Epidemiology and Clinical Characteristics of Ocular Tuberculosis in the United States, 1993-2019

Abstract

Background: Data regarding ocular tuberculosis (OTB) in the United States have not been previously reported. We evaluated trends of OTB compared with other extrapulmonary TB (EPTB).

Methods: We estimated the proportion of all EPTB cases (with or without concurrent pulmonary involvement) with OTB reported to the National Tuberculosis Surveillance System during 1993-2019. We compared demographics and clinical characteristics of people with OTB and other EPTB during 2010-2019. P values were calculated by chi-square test for categorical variables and Kruskal-Wallis for continuous variables.

Results: During 1993-2019, 1766 OTB cases were reported, representing 1.6% of 109 834 all EPTB cases: 200 (0.5% of 37 167) during 1993-1999, 395 (1.0% of 41 715) during 2000-2009, and 1171 (3.8% of 30 952) during 2010-2019. In contrast to persons with other EPTB, persons with OTB were older (median, 48 vs 44 years; P < .01), more likely to be US-born (35% vs 28%; P < .01), more likely to have diabetes (17% vs 13%; P < .01), and less likely to have HIV (1% vs 8%; P < .01). OTB was less likely to be laboratory confirmed (5% vs 75%; P < .01), but patients were more likely to be tested by interferon gamma release assay (IGRA; 84% vs 56%; P < .01) and to be IGRA positive (96% vs 80%; P < .01).

Conclusions: Reported OTB increased during 1993-2019 despite decreasing TB, including EPTB; the largest increase occurred during 2010-2019. OTB was rarely laboratory confirmed and was primarily diagnosed in conjunction with IGRA results. More research is needed to understand the epidemiology of OTB to inform clinical and diagnostic practices.

Keywords: extrapulmonary tuberculosis; infectious uveitis; ocular tuberculosis; tuberculosis epidemiology; tuberculosis surveillance.

Figure 1.

Reported cases of ocular TB in the United States and percentage of reported TB represented by ocular TB, 1993–2019. Abbreviation: TB, tuberculosis.

Figure 2.

Reported ocular TB cases as percentage of reported extrapulmonary TB, by US census division. TB reporting jurisdictions (50 US states, District of Columbia, and New York City) listed by census division: East North Central: IL, IN, MI, OH, WI. East South Central: AL, KY, MS, TN. Middle Atlantic: NJ, NY, NYC, PA. Mountain: AZ, CO, ID, MT, NM, NV, UT, WY. New England: CT, MA, ME, NJ, RI, VT. Pacific: AK, CA, HI, OR, WA. South Atlantic: DC, DE, FL, GA, MD, NC, SC, VA, WV. West North Central: IA, KS, MN, MO, ND, NE, SD. West South Central: AR, LA, OK, TX. Abbreviation: TB, tuberculosis.