How is ocular tuberculosis in HIV infection diagnosed?

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Perform a detailed history and physical examination, attempting to rule out other causes of granulomatous disease, such as sarcoidosis, syphilis, leprosy, and brucellosis. Order a chest radiograph.

Perform a purified protein derivative (PPD) skin test. A reaction induration of more than 5 mm is considered positive in patients with the following:

  • HIV infection

  • History of close contact with persons with infectious tuberculosis

  • A positive chest x-ray showing fibrotic lesions

A PPD reaction induration of more than 10 mm is considered positive for persons with the following:

  • Medical risk factors for reactivation of latent tuberculosis

  • Early life in an area with high tuberculosis prevalence

  • Member of a low-income population (eg, blacks, Hispanics, Native Americans)

  • Intravenous drug use

  • Nursing home residence

A PPD reaction induration of more than 15 mm is considered positive in individuals with no risk factors for tuberculosis. The QuantiFERON-TB Gold in-Tube test and T-Spot TB test are used to measure the immune system’s reaction to tuberculosis bacteria.

Culture for positive growth of Mycobacterium tuberculosis is needed to confirm the diagnosis of tuberculosis.


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