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Patient Details

Patient Name
Patient ID
Age
Gender
Country
Physician Name

Findings

Clinical Phenotype:

Following the principles of the Standardization of Uveitis Nomenclature (SUN) classification (reference # 4):

Tubercular anterior uveitis (TAU) is defined as inflammation limited to the anterior segment, where the primary site of inflammation is the anterior chamber involving the iris and ciliary body.

Tubercular intermediate uveitis (TIU) is defined as the vitreous being the major site of inflammation.

Tubercular posterior uveitis (TPU) is defined as the lack of predominant site of inflammation with inflammation observed in the anterior chamber, vitreous, and retina and/or choroid.

Active tubercular retinal vasculitis (TRV) is described to be evidence of ocular inflammation and retinal vascular changes, including perivascular sheathing and vascular leakage or occlusion on fluorescein angiogram as evidence of retinal vascular disease. Inactive TRV is described to be retinal vascular changes without evidence of ocular inflammation.

Tubercular serpiginous like choroiditis (TB SLC) is defined as inflammation limited to the choroid, the primary site of inflammation, and is characterized by single or multiple discrete yellowish-white fuzzy choroidal lesions and slightly raised edges that show wave-like progression with an active serpiginous-like edge with central healing. Choroidal Tuberculoma (or choroidal nodule) as defined by SUN 2021 is defined as inflammation limited to the choroid, the primary site of inflammation, and is characterized by single or multiple yellowish subretinal lesions with indistinct borders and surrounding exudative fluid, along with oval or round lesion in the choroidal stroma.

Tubercular Multifocal (NonSerpiginous) Choroiditis (TB NSC) is defined as inflammation limited to the choroid, the primary site of inflammation, and is characterized by unifocal or multifocal choroiditis lesions with a phenotype similar to idiopathic multifocal choroiditis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and other phenotypes that do not resemble TB SLC.

Endemicity of patient
(Patient from TB endemic or TB non-endemic region)
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Tuberculin Skin Test/Mantoux Test:
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Interferon Gamma Release Assay (IGRA):
T-Spot TB or QFT-Gold or QFT-Gold+
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Chest X-Ray:
Negative (for any old or active signs of TB); Positive (for any healed or active signs of TB)
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Results

Median Score
-
IQR
-
Inference:
this is a test
** The COTS Consensus guidelines are based on expert inputs based on their experience along with their interpretation of the published literature about initiation of Anti-tubercular therapy (ATT) in patients with ocular tuberculosis. Physician discretion is advised in adopting this tool in their clinical practice and it should be used as a guide by the treating physician in concurrence with clinical signs and laboratory and radiological investigations and after ruling out non-TB causes of intraocular inflammation**

Interpretation


Median Score

Median score 1
Very low probability for most experts to consider initiating Anti-tubercular therapy (<20%)
Median score 2
Low probability for most experts to consider initiating Anti-tubercular therapy (21–40%)
Median score 3
Mixed probability for most experts to consider initiating Anti-tubercular therapy (41–60%)
Median score 4
High probability to for most experts to consider initiating Anti-tubercular therapy (61-80%)
Median score 5
Very high probability for most experts to consider initiating Anti-tubercular therapy (81-100%)
 

IQR

IQR 0
Represents absolute consensus, >90% of experts agreeing on the initiation of Anti-tubercular therapy
IQR 1
Represents moderate consensus, >80% of experts agreeing on the initiation of Anti-tubercular therapy
IQR 2
Represents weak consensus, >70% of experts agreeing on the initiation of Anti-tubercular therapy
IQR 3
Represents poor consensus, </=60% of experts agreeing on the initiation of Anti-tubercular therapy

Distribution of Median Score from 486 possible clinical scenarios

Median(IQR)
Frequency
%
1(0)
41
8.43 %
1(1)
52
10.69 %
1(2)
5
1.02 %
2(1)
4
0.82 %
2(2)
63
12.96 %
2(3)
22
4.52 %
3(1)
7
1.44 %
3(2)
74
15.22 %
3(3)
39
8.02 %
4(1)
10
2.05 %
4(2)
51
10.49 %
4(3)
4
0.82 %
5(0)
24
4.93 %
5(1)
72
14.81 %
5(2)
13
2.67 %
5(3)
5
1.02 %


References:
  1. Agrawal R, Testi I, Mahajan S, Yuen YS, Agarwal A, Kon OM, Barisani-Asenbauer T, Kempen JH, Gupta A, Jabs DA, Smith JR, Nguyen QD, Pavesio C, Gupta V; Collaborative Ocular Tuberculosis Study Consensus Group. Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis- Report 1: Guidelines for Initiating Antitubercular Therapy in Tubercular Choroiditis. Ophthalmology. 2021 Feb;128(2):266-276. doi: 10.1016/j.ophtha.2020.01.008. Epub 2020 Jan 11. PMID: 32115264.
  2. Agrawal R, Testi I, Bodaghi B, Barisani-Asenbauer T, McCluskey P, Agarwal A, Kempen JH, Gupta A, Smith JR, de Smet MD, Yuen YS, Mahajan S, Kon OM, Nguyen QD, Pavesio C, Gupta V; Collaborative Ocular Tuberculosis Study Consensus Group. Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis-Report 2: Guidelines for Initiating Antitubercular Therapy in Anterior Uveitis, Intermediate Uveitis, Panuveitis, and Retinal Vasculitis. Ophthalmology. 2021 Feb;128(2):277-287. doi: 10.1016/j.ophtha.2020.06.052. Epub 2020 Jun 27. PMID: 32603726.
  3. Agrawal R, Testi I, Mahajan S, Yuen YS, Agarwal A, Rousselot A, Raje D, Gunasekeran DV, Kon OM, Barisani-Asenbauer T, Kempen JH, Gupta A, Jabs DA, Smith JR, Bodaghi B, Zierhut M, DeSmet M, Cluskey PM, Agarwal M, Agarwal M, Aggarwal K, Agrawal M, Al-Dhibi H, Androudi S, Asyari F, Balasundaram MB, Murthy KB, Baglivo E, Banker A, Bansal R, Basu S, Behera D, Biswas J, Carreño E, Caspers L, Chee SP, Chhabra R, Cimino L, Del Rio LEC, Cunningham ET, Curi ALL, Das D, Denisova E, Denniston AK, Errera MH, Fonollosa A, George A, Goldstein DA, Crosier YG, Gurbaxani A, Invernizzi A, Isa HM, Md Islam S, Jones N, Katoch D, Khairallah M, Khosla A, Kramer M, Kumar A, Kumar A, Nora RD, Lee R, Lowder C, Luthra S, Mahendradas P, Makhoul D, Mazumdar S, Mehta S, Miserocchi E, Mochizuki M, Mohamed OS, Muccioli C, Munk MR, Murthy S, Narain S, Nascimento H, Neri P, Nguyen M, Okada AA, Ozdal P, Palestine A, Pichi F, Rathinam SR, Schlaen A, Sehgal S, Sen HN, Sharma A, Sharma K, Shoughy SS, Singh N, Singh R, Soheilian M, Sridharan S, Thorne JE, Tappeiner C, Teoh S, Tognon MS, Tugal-Tutkun I, Tyagi M, Uy H, Santos DVV, Valentincic NV, Westcott M, Yanai R, Alvarez BY, Zahedur R, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS) Consensus (CON) Group Meeting Proceedings. Ocul Immunol Inflamm. 2020 Apr 6:1-11. doi: 10.1080/09273948.2020.1716025. Epub ahead of print. PMID: 32250731.
  4. Agrawal R, Agarwal A, Jabs DA, Kee A, Testi I, Mahajan S, McCluskey PJ, Gupta A, Palestine A, Denniston A, Banker A, Invernizzi A, Fonollosa A, Sharma A, Kumar A, Curi A, Okada A, Schlaen A, Heiligenhaus A, Kumar A, Gurbaxani A, Bodaghi B, Islam Shah B, Lowder C, Tappeiner C, Muccioli C, Vasconcelos-Santos DV, Goldstein D, Behra D, Das D, Makhoul D, Baglivo E, Denisova E, Miserocchi E, Carreno E, Asyari F, Pichi F, Sen HN, Uy H, Nascimento H, Tugal-Tutkun I, Arevalo JF, Davis J, Thorne J, Hisae Yamamoto J, Smith J, Garweg JG, Biswas J, Babu K, Aggarwal K, Cimino L, Kuffova L, Agarwal M, Zierhut M, Agarwal M, De Smet M, Tognon MS, Errera MH, Munk M, Westcott M, Soheilian M, Accorinti M, Khairallah M, Nguyen M, Kon OM, Mahendradas P, Yang P, Neri P, Ozdal P, Amer R, Lee R, Distia Nora R, Chhabra R, Belfort R, Mehta S, Shoughy S, Luthra S, Mohamed SO, Chee SP, Basu S, Teoh S, Ganesh S, Barisani-Asenbauer T, Guex- Crosier Y, Ozyazgan Y, Akova Y, Habot-Wilner Z, Kempen J, Nguyen QD, Pavesio C, Gupta V; Standardization of Nomenclature for Ocular Tuberculosis - Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop. Ocul Immunol Inflamm. 2019 Dec 10:1-11. doi: 10.1080/09273948.2019.1653933. Epub ahead of print. PMID: 31821096.

Collaborative Ocular Tuberculosis Study Consensus Guidelines Calculator
A joint initiative of COTS, IOIS, IUSG and FOIS