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[眼部结核病]

[Ocular tuberculosis].

作者信息

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

机构信息

Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt France.

Centre national de référence maladies autoimmunes systémiques rares, centre national de référence maladies autoinflammatoires et amylose, département de médecine interne et d'immunologie clinique, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France.

出版信息

Rev Med Interne. 2018 Sep;39(9):755-764. doi: 10.1016/j.revmed.2018.05.003. Epub 2018 Jun 8.

Abstract

Despite extensive investigations, including the use of Interferon-gamma release assays (IGRA), the diagnosis of intraocular tuberculosis (TB) remains challenging. Ocular evidence of Mycobacterium tuberculosis in low endemic countries for TB is extremely rare, leading mostly to a TB-related ocular inflammation presumptive diagnosis. This present work aims: to highlights the main clinical patterns suggestive of ocular TB; and the latest recommended guidelines for diagnosing ocular TB to clarify interferon-gamma release assay (IGRA) contribution and accuracy to the management of intraocular TB and its diagnosis, in addition to other available diagnostic tools, such as tuberculin skin test, bacteriologic and histologic analysis from intra/extra ocular sample and radiographic investigations; to define the accuracy of these diagnostic tools according to the endemic TB prevalence; and finally to identify therapeutic strategies adapted to the main clinical presentations of ocular TB. Our review of the literature shows that management of suspected ocular TB differs significantly based on whether patients are from high or low TB prevalence countries since accuracy of chest X-ray, tuberculin skin test and IGRA is significantly different. Taking into account these discrepancies, distinct guidelines should be determined for managing patients with suspected ocular TB, taking into consideration home prevalence of TB-patients.

摘要

尽管进行了广泛的调查,包括使用干扰素-γ释放试验(IGRA),但眼内结核病(TB)的诊断仍然具有挑战性。在结核病低流行国家,结核分枝杆菌的眼部证据极为罕见,大多只能做出与结核病相关的眼部炎症的推定诊断。本研究旨在:强调提示眼内结核的主要临床模式;阐明诊断眼内结核的最新推荐指南,以明确干扰素-γ释放试验(IGRA)在眼内结核管理及其诊断中的作用和准确性,以及其他可用的诊断工具,如结核菌素皮肤试验、眼内/眼外样本的细菌学和组织学分析以及影像学检查;根据结核病流行情况确定这些诊断工具的准确性;最后确定适合眼内结核主要临床表现的治疗策略。我们对文献的综述表明,疑似眼内结核的管理因患者来自结核病高流行国家还是低流行国家而有显著差异,因为胸部X线检查、结核菌素皮肤试验和IGRA的准确性有显著不同。考虑到这些差异,应根据患者所在地区的结核病流行情况,制定不同的疑似眼内结核患者管理指南。

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