The Emerging Challenge of Diagnosing Drug-resistant Tubercular Uveitis: Experience of 110 Eyes from North India

Ocul Immunol Inflamm. 2021 Jan 2;29(1):107-114. doi: 10.1080/09273948.2019.1655581. Epub 2019 Oct 3.

Abstract

Background: Rapid and timely diagnosis of tubercular uveitis (TBU) is of paramount importance to save these eyes from blindness. The present study was, therefore, undertaken to carry out a comparative evaluation of Gene Xpert MTB/RIF (Xpert), MTBDRplus and Multiplex PCR (MPCR) for the diagnosis of TBU. These tests were performed on vitreous fluid of 110 patients with presumed TBU and 90 controls. rpoB gene sequencing confirmed Rifampicin resistance.Results: Xpert, MTBDRplus and MPCR were positive in 19(17.2%),38 (34.5%) and 79 (71.8 %) patients, respectively. All tests were negative in all controls. Rif resistance was detected in 3 by Xpert and 7 by MTBDRplus. MPCR followed by rpoB gene sequencing detected Rif resistance in 6 cases. One case of false Rif resistance was reported each by MTBDRplus and Xpert.Conclusion: MPCR followed by rpoB sequencing is a robust technique for the diagnosis of paucibacilliary condition like TBU and reliable detection of drug resistance.

Keywords: Drug-resistant tuberculosis; GeneXpert; MTBDRplus; multiplex PCR.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Antibiotics, Antitubercular / pharmacology
  • Bacterial Proteins / analysis
  • Bacterial Proteins / genetics
  • DNA, Bacterial / analysis
  • DNA-Directed RNA Polymerases / analysis
  • DNA-Directed RNA Polymerases / genetics
  • Eye Infections, Bacterial / diagnosis*
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / epidemiology
  • Female
  • Humans
  • India / epidemiology
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / genetics
  • Prevalence
  • Retrospective Studies
  • Rifampin / pharmacology*
  • Tuberculosis, Multidrug-Resistant / diagnosis*
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / epidemiology
  • Uveitis / diagnosis*
  • Uveitis / drug therapy
  • Uveitis / epidemiology
  • Young Adult

Substances

  • Antibiotics, Antitubercular
  • Bacterial Proteins
  • DNA, Bacterial
  • rpoB protein, Mycobacterium tuberculosis
  • DNA-Directed RNA Polymerases
  • Rifampin