TNOA Journal of Ophthalmic Science and Research

: 2018  |  Volume : 56  |  Issue : 2  |  Page : 137-

A case report of optic nerve head tuberculosis

Mahmood Dhahir Al-Mendalawi 
 Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, P. O. Box: 55302, Baghdad Post Office, Baghdad

How to cite this article:
Al-Mendalawi MD. A case report of optic nerve head tuberculosis.TNOA J Ophthalmic Sci Res 2018;56:137-137

How to cite this URL:
Al-Mendalawi MD. A case report of optic nerve head tuberculosis. TNOA J Ophthalmic Sci Res [serial online] 2018 [cited 2020 Jul 10 ];56:137-137
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I read with interest the case report by Periyanayagi et al. on optic nerve head tuberculosis (TB) in an Indian patient.[1] I presume that the authors did not consider the contributory role of infection with human immunodeficiency virus (HIV) to the occurrence of the rare entity of optic nerve head TB in the studied patient. My presumption is based on the following point. The authors obviously mentioned that “systemic workup was found to be normal. Mantoux test was highly positive showing an induration of 19 mm. QuantiFERON TB-GOLD test was positive. Erythrocyte sedimentation rate was raised. Chest X-ray was normal. Screening for toxoplasmosis, other agents, rubella, Cytomegalovirus, herpes simplex, Toxocara, Venereal Disease Research Laboratory, and Voluntary Counseling and Testing Center was negative.”[1] It is well known that HIV infection could affect any organ in the body, and various ocular manifestations have been recognized in almost one-third of HIV-positive patients.[2] To my knowledge, both TB and HIV infections are still alarming health threats in India. The available published data pointed out to the national HIV prevalence of 0.26% compared with a global average of 0.2%.[3] The prevalence of TB/HIV co-infection among HIV Indian patients has been found to be substantial (12.3%) and 56% of TB lesions in patients with HIV/TB co-infection were found to be extrapulmonary.[4] It has been recommended that all TB patients in India should be evaluated for HIV risk factors and counseled to have HIV testing, while all HIV-positive cases should be screened for TB.[4] Therefore, implementing the diagnostic set of CD4 lymphocyte count and viral overload measurements was solicited in the studied patient. If that diagnostic set was conducted and it revealed HIV infection, the case in question could surely expand the spectrum of HIV-associated ocular inflammatory diseases and TB already reported in the Indian literature.[5]

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1Periyanayagi M, Sangeetha S, Deepika SK. A case report of optic nerve head tuberculosis. TNOA J Ophthalmic Sci Res 2018;56:20-2.
2Uemura A, Yashiro S, Takeda N, Oka S. Ocular complications in patients with human immunodeficiency virus infection. Nippon Ganka Gakkai Zasshi 2006;110:698-702.
3Paranjape RS, Challacombe SJ. HIV/AIDS in India: An overview of the Indian epidemic. Oral Dis 2016;22 Suppl 1:10-4.
4Manjareeka M, Nanda S. Prevalence of HIV infection among tuberculosis patients in Eastern India. J Infect Public Health 2013;6:358-62.
5Mehta S, Mansoor H, Khan S, Saranchuk P, Isaakidis P. Ocular inflammatory disease and ocular tuberculosis in a cohort of patients co-infected with HIV and multidrug-resistant tuberculosis in Mumbai, India: A cross-sectional study. BMC Infect Dis 2013;13:225.