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LETTER TO EDITOR
Year : 2006  |  Volume : 54  |  Issue : 1  |  Page : 63-64

Author's reply


Lilavati Hospital and Research Center, Mumbai, India

Correspondence Address:
Salil Mehta
Lilavati Hospital and Research Center, Mumbai
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Mehta S. Author's reply. Indian J Ophthalmol 2006;54:63-4

How to cite this URL:
Mehta S. Author's reply. Indian J Ophthalmol [serial online] 2006 [cited 2019 Oct 20];54:63-4. Available from: http://www.ijo.in/text.asp?2006/54/1/63/21622

Dear Editor,

I thank Dr. Teotia for his interest and comments on my manuscript. I would like to reply to his comments.

1. Dr. Teotia suggests that tuberculous lymphadenopathy and "pulmonary tuberculosis" are two distinct entities with different presentations, and by implication, differing in their management. The spectrum of pathology in pulmonary tuberculosis extends from isolated lymphadenopathy to parenchymal lesions (consolidation, cavity formation, etc.) and constitutes a single disease entity that requires identical management. In a sizable proportion of Indian patients, isolated lymphadenopathy may be the only manifestation and needs to be considered as "pulmonary" tuberculosis. It is in this subgroup that routine chest X-rays may be inadequate, as we have shown in our case.

2. "Active" tuberculosis is a state of active bacterial multiplication, is found throughout the spectrum, and may be determined by various radiological and microbiological criteria.

3. The "classical" symptoms of tuberculous infection such as lassitude, malaise, etc., are often not found and their presence or absence is only of corroborative value.

4. I agree that tuberculous uveitis is not an easy diagnosis to make and the use of chest X-rays, Mantoux tests, etc., are frontline resources. The role of chest CT is in cases with normal or equivocal X-ray findings but a strong clinical suspicion of tuberculous infection.

5. Mantoux test serves as a reliable indicator of tuberculous infection and not the presence of clinical disease, and I agree with Dr. Teotia in this aspect.

6. The left eye has good vision owing to preserved central vision with extensive peripheral loss.

7. The diagnosis of sarcoidosis often requires several clinical and radiological criteria. The presence of chest X-ray alone may not be adequate in some cases, as I have highlighted. Hilar lymphadenopathy, a common finding, should be studied further as it may be seen in many systemic pathologies. Kveim's test is not routinely offered any more and biopsies of tissues are invasive, often more expensive, and require histopathological expertise.

8. I agree that infrastructural limitations exist, and in these areas, a greater reliance on clinical findings may be required. I do not advocate replacing clinical examination but merely suggest alternate chest imaging techniques for a select group of patients.




 

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