1351. How Do Infectious Diseases Clinicians Manage Patients with Suspected Ocular Tuberculosis? Results of an Emerging Infections Network Survey

Abstract Background Ocular tuberculosis (OTb) is uncommon and many ID physicians (IDPs) have limited experience with OT. Ophthalmologists now include IGRAs in evaluating idiopathic uveitis, and some IDPs report increased referrals for possible OTb. Our goal was to understand how IDPs approach diagnosis, treatment, and reporting of OTb. Methods The Emerging Infections Network surveyed members treating adult ID patients in 2019 about referrals for suspected OTb. The survey used hypothetical case scenarios to evaluate factors influencing the management of possible OTb, and queried involvement of public health agencies. Results 754 of 1,379 (55%) physicians responded. 141 (19%) reported ≥1 referral for possible OTb in the past 3 years; 35% of these reported increasing referrals over time. Most frequent indications for referral were uveitis and positive IGRA (60%) and idiopathic uveitis without positive IGRA or TST (33%). For a hypothetical case with uveitis, positive IGRA but no other symptoms, respondents were much more likely (79% vs. 29%) to treat as TB disease if TB risk factors were present. Respondents were more likely to require a positive eye culture or NAAT prior to treating a risk factor-negative patient (39% vs. 12%). 54% of respondents believed <10% of eye specimens were culture or NAAT-positive for suspected OTb. 94% would treat suspected OTb with INH, RIF, PZA ± EMB but duration of treatment varied with 27% stopping therapy for lack of clinical response and 59% continuing for at least 6 months regardless of response. 44% were unsure if improvement should be expected on therapy. One-third of respondents either did not report or reported only culture-confirmed OTb cases on treatment to public health agencies. Conclusion IDPs report increased referrals for possible OTb, mainly for idiopathic uveitis and positive IGRAs. There is considerable practice variation in management of possible OTb. The decision to treat as TB disease is heavily influenced by TB epidemiologic risk factors, and there is heterogeneity in treatment duration and in expectation of response to therapy. Prospective studies to assess treatment responses in OTb and improved collaboration with ophthalmologists are necessary to better manage this emerging syndrome. Treated OTb cases should be reported to public health agencies. Disclosures All authors: No reported disclosures.