Demystifying the role of the Mantoux test in ocular tuberculosis

Abstract

Context: The diagnosis and management of ocular tuberculosis (OTB) is largely a mystery, and the fact that it is a great imitator of various ocular pathologies adds to the difficulty in the diagnosis of patients. Aims: The aim of this study was to assess the role of the Mantoux test in the diagnosis of OTB. Settings and Design: This was a retrospective chart review of patients who were diagnosed to have and treated as OTB in 1 year at our tertiary care center in Western India. Methods: The study population included 34 patients who presented to us and were diagnosed to have OTB, using standards published by the Department of Health Research, Ministry of Health and Family Welfare, Government of India, and the Indian Council of Medical Research. Results: A total of 34 patients were diagnosed to have OTB in the study period of 1 year between January 1, 2021, and December 31, 2021. Of these 34 patients; 14 were male and 20 were female. The Mantoux test had been done in 32/34 patients. It was positive in 26 patients and negative in six patients. Looking specifically at the six patients in whom the Mantoux was negative, apart from having ocular signs of tuberculosis (TB), they had positive findings suggestive of old/active TB on contrast-enhanced chest computed tomography scan. Of the 34 patients, only five patients were treated based only on the clinical signs of OTB with only a positive Mantoux test, but even they all showed a response to treatment. Conclusions: There is a definite role of the Mantoux test when interpreted considering the clinical phenotype and radiology findings in OTB.

Keywords

• clinical phenotype of ocular tuberculosis
• extrapulmonary tuberculosis
• mantoux test
• ocular tuberculosis
• standard treatment workflow for the management of intraocular tuberculosis
• tuberculin skin test