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Abudukadier M, Zhang Y, Li M, Muhetaer M, Mijiti Y, Simayi Z, Aireti M, Tian J, Maimaiti M. A Novel Differentiation Nomogram Model for Brucellar Spondylitis and Tuberculous Spondylitis. Infect Drug Resist 2024; 17:5895-5907. [PMID: 39749158 PMCID: PMC11693859 DOI: 10.2147/idr.s497404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 12/17/2024] [Indexed: 01/04/2025] Open
Abstract
Background Tuberculous spondylitis (TS) and brucellar spondylitis (BS) exhibit certain similarities in clinical presentation and imaging characteristics, making differential diagnosis challenging. Developing a reliable differential diagnosis model can assist clinicians in distinguishing between these two conditions at an early stage, allowing for targeted prevention and treatment strategies. Methods Patients diagnosed with TS and BS were retrospectively collected and randomized into training and validation cohorts (ratio 7:3). The least absolute shrinkage and selection operator (LASSO) regression was used to reduce data dimensionality and select variables. Multivariate logistic regression was used to build predictive models. A nomogram was constructed to provide a visual representation of the model. Receiver operating characteristic (ROC) curve, calibration plots and decision curve analysis (DCA) were used to measure the predictive performance of the nomogram. Results A total of 183 patients included (101 cases of TB, 82 cases of BS) our study. Our results showed that these variables including time from symptom onset to admission, anorexia, adenosine deaminase (ADA) and psoas abscess were important to differentiate TS and BS. The area under the curve (AUC) of ROC curve was 0.820 [95% CI (0.749, 0.892)] and 0.899 [95% CI (0.823, 0.976)] for the training and validation cohort, respectively. The results of calibration curve and DCA confirmed that the nomogram performed well in differentiating TS patient from BS. Conclusion The combination of time from symptom onset to admission, anorexia, ADA and psoas abscess demonstrated good differential properties for TS and BS. We developed a new nomogram model that can effectively differentiate TS and BS based on these four characteristics, which could be a valid and useful clinical tool for clinicians to aid in early differential diagnosis and targeted treatment.
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Affiliation(s)
- Maimaitiyibubaji Abudukadier
- Department of Hand and Foot Microsurgery, Children’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hospital of Beijing Children’s Hospital, Urumqi, Xinjiang, 830000, People’s Republic of China
| | - Yuxin Zhang
- Department of Spine Surgery, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, People’s Republic of China
| | - Maozhao Li
- Department of Spine Surgery, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, People’s Republic of China
| | - Munire Muhetaer
- Department of Spine Surgery, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, People’s Republic of China
| | - Yibulayinjiang Mijiti
- Department of Spine Surgery, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, People’s Republic of China
| | - Zumulaiti Simayi
- Department of Neurology, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, People’s Republic of China
| | - Maimaitijiang Aireti
- Department of Orthopedic, Children’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hospital of Beijing Children’s Hospital, Urumqi, Xinjiang, 830000, People’s Republic of China
| | - Jingshun Tian
- Department of Hand and Foot Microsurgery, Children’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hospital of Beijing Children’s Hospital, Urumqi, Xinjiang, 830000, People’s Republic of China
| | - Maimaitishawutiaji Maimaiti
- Department of Spine Surgery, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, People’s Republic of China
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Liu B, Zhang Y, Yuan Z, Zhang Q. Cervical Brucella Spondylitis: A Case Report on Diagnosis and Surgical Management. Infect Drug Resist 2024; 17:3537-3545. [PMID: 39161468 PMCID: PMC11330751 DOI: 10.2147/idr.s474589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/09/2024] [Indexed: 08/21/2024] Open
Abstract
Background Brucellosis is a zoonotic disease that can affect various organs, including the spine. Cervical spondylitis caused by Brucella is rare but can lead to significant morbidity if not diagnosed and treated promptly. Case Presentation We report a case of a 46-year-old female who presented with intermittent high fever and intractable neck, shoulder, and back pain for two months. She was diagnosed with Brucella cervical spondylitis based on clinical manifestations, Rose-Bengal Plate Agglutination Test (RBPT, positive), and cervical MRI findings. She was treated with a combination of antibiotics for at least two weeks, followed by surgical intervention including abscess clearance, partial vertebral resection, and titanium mesh bone fusion. Real-time Polymerase Chain Reaction (RT-PCR) confirmed the presence of sheep Brucella DNA. The patient recovered well postoperatively with significant pain reduction and restoration of full mobility in the right upper limb. Conclusion This case highlights the diagnostic value of RT-PCR and tissue biopsy in cervical brucellosis spondylitis. Our study found that anterior cervical subtotal corpectomy can restore cervical stability, clear abscess, and relieve spinal cord compression on the basis of drug treatment, with good clinical results.
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Affiliation(s)
- Bo Liu
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, National Center for Infectious Diseases, Beijing, 100015, People’s Republic of China
| | - Yao Zhang
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, National Center for Infectious Diseases, Beijing, 100015, People’s Republic of China
| | - Zheng Yuan
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, National Center for Infectious Diseases, Beijing, 100015, People’s Republic of China
| | - Qiang Zhang
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, National Center for Infectious Diseases, Beijing, 100015, People’s Republic of China
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Na S, Lyu Z, Zhang S. Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions. Orthop Surg 2023. [PMID: 37186216 DOI: 10.1111/os.13744] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.
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Affiliation(s)
- Shibo Na
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - ZhenShan Lyu
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - Shaokun Zhang
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
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Sharma K, Sharma M, Sharma A, Dhillon MS. Diagnosing osteo-articular tuberculosis and multidrug resistance using real-time polymerase chain reaction and high-resolution melt-curve analysis. J Orthop Res 2023; 41:891-896. [PMID: 35780389 DOI: 10.1002/jor.25410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
The study evaluated real-time quantitative polymerase chain reaction (qPCR) and high-resolution melt-curve analysis (HRM) for simultaneous diagnosis of osteo-articular tuberculosis (OATB) and drug resistance. Two hundred and fifty synovial fluid and pus specimens (20 confirmed OATB by culture, 130 suspected OATB, and 100 controls) processed in the Department of Medical Microbiology, PGIMER were subjected to qPCR using rpoB, MPB64, and IS6110 genes. All OATB positive specimens were subjected to HRM for detecting resistance to rifampicin and isoniazid. qPCR detected 129/150 OATB cases with a sensitivity of 86% (95% for confirmed and 84.6% for suspected OATB cases) and specificity of 100%. rpoB and MPB64 genes had higher sensitivity than IS6110 (86% vs. 74.6%). HRM reported eight multidrug resistant (MDR), two mono-rifampicin, and five mono-isoniazid resistant cases, all were concordant with gene sequencing. qPCR followed by HRM analysis offer a simple, accurate, and rapid platform for simultaneous detection of OATB and MDR.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Herren C, von der Hoeh NH, Zwingenberger S, Sauer D, Jung N, Pieroh P, Drange S, Pumberger M, Scheyerer MJ. Spondylodiscitis in Geriatric Patients: What Are the Issues? Global Spine J 2023; 13:73S-84S. [PMID: 37084348 PMCID: PMC10177302 DOI: 10.1177/21925682221121300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Review article. OBJECTIVES A review of literature on the treatment of pyogenic spondylodiscitis in geriatric patients was performed with the aim to give an overview about these special patients and a recommendation on necessary diagnostics as well as conservative and operative treatment options. METHODS A systematic computerized literature search was done by the spondylodiscitis working group of the German Society for Orthopedics and Trauma Surgery. RESULTS Spondylodiscitis has an increasing incidence by age with a peak at 75 years or older. The 1-year mortality without an appropriate treatment is with 15 to 20% extremely high. Pathogen detection is the essential diagnostic step and the basis for a sufficient antibiotic treatment. Geriatric patients have initially less elevated inflammatory parameters. Compared to younger patients. They have a longer length of hospital stay and take longer for CRP normalization. Even the outcome between conservative and operative treatment is comparable after one year. Patients with spinal instability, immobilizing pain, epidural abscess, and newly emerged neurological deficits should be considered for operative treatment. CONCLUSIONS The treatment of geriatric patients with pyogenic spondylodiscitis must take into account that these patients usually have multiple comorbidities. The main goals are resistance-based antibiotics and the shortest possible time of immobilization of the patient.
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Affiliation(s)
- Christian Herren
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, Germany
| | | | - Stefan Zwingenberger
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Germany
| | - Daniel Sauer
- Spinecenter, Schön Klinik Munich Harlaching University, Deutschland
| | - Norma Jung
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, University of Cologne, Germany
| | - Philipp Pieroh
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Steffen Drange
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Germany
| | - Matthias Pumberger
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine BerlinUniversity, Germany
| | - Max J Scheyerer
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Germany
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Hammami F, Koubaa M, Feki W, Chakroun A, Rekik K, Smaoui F, Marrakchi C, Mnif Z, Jemaa MB. Tuberculous and Brucellar Spondylodiscitis: Comparative Analysis of Clinical, Laboratory, and Radiological Features. Asian Spine J 2020; 15:739-746. [PMID: 33198439 PMCID: PMC8696053 DOI: 10.31616/asj.2020.0262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/18/2020] [Indexed: 11/25/2022] Open
Abstract
Study Design This was a retrospective study. Purpose The aim was to compare the clinical, laboratory, radiological, and evolutionary features of tuberculous spondylodiscitis (TS) and brucellar spondylodiscitis (BS). Overview of Literature Clinical presentation of spondylodiscitis varies according to the underlying etiology, among which brucellosis and tuberculosis represent the primary cause, in endemic countries. Only a few studies have compared the characteristics between TS and BS. Methods A retrospective study was conducted using the data of all patients hospitalized for TS and BS in the infectious diseases department between 1991 and 2018. Results Among a total of 117 patients, 73 had TS (62.4%) and 44 had BS (37.6%). Females were significantly more affected with TS than males (56.2% vs. 22.7%, p<0.001). Fever (72.7% vs. 45.2%, p=0.004) and sweating (72.7% vs. 47.9%, p=0.009) were significantly more frequent among patients with BS. The median erythrocyte sedimentation rate was significantly higher in the TS group (median, 70 mm/hr; interquartile range [IQR], 45–103 mm/hr) than in the BS group (median, 50 mm/hr; IQR, 16–75 mm/hr) (p=0.003). Thoracic involvement was significantly more frequent in the TS group (53.4% vs. 34.1%, p=0.04), whereas lumbar involvement was significantly more frequent in the BS group (72.7% vs. 49.3%, p=0.01). Initial imaging findings revealed significantly higher frequencies of posterior vertebral arch involvement, vertebral compaction, and spinal cord compression in the TS group. Percutaneous abscess drainage (20.5% vs. 2.3%, p=0.005) and surgical treatment (17.8% vs. 2.3%, p=0.01) were more frequently indicated in the TS group, with a significant difference. Conclusions A combination of clinical, laboratory, and radiological features can be used to distinguish between TS and BS while these patients await diagnosis confirmation.
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Affiliation(s)
- Fatma Hammami
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.,Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Makram Koubaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.,Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Wiem Feki
- Radiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Amal Chakroun
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.,Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Khaoula Rekik
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.,Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Fatma Smaoui
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.,Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Chakib Marrakchi
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.,Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Zeineb Mnif
- Radiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.,Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
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Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J 2019; 19:1858-1870. [PMID: 31102727 DOI: 10.1016/j.spinee.2019.05.002] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 02/03/2023]
Abstract
Nearly one-third of the human population is infected with tuberculosis. Of those with active disease, approximately 10% are impacted by skeletal tuberculosis. Though, traditionally a disease of the developing world and susceptible populations, with the rise of immigration, patients may present in developed countries. The microbe responsible is the mycobacterium tuberculosis complex bacillus. The infection begins in the anterior vertebral bodies. The natural history and presentation are notable for cold abscesses causing mass effect, early or late neurological deficit, and kyphotic deformity of the spine caused by anterior vertebral body destruction. The disease can be diagnosed with laboratory studies and characteristic imaging findings, but tissue diagnosis with cultures, histology, and polymerase chain reaction is the gold standard. The cornerstone of medical management is multidrug chemotherapy to minimize relapse and drug resistance, and can be curative for spinal tuberculosis with minimal residual kyphosis. Surgical management is reserved for patients presenting with neurological deficits or severe kyphosis. The mainstays of surgical management are debridement, correction of spinal deformity and stable fusion. With appropriate and timely management, clinical outcomes of the treatment of spinal tuberculosis are overall excellent.
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Laboratory Diagnostic Procedures for Human Brucellosis: An Overview of Existing Approaches. Jundishapur J Microbiol 2019. [DOI: 10.5812/jjm.91200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sharma K, Meena RK, Aggarwal A, Chhabra R. Multiplex PCR as a novel method in the diagnosis of spinal tuberculosis-a pilot study. Acta Neurochir (Wien) 2017; 159:503-507. [PMID: 28110400 DOI: 10.1007/s00701-016-3065-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Establishment of a reliable and rapid diagnosis is of paramount importance in spinal tuberculosis. The available gadgetry of investigations, such as AFB smear, culture of Mycobacterium tuberculosis, and Uniplex PCR, suffers from a lack of adequate sensitivity and/or a lack of rapidity. Therefore, many times a diagnosis is made either very late in the disease process or sometimes empirical therapy has to be started because a definite diagnosis could not be made. All of these are not ideal situations for a clinician. The present study was done with the aim to establish a rapid and reliable diagnosis of M. tuberculosis infection. This was established by identifying M. tuberculosis genes. METHODS The study was done on nine consecutive patients who presented with non-traumatic spontaneous vertebral compression collapse. CT-guided aspirate from the involved vertebra was subjected to Multiplex PCR (MPCR) using three primers: IS6110, protein b, and MPB 64. The aspirate was also subjected to smear and culture. The results of MPCR were compared with the final diagnosis. RESULTS Seven out of nine patients had a final diagnosis of tuberculosis. MPCR was positive in six of these seven patients, thus showing sensitivity of 85.7% and specificity of 100%. Results of MPCR were obtained within 24 h. CONCLUSIONS MPCR using IS6110, protein b, and MPB64 primers has a high sensitivity and specificity in rapid diagnosis of spinal tuberculosis. To the best of our knowledge, this has not been attempted before in spinal tuberculosis. This is particularly useful for paucibacillary infections like spinal tuberculosis. However, further studies using large sample sizes are needed to confirm the practical applicability of this technique.
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Affiliation(s)
- Kusum Sharma
- Department of Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Kumar Meena
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Ashish Aggarwal
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Chhabra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Mycobacterium tuberculosis Contaminant Risk on Bone Marrow Aspiration Material from Iliac Bone Patients with Active Tuberculous Spondylitis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3852940. [PMID: 27294117 PMCID: PMC4879251 DOI: 10.1155/2016/3852940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 01/08/2023]
Abstract
There was a concern on Mycobacterium tuberculosis spreading to the bone marrow, when it was applied on tuberculous spine infection. This research aimed to study the probability of using autologous bone marrow as a source of mesenchymal stem cell for patients with tuberculous spondylitis. As many as nine patients with tuberculous spondylitis were used as samples. During the procedure, the vertebral lesion material and iliac bone marrow aspirates were obtained for acid fast staining, bacteria culture, and PCR (polymerase chain reaction) tests for Mycobacterium tuberculosis at the Clinical Microbiology Laboratory of Faculty of Medicine Universitas Indonesia. This research showed that there was a relationship between diagnostic confirmation of tuberculous spondylitis based on the PCR test and bacterial culture on the solid vertebral lesion material with the PCR test and bacterial culture from the bone marrow aspirates. If the diagnostic confirmation concluded positive results, then there was a higher probability that there would be a positive result for the bone marrow aspirates, so that it was not recommended to use autologous bone marrow as a source of mesenchymal stem cell for patients with tuberculous spondylitis unless the PCR and culture examination of the bone marrow showed a negative result.
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Abstract
INTRODUCTION The incidence of vertebral osteomyelitis is increasing, attributed to an ageing population with inherent co-morbidities and improved case ascertainment. SOURCES OF DATA References were retrieved from the PubMed database using the terms 'vertebral osteomyelitis' and 'spondylodiscitis' between January 1, 2009 and April 30, 2014 published in English as checked in May 2014 (>1000 abstracts checked). AREAS OF AGREEMENT Blood cultures and whole spine imaging with magnetic resonance imaging are essential investigations. Thorough debridement is the mainstay of surgical management, although placing metalwork in active infection is becoming increasingly common. AREAS OF CONTROVERSY The extent of pursuing spinal biopsies to determine aetiology, antimicrobial choices and duration, monitoring the response to treatment, and surgical techniques and timing all vary widely in clinical practice with heterogeneous studies limiting comparisons. Surgery, rather than conservative approaches, is being proposed as the default management choice, because it can, in carefully selected patients, offer faster reduction in pain scores and improved quality of life. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies are needed to define the most effective technique for spinal biopsies to maximize determining aetiology. High-quality trials are required to provide an evidence base for both the medical and surgical management of vertebral osteomyelitis, including challenging medical management as the default option.
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Affiliation(s)
- Emma K Nickerson
- Department of Infectious Diseases, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Rohitashwa Sinha
- Department of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Márquez Sánchez P. Spondylodiscitis. RADIOLOGIA 2016; 58 Suppl 1:50-9. [PMID: 26869521 DOI: 10.1016/j.rx.2015.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/19/2015] [Accepted: 12/16/2015] [Indexed: 11/24/2022]
Abstract
Spondylodiscitis is an infection of the spine that has been known since ancient times. Its incidence is rising, due to the increases in life expectancy and debilitating conditions. Its age distribution is bimodal, affecting persons younger than 20 years of age or persons aged 50-70 years. According to its origin, it is classified as pyogenic, granulomatous or parasitic, though the first form is the most common, usually caused by Staphylococcus aureus or Escherichia coli. The clinical presentation is insidious, resulting in a delayed diagnosis, particularly in tuberculous spondylodiscitis. The initial onset usually involves inflammatory back pain, though the disease may course with fever, asthenia and neurological deficit, these being the most severe complications. Diagnosis is based on clinical, radiological, laboratory, microbiological and histopathological data. Magnetic resonance imaging is the technique of choice for the diagnosis of spondylodiscitis. The differential diagnosis involves, among other conditions, intervertebral erosive osteochondrosis, tumour, axial spondyloarthropathy, haemodialysis spondyloarthropathy, Modic type 1 endplate changes and Charcot's axial neuroarthropathy. Treatment is based on eliminating the infection with antibiotics, preventing spinal instability with vertebral fixation, and ample debridement of infected tissue to obtain samples for analysis.
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Affiliation(s)
- P Márquez Sánchez
- Sección de Musculoesquelético, Servicio de Radiodiagnóstico, Hospital Regional Universitario, Málaga.
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Syndromic Diagnostic Approaches to Bone and Joint infections. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang Y, Wang Z, Zhang Y, Bai L, Zhao Y, Liu C, Ma A, Yu H. Polymerase chain reaction-based assays for the diagnosis of human brucellosis. Ann Clin Microbiol Antimicrob 2014; 13:31. [PMID: 25082566 PMCID: PMC4236518 DOI: 10.1186/s12941-014-0031-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/09/2014] [Indexed: 12/14/2022] Open
Abstract
Polymerase chain reaction (PCR) is an in vitro technique for the nucleic acid amplification, which is commonly used to diagnose infectious diseases. The use of PCR for pathogens detection, genotyping and quantification has some advantages, such as high sensitivity, high specificity, reproducibility and technical ease. Brucellosis is a common zoonosis caused by Brucella spp., which still remains as a major health problem in many developing countries around the world. The direct culture and immunohistochemistry can be used for detecting infection with Brucella spp. However, PCR has the potential to address limitations of these methods. PCR are now one of the most useful assays for the diagnosis in human brucellosis. The aim of this review was to summarize the main PCR techniques and their applications for diagnosis and follow-up of patients with brucellosis. Moreover, advantages or limitation of the different PCR methods as well as the evaluation of PCR results for treatment and follow-up of human brucellosis were also discussed.
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Amplicon DNA melting analysis for the simultaneous detection of Brucella spp and Mycobacterium tuberculosis complex. Potential use in rapid differential diagnosis between extrapulmonary tuberculosis and focal complications of brucellosis. PLoS One 2013; 8:e58353. [PMID: 23520501 PMCID: PMC3592798 DOI: 10.1371/journal.pone.0058353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 02/03/2013] [Indexed: 12/26/2022] Open
Abstract
Some sites of extrapulmonary tuberculosis and focal complications of brucellosis are very difficult to differentiate clinically, radiologically, and even histopathologically. Conventional microbiological methods for the diagnosis of extrapulmonary tuberculosis and complicated brucellosis not only lack adequate sensitivity, they are also time consuming, which could lead to an unfavourable prognosis. The aim of this work was to develop a multiplex real-time PCR assay based on SYBR Green I to simultaneously detect Brucella spp and Mycobacterium tuberculosis complex and evaluate the efficacy of the technique with different candidate genes. The IS711, bcsp31 and omp2a genes were used for the identification of Brucella spp and the IS6110, senX3-regX3 and cfp31 genes were targeted for the detection of the M. tuberculosis complex. As a result of the different combinations of primers, nine different reactions were evaluated. A test was defined as positive only when the gene combinations were capable of co-amplifying both pathogens in a single reaction tube and showed distinguishable melting temperatures for each microorganism. According to the melting analysis, only three combinations of amplicons (senX3-regX3+bcsp31, senX3-regX3+IS711 and IS6110+IS711) were visible. Detection limits of senX3-regX3+bcsp31 and senX3-regX3+IS711 were of 2 and 3 genome equivalents for M. tuberculosis complex and Brucella while for IS6110+IS711 they were of 200 and 300 genome equivalents, respectively. The three assays correctly identified all the samples, showing negative results for the control patients. The presence of multicopy elements and GC content were the components most influencing the efficiency of the test; this should be taken into account when designing a multiplex-based SYBR Green I assay. In conclusion, multiplex real time PCR assays based on the targets senX3-regX3+bcsp31 and senX3-regX3+IS711 using SYBR Green I are highly sensitive and reproducible. This may therefore be a practical approach for the rapid differential diagnosis between extrapulmonary tuberculosis and complicated brucellosis.
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Guarner J. Detection of microorganisms in granulomas that have been formalin-fixed: review of the literature regarding use of molecular methods. SCIENTIFICA 2012; 2012:494571. [PMID: 24278704 PMCID: PMC3820445 DOI: 10.6064/2012/494571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 06/02/2023]
Abstract
Granuloma is an organized aggregate of immune cells that under the microscope appear as epithelioid macrophages. A granuloma can only be diagnosed when a pathologist observes this type of inflammation under the microscope. If a foreign body or a parasite is not observed inside the granuloma, stains for acid-fast bacilli and fungi are ordered since mycobacteria and fungi are frequently the cause of this type of inflammation. It is calculated that 12 to 36% of granulomas do not have a specific etiology and many have wondered if with new molecular methods we could reduce this number. This paper will summarize the frequently known causes of granulomas and will present the recent literature regarding the use of molecular techniques on tissue specimens and how these have helped in defining causative agents. We will also briefly describe new research regarding formation and function of granulomas and how this impacts our ability to find an etiologic agent.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA
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Mehta PK, Raj A, Singh N, Khuller GK. Diagnosis of extrapulmonary tuberculosis by PCR. ACTA ACUST UNITED AC 2012; 66:20-36. [PMID: 22574812 DOI: 10.1111/j.1574-695x.2012.00987.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/24/2012] [Accepted: 05/04/2012] [Indexed: 11/30/2022]
Abstract
During the last two decades, the resurgence of tuberculosis (TB) has been documented in both developed and developing nations, and much of this increase in TB burden coincided with human immunodeficiency virus (HIV) epidemics. Since then, the disease pattern has changed with a higher incidence of extrapulmonary tuberculosis (EPTB) as well as disseminated TB. EPTB cases include TB lymphadenitis, pleural TB, TB meningitis, osteoarticular TB, genitourinary TB, abdominal TB, cutaneous TB, ocular TB, TB pericarditis and breast TB, although any organ can be involved. Diagnosis of EPTB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens. A negative smear for acid-fast bacilli, lack of granulomas on histopathology and failure to culture Mycobacterium tuberculosis do not exclude the diagnosis of EPTB. Novel diagnostic modalities such as nucleic acid amplification (NAA) can be useful in varied forms of EPTB. This review is primarily focused on the diagnosis of several clinical forms of EPTB by polymerase chain reaction (PCR) using different gene targets.
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Affiliation(s)
- Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, Haryana, India.
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Pigrau-Serrallach C, Rodríguez-Pardo D. Bone and joint tuberculosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 4:556-66. [PMID: 22711012 DOI: 10.1007/s00586-012-2331-y] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 04/17/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Bone and joint tuberculosis has increased in the past two decades in relation with AIDS epidemics. MATERIAL AND METHODS A literature review of bone and joint tuberculosis, focusing on Pott's disease. RESULTS Bone and joint TB comprises a group of serious infectious diseases whose incidence has increased in the past two decades, especially in underdeveloped countries, in part due to the AIDS epidemic. Tuberculous spinal infections should be suspected in patients with an insidious, progressive history of back pain and in individuals from an endemic area, especially when the thoracic vertebrae are affected and a pattern of bone destruction with relative disc preservation and paravertebral and epidural soft tissue masses are observed. Atypical tuberculous osteoarticular manifestations involving the extraspinal skeleton, a prosthetic joint, or the trochanteric area, and nontuberculous mycobacterial infections should be considered in favorable epidemiological contexts. Surgery combined with prolonged specific antituberculous chemotherapy is mainly indicated in patients with neurological manifestations or deformities, and provides satisfactory results in most cases. CONCLUSIONS Spinal tuberculosis is still a relative common extra spinal manifestation of spinal tuberculosis that requires a high degree of suspicion in order to avoid neurological complications and need of surgery.
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Affiliation(s)
- Carlos Pigrau-Serrallach
- Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona REIPI (Spanish Network for Research in Infectious Disease), Passeig Vall d'Hebron 119-129, Barcelona, Spain.
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Shi J, Wang Z, Li H, Yuan H. Diagnostic performance of the urinary deoxypyridinoline in spinal tuberculosis. Orthopedics 2012; 35:e922-6. [PMID: 22691668 DOI: 10.3928/01477447-20120525-36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated the diagnostic significance of urinary deoxypyridinoline measurement as a screening tool for spinal tuberculosis in patients with pulmonary tuberculosis.Urinary deoxypyridinoline levels were measured by automated chemiluminescence immunoassay and automated chemistry methods in patients with spinal (n=33) and pulmonary tuberculosis (n=33) and in healthy controls (n=30). Urinary deoxypyridinoline was divided by urinary creatine to exclude the factors of body mass index and urine dilution. The results underwent validity analysis. The measurements of urinary deoxypyridinoline in the spinal tuberculosis, pulmonary tuberculosis, and control groups were 14.9 ± 9.8, 6.4 ± 2.6, and 6.3 ± 2.0 μmol/molCr, respectively. Compared with the other 2 groups, the urinary deoxypyridinoline level in the spinal tuberculosis group was significantly increased (P=.001 and P=.000, respectively). However, urinary deoxypyridinoline levels were not significantly different between the pulmonary tuberculosis and control groups (P=.751). The receiver operating characteristic curve in the spinal tuberculosis group was 0.83. For deoxypyridinoline, the sensitivity (88%) and specificity (95%) were seen at the cutoff level of 8.0 μmol/molCr. The false positive and false negative were 12% and 5%, respectively. Diagnostic validity of the method was 93%.Bone metabolism alteration occurs during the progression of spinal tuberculosis, which can be reflected by the sensitivity and specificity of urinary deoxypyridinoline. The detection of urinary deoxypyridinoline is a benefit of screening patients with pulmonary tuberculosis for spinal tuberculosis.
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Affiliation(s)
- Jiandang Shi
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Xingqing District, Yinchuan, China
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Establishing the diagnosis of tuberculous vertebral osteomyelitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 4:579-86. [PMID: 22576157 DOI: 10.1007/s00586-012-2348-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 04/22/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this article has been to analyze the clinical and radiological data suggesting tuberculous vertebral osteomielitis (TVO), and then discuss the steps to be followed to achieve an aetiological diagnosis. METHODS A thorough literature search was carried out to identify the best clinical and microbiological evidence for a fast and efficient diagnosis of TVO. RESULTS The clinical and radiological diagnosis of spinal tuberculosis suffers from serious limitations, with a high percentage of cases requiring vertebral biopsy to reach a definitive diagnosis. The increasing incidence of multidrug-resistant tuberculosis has highlighted the insufficiency of the histopathological diagnosis and the need for microbiological diagnosis. Unfortunately, the maximum sensitivity of spinal tuberculosis cultures is 80 %, and traditional methods require 6 to 8 weeks for the isolation, identification and sensitivity study. New culture media and identification methods have improved sensitivity and reduced the time required for the identification. Molecular methods have now been integrated into a single test, with identification of the mycobacterium responsible and its sensitivity to rifampicin. Additionally, multiplex-PCR tests have been developed that allow a rapid differential diagnosis between granulomatous spondylodiscitis. CONCLUSIONS All patients with subacute inflammatory back or neck pain showing suggestive radiological findings should be studied to rule out TVO. If there is no clear evidence of tuberculosis from another location or indication for surgery, a percutaneous vertebral biopsy should be performed. When TVO is suspected, all spinal or paravertebral tissue samples should be sent simultaneously to pathology and microbiology laboratories for appropriate processing.
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Merino P, Candel FJ, Gestoso I, Baos E, Picazo J. Microbiological diagnosis of spinal tuberculosis. INTERNATIONAL ORTHOPAEDICS 2012; 36:233-8. [PMID: 22252412 DOI: 10.1007/s00264-011-1461-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/02/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to review the clinical features and diagnosis of spinal tuberculosis cases reported in the literature. METHODS A medical literature search in the Medline Pubmed database was undertaken to review tuberculosis spinal infection and extra-pulmonary tuberculosis diagnosis improvement. We introduced the following search items and boolean operators: "spinal infection", "spinal tuberculosis infection", "microbiological diagnosis of spinal tuberculosis" and "spinal tuberculosis PCR." Single cases or series without microbiological diagnosis were rejected. Manuscript language was restricted to Spanish, French, and English versions. RESULTS AND CONCLUSIONS Spinal tuberculosis is more common in developing countries and is probably underdiagnosed. Delayed diagnosis is characteristic; it worsens the prognosis and increases morbidity. The microbiological diagnosis is crucial for several reasons. Despite surgical treatment, medical treatment with anti-tuberculous drugs is always necessary. A total of 20-40% of the spinal tuberculosis patients show another locus of infection. Pulmonary location can become a public health problem. Previously treated patients for other tuberculosis locations, incomplete treatments, or poor adherence can change the M. tuberculosis sensitivity pattern. Drug resistance test becomes a major need in the microbiology laboratory. PCR diagnostic techniques advance the diagnosis and increase the sensitivity and specificity rate.
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Affiliation(s)
- Paloma Merino
- Clinical Microbiology Department, Clinico San Carlos Hospital, Madrid, Spain.
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Al Dahouk S, Nöckler K. Implications of laboratory diagnosis on brucellosis therapy. Expert Rev Anti Infect Ther 2012; 9:833-45. [PMID: 21810055 DOI: 10.1586/eri.11.55] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Brucellosis is a worldwide zoonosis with a huge economic impact on animal husbandry and public health. The diagnosis of human brucellosis can be protracted because the disease primarily presents as fever of unknown origin with unspecific clinical signs and symptoms. The isolation rate of the fastidious etiologic agent from blood cultures is low, and therefore laboratory diagnosis is mainly based on serologic and molecular testing. However, seronegative brucellosis patients have been described, and antibody titers of diagnostic significance are difficult to define. Whether the molecular detection of Brucella DNA in clinical samples should be followed by long-term antibiotic treatment or not is also a matter of debate. The aim of this article is to review and discuss the implications of laboratory test results in the diagnosis of human brucellosis on disease therapy.
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Affiliation(s)
- Sascha Al Dahouk
- Federal Institute for Risk Assessment, Hygiene and Microbiology, Diedersdorfer Weg 1, D-12277 Berlin, Germany.
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Changing Trends in the Epidemiology of Pyogenic Vertebral Osteomyelitis: The Impact of Cases with No Microbiologic Diagnosis. Semin Arthritis Rheum 2011; 41:247-55. [DOI: 10.1016/j.semarthrit.2011.04.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/03/2011] [Accepted: 04/05/2011] [Indexed: 11/29/2022]
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Abstract
Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.
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Affiliation(s)
- Ravindra Kumar Garg
- Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
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Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management--authors' responses. J Antimicrob Chemother 2011. [DOI: 10.1093/jac/dkr079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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