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      Orbital and adnexal tuberculosis: a case series from a South Indian population

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          Abstract

          Background

          Orbital tuberculosis (OTb) is rare and may be regarded as a manifestation of extrapulmonary tuberculosis. We report an interesting case series of six patients with varied presentations of orbital and adnexal tuberculosis in a South Indian patient population.

          Results

          A retrospective, interventional case series of six patients diagnosed with orbital and adnexal tuberculosis on the basis of clinical, radiological and histopathological evaluations between 2010 and 2013 was performed. Among the six patients with histopathologically proven OTb, five were women. The varied presentations included tubercular dacryoadenitis (two cases), classical periostitis (two cases), OTb with bone involvement (one case) and ocular adnexal tuberculosis (one case). Systemic involvement was seen in one case. All cases were treated with a regimen of antitubercular therapy (ATT).

          Conclusions

          OTb, though rare, should form a part of the differential diagnosis of orbital lesions in a high tuberculosis (TB) endemic country like ours. Biopsy still remains the mainstay of diagnosis.

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          Most cited references15

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          Intraocular tuberculosis--an update.

          The lack of any uniform diagnostic criteria for intraocular tuberculosis, in either immunocompetent or immunocompromised individuals, has contributed to the confusion regarding diagnosis and management. However, recent studies addressing the clinical significance of purified protein derivative test results, computerized tomography of the chest, and molecular diagnostic procedures have provided a new approach to establishing the diagnosis of ocular tuberculosis. The current review focuses on the diagnostic modalities used for the clinical management of intraocular tuberculosis, with the emphasis on diagnostic criteria, various clinical features, and treatments recommended in recent publications. Furthermore, the current review addresses the diagnostic criteria for intraocular tuberculosis, the spectrum of tuberculosis in patients with AIDS and in those on anti-tumor necrosis factor agents, and management of drug-resistant tuberculosis.
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            Orbital tuberculosis: a review of the literature.

            To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB). Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals. Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved. Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-gamma immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.
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              Pictorial essay: Orbital tuberculosis

              Tuberculosis of the orbit is rare, even in places where tuberculosis is endemic. The disease may involve soft tissue, the lacrimal gland, or the periosteum or bones of the orbital wall. Intracranial extension, in the form of extradural abscess, and infratemporal fossa extension has been described. This pictorial essay illustrates the imaging findings of nine histopathologically confirmed cases of orbital tuberculosis. All these patients responded to antituberculous treatment.
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                Author and article information

                Contributors
                Journal
                J Ophthalmic Inflamm Infect
                J Ophthalmic Inflamm Infect
                Journal of Ophthalmic Inflammation and Infection
                Springer
                1869-5760
                2014
                22 May 2014
                : 4
                : 12
                Affiliations
                [1 ]Vittala International Institute of Ophthalmology, Bangalore 560085, India
                [2 ]Prabha Eye Clinic and Research Centre, 504, 40th Cross, Jayanagar 8th Block, Bangalore 560070, India
                Article
                1869-5760-4-12
                10.1186/1869-5760-4-12
                4042138
                d336a4bc-aca2-4089-a590-f51e58ca2213
                Copyright © 2014 Babu et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                : 10 January 2014
                : 30 April 2014
                Categories
                Original Research

                Ophthalmology & Optometry
                orbital tuberculosis,mycobacterium tuberculosis,proptosis,antitubercular therapy

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