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Ocular Involvement in Patients with Miliary Tuberculosis - Examinations in Mexico

¹Tenorio Guajardo G., 3Froehlich S. J., 1Sanchez Santiago R., 2Cueto G., 2Escobedo L.,
3Miño de Kaspar H.

¹Eye department, ²Pulmonological Department, General Hospital of Mexico City; ³Department of Ophthalmology, Ludwig-Maximilians-Universität, Munich, Germany

Introduction: Infection with Mycobacterium tuberculosis is still of great importance mainly in developing countries. Because of the worldwide increase of AIDS, its role gets more and more important also in industrialized countries. Haematogenous infection, the so-called miliary tuberculosis, belongs to the most severe forms. This study is made to assess the frequency of ocular involvement in HIV-negative patients with miliary tuberculosis.
Methods: In this prospective study, a total of 28 patients with miliary tuberculosis was examined ophthalmologically between 1997 and 2000. All patients were refered from pulmonologists. Diagnosis was made by detection of rods in expectoration, by X-ray screening, puncture of bone marrow, blood and urine analysis. All patients were HIV-negative according to the ELISA-test.
Results: In 23 of 28 patients (82%), ophthalmological examination revealed no pathological findings. In 5 patients (18%), we found alterations of the fundus which can be attributed to miliary tuberculosis. In 1 case a chorioretinic scar at the posterior pole, in 1 case a peripheral vasculitis and in 1 case a granuloma of the choroid could be seen. 2 patients showed a multifocal choroiditis.
Discussion: Most reports on ocular tuberculosis derive from patients with AIDS. According to the results of this study, in 18% of the HIV-negative patients with miliary tuberculosis ocular involvement could be observed. The most common finding was a posterior uveitis. Prognosis depends strictly on the time of diagnosis.

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