Tuberculosis and other causes of uveitis in Indonesia

• Published in: Eye (London) Vol. 32; no. 3; pp. 546 - 554
• Main Authors: La Distia Nora, R, Sitompul, R, Bakker, M, Susiyanti, M, Edwar, L, Sjamsoe, S, Singh, G, van Hagen, M P, Rothova, A
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.03.2018
• Subjects: Acuity; Adult; Aged; Analysis of Variance; Clinical Study; Cohort Studies; Female; HIV; Human immunodeficiency virus; Humans; Indonesia; Interferon-gamma Release Tests; Male; Middle Aged; Prospective Studies; Toxoplasmosis; Toxoplasmosis - complications; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Uveitis; Uveitis - etiology; Visual Acuity; Young Adult; Indonesia
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2017.231

PurposeThe purpose of this study is to assess the causes of uveitis in Indonesia and determine the importance of tuberculosis (TB) as a cause of uveitis.Patients and methodsProspective cohort study examining 146 consecutive new human immunodeficiency virus-negative patients with active uveitis between June 2014 and May 2015. We assessed the anatomic locations and specific causes of uveitis, as well as associations with infectious and non-infectious systemic diseases. We determined the prevalence of positive QuantiFERON Tb Gold test (QFT) results in Indonesian patients with uveitis and calculated the number of patients with active systemic TB.ResultsPosterior and panuveitis were the most common anatomic entities (38% each). Infections represented the most frequent cause of uveitis (33%); the most prevalent were toxoplasmosis (19%) and active systemic TB (8%). The majority of patients were QFT positive (61%). A specific diagnosis could not be established in 45% of the patients. At first presentation to the ophthalmologist, the majority of patients (66%) had a visual acuity of less than finger counting at 3 m and already exhibited various complications of uveitis. When classifying the QFT-positive patients with unexplained uveitis into a TB-related group, the percentage of 'TB-associated' uveitis cases increased from 8-48%. Highly elevated QFT levels were observed in patients with uveitis of unknown cause and no signs of active systemic TB.ConclusionsIn Indonesia, infectious uveitis was the most common type of uveitis and the leading causes consisted of toxoplasmosis and TB. The association observed between highly elevated QFT results and uveitis of otherwise unexplained origins indicates that a link exists between the latent TB infection and the development of uveitis.