1 Indian Journal of Medical Microbiology, (2015) 33(Supplement 1): S43-45
Original Article
Association of mycobacterium tuberculosis in the causation of Eales’ disease: An institutional experience Rajpal, *UB Singh, S Mohapatra, VK Wagh, C Porwal, A Kaushik
Abstract Background: Eales’ disease is an idiopathic retinal vasculitis characterized by retinal inflammation, ischemia, and neo-vascularisation. It frequently causes massive vitreous haemorrhage and retinal detachment leading to blindness. Although the exact etiology is unknown, this condition is considered to be a consequence of hypersensitivity reaction to tubercular protein due to previous Mycobacterium tuberculosis (M. tuberculosis) infection. This study is aimed at the detection of association of M. tuberculosis in patients with Eales’ disease. Materials and Methods: A prospective case-control study was undertaken in 65 clinically diagnosed cases of Eales’ disease. Patients with proliferative diabetic retinopathy, neo-vascular proliferation, macular oedema, premacular fibrosis and tractional retinal detachment were taken as controls. M. tuberculosis DNA was detected (MPT64 gene by polymerase chain reaction, PCR) in patients with Eales’ disease. Clinical symptoms along with tuberculin skin test (TST) and erythrocyte sedimentation rate (ESR) were used as gold standard for comparing results of PCR. Result: PCR positivity was found in 12 (38.7%) patients with Eales’ disease. The PCR positivity was significantly associated with the patients with high TST reading and high ESR values. Conclusion: Patients with a high TST reading and ESR value and a positive PCR in vitreous samples have a high likelihood of having M. tuberculosis as an etiology. Key words: Eales’ disease, Mycobacterium tuberculosis, retinal detachment, vitreous haemorrhage
Introduction Eales’ disease is a well-established clinical entity for more than a century. The disease is predominantly an obliterative vasculitis, which results in peripheral and retinal hypoxia leading to neo-vascularisation. Vitreous haemorrhage with or without tractional rhegmatogenous retinal detachment is the common sequelae of this disease.[1] However, the exact etiopathogenesis and treatment of Eales’ disease is still elusive. Of the several causes suggested, Mycobacterium tuberculosis (M. tuberculosis) is the commonest one. Its role in the etiopathogenesis of Eales’ disease as an active infection or hypersensitivity reaction to tubercular protein has been discussed in literature.[2] It is primarily a disease of healthy *Corresponding author (email: ) Department of Microbiology (UBS, CP, AK), Dr. Rajendra Prasad Centre for Ophthalmic Sciences (R, VKW), All India Institute of Medical Sciences, Department of Microbiology (SM), Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India Received: 01-09-2013 Accepted: 09-04-2014 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148829
adult males. Approximately 35% of patients with Eales’ disease have been associated with pulmonary tuberculosis. In India, the incidence of Eales’ disease was found to be 1 in 135 ophthalmic patients, in a referral centre, and 1 in 200 in a general eye hospital.[3] Various studies have been carried out using immunological parameters to demonstrate a correlation with tuberculosis, but the results are inconclusive. Thus, the etiopathogenesis of Eales’ disease is still poorly understood, and the role of M. tuberculosis is not yet clear. Because of nonavailability of tests with a high predictive value, it is difficult to prove conclusively the role of M. tuberculosis in Eales’ disease. However, the increasing use of polymerase chain reaction (PCR) for various ocular diseases has helped reaching a final diagnosis. MPT64 gene in M. tuberculosis translates into a highly immunogenic protein. PCR for this gene has been successfully used in our laboratory for diagnostic purposes for over 18 years. We designed a case-control study for the detection of M. tuberculosis DNA in vitreous samples of patients with Eales’ disease, by PCR targeting this gene. Materials and Methods Sample collection A total of 65 patients (31 cases with clinical diagnosis of Eales’ disease and 34 controls) were enrolled for this study. Patients with a complication of Eales’ disease such as non-resolving vitreal haemorrhage for ≥4 months, vitreal haemorrhage 10 mm. The results correlated well with the TST reading [Table 2]. Moreover, in patients with tractional retinal detachment, secondary rhegmatogenous retinal detachment and diffuse vasculitis, the PCR positivity is higher than in the control group. However, the number of patients in each group is not significant to prove its statistical significance. In the test group, patients with high TST reading (>10 mm) showed a higher PCR positivity, whereas those with a lower TST reading (
Original Article
Association of mycobacterium tuberculosis in the causation of Eales’ disease: An institutional experience Rajpal, *UB Singh, S Mohapatra, VK Wagh, C Porwal, A Kaushik
Abstract Background: Eales’ disease is an idiopathic retinal vasculitis characterized by retinal inflammation, ischemia, and neo-vascularisation. It frequently causes massive vitreous haemorrhage and retinal detachment leading to blindness. Although the exact etiology is unknown, this condition is considered to be a consequence of hypersensitivity reaction to tubercular protein due to previous Mycobacterium tuberculosis (M. tuberculosis) infection. This study is aimed at the detection of association of M. tuberculosis in patients with Eales’ disease. Materials and Methods: A prospective case-control study was undertaken in 65 clinically diagnosed cases of Eales’ disease. Patients with proliferative diabetic retinopathy, neo-vascular proliferation, macular oedema, premacular fibrosis and tractional retinal detachment were taken as controls. M. tuberculosis DNA was detected (MPT64 gene by polymerase chain reaction, PCR) in patients with Eales’ disease. Clinical symptoms along with tuberculin skin test (TST) and erythrocyte sedimentation rate (ESR) were used as gold standard for comparing results of PCR. Result: PCR positivity was found in 12 (38.7%) patients with Eales’ disease. The PCR positivity was significantly associated with the patients with high TST reading and high ESR values. Conclusion: Patients with a high TST reading and ESR value and a positive PCR in vitreous samples have a high likelihood of having M. tuberculosis as an etiology. Key words: Eales’ disease, Mycobacterium tuberculosis, retinal detachment, vitreous haemorrhage
Introduction Eales’ disease is a well-established clinical entity for more than a century. The disease is predominantly an obliterative vasculitis, which results in peripheral and retinal hypoxia leading to neo-vascularisation. Vitreous haemorrhage with or without tractional rhegmatogenous retinal detachment is the common sequelae of this disease.[1] However, the exact etiopathogenesis and treatment of Eales’ disease is still elusive. Of the several causes suggested, Mycobacterium tuberculosis (M. tuberculosis) is the commonest one. Its role in the etiopathogenesis of Eales’ disease as an active infection or hypersensitivity reaction to tubercular protein has been discussed in literature.[2] It is primarily a disease of healthy *Corresponding author (email: ) Department of Microbiology (UBS, CP, AK), Dr. Rajendra Prasad Centre for Ophthalmic Sciences (R, VKW), All India Institute of Medical Sciences, Department of Microbiology (SM), Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India Received: 01-09-2013 Accepted: 09-04-2014 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148829
adult males. Approximately 35% of patients with Eales’ disease have been associated with pulmonary tuberculosis. In India, the incidence of Eales’ disease was found to be 1 in 135 ophthalmic patients, in a referral centre, and 1 in 200 in a general eye hospital.[3] Various studies have been carried out using immunological parameters to demonstrate a correlation with tuberculosis, but the results are inconclusive. Thus, the etiopathogenesis of Eales’ disease is still poorly understood, and the role of M. tuberculosis is not yet clear. Because of nonavailability of tests with a high predictive value, it is difficult to prove conclusively the role of M. tuberculosis in Eales’ disease. However, the increasing use of polymerase chain reaction (PCR) for various ocular diseases has helped reaching a final diagnosis. MPT64 gene in M. tuberculosis translates into a highly immunogenic protein. PCR for this gene has been successfully used in our laboratory for diagnostic purposes for over 18 years. We designed a case-control study for the detection of M. tuberculosis DNA in vitreous samples of patients with Eales’ disease, by PCR targeting this gene. Materials and Methods Sample collection A total of 65 patients (31 cases with clinical diagnosis of Eales’ disease and 34 controls) were enrolled for this study. Patients with a complication of Eales’ disease such as non-resolving vitreal haemorrhage for ≥4 months, vitreal haemorrhage 10 mm. The results correlated well with the TST reading [Table 2]. Moreover, in patients with tractional retinal detachment, secondary rhegmatogenous retinal detachment and diffuse vasculitis, the PCR positivity is higher than in the control group. However, the number of patients in each group is not significant to prove its statistical significance. In the test group, patients with high TST reading (>10 mm) showed a higher PCR positivity, whereas those with a lower TST reading (
![[Eales disease and tuberculosis: A case report].](/assets/img/hold.png)
