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1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey

BACKGROUND: Ocular tuberculosis (OTb) is uncommon and many ID physicians (IDPs) have limited experience with OT. Ophthalmologists now include IGRAs in evaluating idiopathic uveitis, and some IDPs report increased referrals for possible OTb. Our goal was to understand how IDPs approach diagnosis, tre...

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Autores principales: Fraimow, Henry S, Beekmann, Susan E, Polgreen, Philip M, Sunstrum, James
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809071/
http://dx.doi.org/10.1093/ofid/ofz360.1215
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author Fraimow, Henry S
Beekmann, Susan E
Polgreen, Philip M
Sunstrum, James
author_facet Fraimow, Henry S
Beekmann, Susan E
Polgreen, Philip M
Sunstrum, James
author_sort Fraimow, Henry S
collection PubMed
description BACKGROUND: Ocular tuberculosis (OTb) is uncommon and many ID physicians (IDPs) have limited experience with OT. Ophthalmologists now include IGRAs in evaluating idiopathic uveitis, and some IDPs report increased referrals for possible OTb. Our goal was to understand how IDPs approach diagnosis, treatment, and reporting of OTb. METHODS: The Emerging Infections Network surveyed members treating adult ID patients in 2019 about referrals for suspected OTb. The survey used hypothetical case scenarios to evaluate factors influencing the management of possible OTb, and queried involvement of public health agencies. RESULTS: 754 of 1,379 (55%) physicians responded. 141 (19%) reported ≥1 referral for possible OTb in the past 3 years; 35% of these reported increasing referrals over time. Most frequent indications for referral were uveitis and positive IGRA (60%) and idiopathic uveitis without positive IGRA or TST (33%). For a hypothetical case with uveitis, positive IGRA but no other symptoms, respondents were much more likely (79% vs. 29%) to treat as TB disease if TB risk factors were present. Respondents were more likely to require a positive eye culture or NAAT prior to treating a risk factor-negative patient (39% vs. 12%). 54% of respondents believed <10% of eye specimens were culture or NAAT-positive for suspected OTb. 94% would treat suspected OTb with INH, RIF, PZA ± EMB but duration of treatment varied with 27% stopping therapy for lack of clinical response and 59% continuing for at least 6 months regardless of response. 44% were unsure if improvement should be expected on therapy. One-third of respondents either did not report or reported only culture-confirmed OTb cases on treatment to public health agencies. CONCLUSION: IDPs report increased referrals for possible OTb, mainly for idiopathic uveitis and positive IGRAs. There is considerable practice variation in management of possible OTb. The decision to treat as TB disease is heavily influenced by TB epidemiologic risk factors, and there is heterogeneity in treatment duration and in expectation of response to therapy. Prospective studies to assess treatment responses in OTb and improved collaboration with ophthalmologists are necessary to better manage this emerging syndrome. Treated OTb cases should be reported to public health agencies. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68090712019-10-28 1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey Fraimow, Henry S Beekmann, Susan E Polgreen, Philip M Sunstrum, James Open Forum Infect Dis Abstracts BACKGROUND: Ocular tuberculosis (OTb) is uncommon and many ID physicians (IDPs) have limited experience with OT. Ophthalmologists now include IGRAs in evaluating idiopathic uveitis, and some IDPs report increased referrals for possible OTb. Our goal was to understand how IDPs approach diagnosis, treatment, and reporting of OTb. METHODS: The Emerging Infections Network surveyed members treating adult ID patients in 2019 about referrals for suspected OTb. The survey used hypothetical case scenarios to evaluate factors influencing the management of possible OTb, and queried involvement of public health agencies. RESULTS: 754 of 1,379 (55%) physicians responded. 141 (19%) reported ≥1 referral for possible OTb in the past 3 years; 35% of these reported increasing referrals over time. Most frequent indications for referral were uveitis and positive IGRA (60%) and idiopathic uveitis without positive IGRA or TST (33%). For a hypothetical case with uveitis, positive IGRA but no other symptoms, respondents were much more likely (79% vs. 29%) to treat as TB disease if TB risk factors were present. Respondents were more likely to require a positive eye culture or NAAT prior to treating a risk factor-negative patient (39% vs. 12%). 54% of respondents believed <10% of eye specimens were culture or NAAT-positive for suspected OTb. 94% would treat suspected OTb with INH, RIF, PZA ± EMB but duration of treatment varied with 27% stopping therapy for lack of clinical response and 59% continuing for at least 6 months regardless of response. 44% were unsure if improvement should be expected on therapy. One-third of respondents either did not report or reported only culture-confirmed OTb cases on treatment to public health agencies. CONCLUSION: IDPs report increased referrals for possible OTb, mainly for idiopathic uveitis and positive IGRAs. There is considerable practice variation in management of possible OTb. The decision to treat as TB disease is heavily influenced by TB epidemiologic risk factors, and there is heterogeneity in treatment duration and in expectation of response to therapy. Prospective studies to assess treatment responses in OTb and improved collaboration with ophthalmologists are necessary to better manage this emerging syndrome. Treated OTb cases should be reported to public health agencies. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809071/ http://dx.doi.org/10.1093/ofid/ofz360.1215 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Fraimow, Henry S
Beekmann, Susan E
Polgreen, Philip M
Sunstrum, James
1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey
title 1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey
title_full 1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey
title_fullStr 1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey
title_full_unstemmed 1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey
title_short 1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey
title_sort 1351. how do infectious diseases clinicians manage patients with suspected ocular tuberculosis? results of an emerging infections network survey
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809071/
http://dx.doi.org/10.1093/ofid/ofz360.1215
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