existe de réelles différences concernant les outils diagnostiques, selon que le patient vit en zone de faible ou de forte endémie vis-à-vis de la tuberculose, avec une contribution diagnostique des radiographies thoraciques, de l’IDR et des IGRA, qui diffère significativement. Ces différences incitent à une approche diagnostique différente selon les caractéristiques de la prévalence de la maladie où séjourne le patient.

Pour obtenir la version PDF, contacter le CMIO :  salim.trad@aphp.fr

Des questions ?

Salim Trad CMIO - Trésorier

Dr Salim TRAD

Service de Médecine Interne, Centre Hospitalier Ambroise-Paré, 9 avenue Charles de Gaulle, 92100 – Boulogne Billancourt

Pour toute information relative à la Tuberculose vous pouvez joindre le docteur Salim Trad à l’adresse suivante : salim.trad@aphp.fr.