Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Eye (Lond). 2018 Feb;32(2):451-456. doi: 10.1038/eye.2017.214. Epub 2017 Oct 20.
PurposeTimely diagnosis of intraocular tuberculosis (IOTB) along with detection of drug resistance can save many eyes from visual impairment. With the growing incidence of IOTB and rising drug resistance, a reliable diagnostic platform for simultaneous detection of the agent and mutated gene is urgently needed. The MTBDRplus assay was evaluated directly on vitreous fluid samples for the same.Patients and methodsIn a prospective study, The MTBDRplus assay was performed on 127 vitreous fluid samples (77 'study group' comprising cases of presumed ocular tuberculosis and 50 'control group' cases of disease controls (n=25) and non-uveitic controls (n=25)). All samples positive by MTBDRplus assay were subjected to gene sequencing to confirm the mutations for rifampicin and isoniazid resistance.ResultsThe MTBDRplus assay produced a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 36.36%, 100%, 100%, and 50.50%, respectively, for the detection of IOTB. Among the 28 cases from study group that were positive by MTBDRplus assay, rifampicin resistance was reported in six and isoniazid resistance in two cases. On sequencing of rpoB and katG gene, one case of false rifampicin-resistant by MTBDRplus was found. The other resistant isolates showed concordant mutations between MTBDRplus assay and sequencing.ConclusionThe MTBDRplus assay is an effective tool for the rapid diagnosis of IOTB along with detection of drug resistance, thereby improving the outcome in IOTB.
及时诊断眼内结核（IOTB）并检测耐药性可以使许多眼睛免受视力损害。随着 IOTB 的发病率不断上升和耐药性的增加，迫切需要一种可靠的诊断平台来同时检测病原体和突变基因。本研究直接在玻璃体液样本上评估了 MTBDRplus 检测法。
在一项前瞻性研究中，对 127 份玻璃体液样本（77 例“研究组”，包括疑似眼结核病例，50 例“对照组”，其中疾病对照 25 例，非葡萄膜炎对照 25 例）进行了 MTBDRplus 检测。所有 MTBDRplus 检测阳性的样本均进行基因测序，以确认利福平耐药和异烟肼耐药的突变。
MTBDRplus 检测法对 IOTB 的检测灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 36.36%、100%、100%和 50.50%。在 MTBDRplus 检测阳性的 28 例研究组病例中，有 6 例报告利福平耐药，2 例异烟肼耐药。rpoB 和 katG 基因测序发现 1 例 MTBDRplus 检测假利福平耐药。其他耐药分离株的突变与 MTBDRplus 检测和测序结果一致。
MTBDRplus 检测法是一种快速诊断 IOTB 并检测耐药性的有效工具，从而改善 IOTB 的预后。
