Tuberculosis is a highly contagious bacterial infection of the lungs that can be spread through the air when a person speaks, coughs or sneezes. Radiological and microbiological findings thus indicated the diagnosis of tuberculous spondylitis potts disease resulting from disseminated postprimary pulmonary tuberculosis. Ankylosing spondylitis and pulmonary tuberculosis sciencedirect. Naturally, such forecast issues are by their nature. Clinical presentation and diagnosis of tuberculosis. Antitnf agents have emerged as an important treatment for rheumatic diseases, particularly for ankylosing spondylitis as. Tuberculous spondylitis diagnosed through xpert mtbrif. Despite all technological advances, the diagnosis of tuberculous spondylitis remains a clinical challenge since it depends on a high grade of clinical suspicion. Patients who have a positive ppd test but not active tuberculosis may decrease their risk by properly taking medicines to prevent tuberculosis. As a result, the diagnosis of tb disease may be delayed or even overlooked, and the. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous kyphoplasty pkp. A 61yearold woman presented to our institution complaining of back pain following a fall 7 days before. Stb accounts for around 2% of all cases of tb and around. The second case was treated with emergency surgery and the patient regained full neurologic function at followup.
This fusing makes the spine less flexible and can result in a hunchedforward posture. It is associated with significant morbidity and can lead to severe functional impairment. The existence of tuberculosis tb in ancient times is evident from the fact that it was observed in mummies from egypt and peru 9000 bc and has also been described as yakshama in the oldest indian medical treatises of charaka samhita and sushruta samhita, dating back to and 600 bc, respectively. The vertebra is affected in 25% to 60% of cases of osseous tuberculosis. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive. Tuberculous spondylitis potts disease is the most common manifestation of musculoskeletal tuberculosis tb. Tuberculosis tb is a disease that primarily affects the lungs. Spondylitis tb is an infection of mycobacterium tb involving the spine. Comparison of pyogenic spondylitis and tuberculous spondylitis. Tuberculous spondylitis has been common in developing countries, and the number of patients with the disease. Diagnosis of tuberculosis disease centers for disease.
Attention is drawn to the thoracic changes which occur in ankylosing spondylitis and to the frequency of respiratory disease as a complication. Constitutional symptoms include fever and weight loss. Early diagnosis of spinal tuberculosis sciencedirect. Pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. The spine is the most frequent location of musculoskeletal tuberculosis, and commonly related symptoms are back pain and lower limb weaknessparaplegia. Pott disease, also known as tuberculous spondylitis, is one of the oldest demonstrated diseases of humankind, having been documented in spinal remains from the. What is pyogenic spondylitiscausessymptomstreatment. Tb epidemic through its impact on susceptibilityto m. Tuberculosis of the spine, or tubercular spondylitis is an inflammatory disease of the spine, a characteristic feature of which is the primary destruction of the vertebral bodies with subsequent deformation of the spine tuberculous spondylitis ranks first among all localizations of osteoarticular tuberculosis. First, the recommendation to discontinue the regimen based on just 2 months of rifampicin 2hrze6he and change to the regimen based on a full 6 months of. Tuberculosis was detected through genexpert mtbrif in centrifuged urine, with no resistance to rifampicin. Tuberculosis tb, consumption diagnosis and treatment see online here tuberculosis tb is a disease caused by mycobacterium tuberculosis. Tuberculous spondylitis an overview sciencedirect topics. Pyogenic spondylitis consists of various other clinical entities, such as septic discitis, pyogenic spondylodiscitis, epidural abscess and vertebral osteomyelitis.
The diagnosis of tuberculous spondylitis should be investigated if strong clinical suspicion exists, even if suggestive pulmonary radiology findings are absent. The classical constitutional features of tuberculosis indicating presence of an active disease. We wanted to make the early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis according to the. The diagnosis of latent tuberculosis and decisionmaking regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials.
Pyogenic spondylitis and tuberculous spondylitis entail various types of clinical behavior, and a differential diagnosis is less likely to be conducted. The first lumbar vertebral body is most commonly infected. Aug 08, 2019 pott disease, also known as tuberculous spondylitis, is one of the oldest demonstrated diseases of humankind, having been documented in spinal remains from the iron age in europe and in ancient mummies from egypt and the pacific coast of south america. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more. This article discusses the clinical manifestations, diagnosis and treatment of tuberculous spondylitis. Pdf early diagnosis of spinal tuberculosis researchgate. Information from imaging studies, microbiology, and anatomic. The diagnosis of mdrtb spondylitis requires a high index of suspicion based on epidemiologic, clinical, and radiologic features. Latent tuberculosis infection ltbi is the presence of mycobacterium tuberculosis in the body without signs and symptoms, or radiographic or bacteriologic evidence of tuberculosis. Pdf differential diagnosis between tuberculous spondylitis. Extrapulmonary tuberculosis remains a challenge because of the delaying the diagnosis. We report two cases of suspected tuberculous spondylitis diagnosed through xpert mtbrif in urine samples from a rural tanzanian hospital.
Ct and mri in the diagnosis of tuberculosis article pdf available in the indian journal of pediatrics 6911. Microscopy for diagnosis of tuberculosis is initiated in 1880 the conceptions have not changed since then. In this longitudinal observational study, from july 2010 to december 2011, 70 consecutive patients 40 males and 30 females spinal tuberculosis were enrolled. Apr 02, 2020 many persons with pott disease 6290% of patients in reported seriesref17ref18 have no evidence of extraspinal tuberculosis. In developed countries, the proportion of extrapulmonary tuberculosis cases is increasing. Tuberculous spondylitis of the augmented vertebral column following percutaneous vertebroplasty or kyphoplasty has rarely been described. Tuberculosis of the spine symptoms and treatment of. Clinical presentation and diagnosis of tuberculosis 10 diagnostic process the first step. Nonsteroidal antiinflammatory drugs nsaids such as naproxen naprosyn and indomethacin indocin, tivorbex are the medications doctors most commonly use to treat ankylosing spondylitis. We report two cases of suspected tuberculous spondylitis diagnosed.
Although tuberculosis tb is an ancient disease, it remains a major global public health. Ankylosing spondylitis is a rare type of arthritis in your spine that most often affects people younger than 45. Mar 23, 2020 tuberculosis is found worldwide and is one of the most frequently encountered infectious diseases along with aids and malaria. Pdf the spinal column is involved in less than 1% of all cases of tuberculosis tb. Pdf spinal tuberculosis stb is a common manifestation of extrapulmonary tuberculosis tb. Know the causes, symptoms, treatment and diagnosis of pyogenic spondylitis.
Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to your joints. Recently magnetic resonance imaging has been reported to be beneficial for early diagnosis and differential diagnosis of the spondylitis, and is being used extensively for diagnosis. Ankylosing spondylitis symptoms and causes mayo clinic. The proposed syndrome is to facilitate the differential diagnosis of tuberculous spondylitis from spinal tumors, degenerative and dystrophic processes, and nonspecific osteomyelitis of the.
Ankylosing spondylitis affects men more often than women. However, in the absence of a positive culture, tb may also be diagnosed on the basis of clinical signs and symptoms. Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. Cureus challenges in the diagnosis and management of. The primary method used to confirm the presence of bacilli is a sputum smear, in which a sputum specimen is smeared onto a slide, stained with a compound that penetrates the organism. The prognosis of tuberculosis may include the duration of tuberculosis, chances of complications of tuberculosis, probable outcomes, prospects for recovery, recovery period for tuberculosis, survival rates, death rates, and other outcome possibilities in the overall prognosis of tuberculosis. The recent reemergence of mycobacterium tuberculosis m. It is difficult to differentiate tuberculous spondylitis and pyogenic spondylitis clinically and radiologically. A rheumatologist is commonly the type of physician who will diagnose ankylosing spondylitis as, since they are doctors who are specially trained in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments, connective tissue, and bones. Tuberculosis tb is not as common as it was many years ago in the united states.
We report two cases of suspected tuberculous spondylitis. India, tuberculosis being very common, there is a possibility that the patient may receive. A retrospective study of 23 patients with spinal tuberculosis tb was conducted, with special attention to the diagnosis and method of treatment. The gold standard in the diagnosis of tuberculosis is the culture of mycobacterium. Best efforts should be put to obtain sputum, processing of saliva loses all valuable clues to diagnose. According to the robert koch institute rki, rd of the world population is infected with mycobacterium tuberculosis, and during their lifetime, 5% to 10 % develop tuberculosis disease that requires treatment. Pott disease tuberculous tb spondylitis differential. Pdf comparison of pyogenic spondylitis and tuberculous. A rheumatologist is commonly the type of physician who will diagnose ankylosing spondylitis as, since they are doctors who are specially trained in diagnosing and treating disorders that. The bacteria that cause the disease can be spread from one person to another through airborne droplets from coughs and sneezes. To effectively treat tuberculosis, it is crucial that patients take their medications exactly as.
Attention is drawn to the thoracic changes which occur in ankylosing spondylitis. Tuberculous spondylitis, also known as pott disease, refers to vertebral body osteomyelitis and intervertebral diskitis from tuberculosis tb. Aug 08, 2019 pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Constitutional symptoms are present in approximately 2030% of cases of osteoarticular tuberculosis. The patients may also have fever, fatigue and weight loss, common features of active tuberculosis. Extrapulmonary tuberculosis is challenging to diagnose, but knowledge of its pathophysiology and imaging features can help the radiologist identify this infectious disease in highrisk patients. Tuberculous spondylitis radiology reference article. Summary of advanced information for early diagnosis of spinal tuberculosis.
Spondylitis comprises the most common form of osteoarticular tuberculosis and results from secondary hematogenous spread from a primary focus mainly localized in lungs, lymph nodes, and other tissues. Neurologic abnormalities in 50% of cases paraplegia, paresis, impaired sensation, nerve root pain, or cauda equina syndrome. These cases demonstrate the importance of considering spinal tuberculosis in the differential diagnosis. The course of spondylitis tb is relatively indolent without pain, thus early diagnosis is challenging. Tuberculosis is still one of the most important health problems in the world. It would be feasible for clinical and radiologic indices to be beneficially utilized on the differential diagnosis. At rural health facilities in highburden countries, the diagnosis of spinal tb is usually based on clinical and radiological findings. The lower thoracic and upper lumbar vertebrae are the areas of the spine most. Pott disease is the eponym of tuberculous spondylitis. Although the thoracolumbar junction seems to be the most common site of the spinal column involvement in spinal tb.
Pott disease tuberculous spondylitis statpearls ncbi bookshelf. The diagnosis tends to be delayed because of a nonspecific initial early manifestations andor low degree of suspicion. Differential diagnosis between tuberculous and pyogenic spondylitis is of clinical importance, but may be difficult on the basis of radiological findings alone. In this study diagnosis of spinal tuberculosis and its differentiation from pyogenic was based on studies by jung6 and smith. The current trend is a decrease in spinal infections due to good nutritional and hygienic status, but an increase in the resistant strains of the organism of pyogenic spondylitis 1, 2. Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the small bones in your spine vertebrae to fuse. A diagnosis of tb disease is usually based on positive cultures for m. The spinal tuberculosis should also be considered in immigrant patients of chronic back pain coming from endemic countries. A definitive diagnosis of tuberculosis can only be made by culturing mycobacterium tuberculosis organisms from a specimen taken from the patient most often sputum, but may also include pus, csf, biopsied tissue, etc. Diagnosis of tb spondylitis requires both multidisciplinary collaborations and diagnosis experience. It is a potentially serious disease that is infectious. Pdf spondylitis tuberculosis in neurosurgery department. Nowadays tuberculous spondylitis, also known as pott disease, is a rare clinical condition but can cause severe vertebral and neurological sequelae that can be prevented with an early correct diagnosis. Notwithstanding the low reported mortality of tuberculous spondylitis.
Tuberculosis, myelopathy, spinal cord, antituberculous treatment. Tuberculous spondylitis diagnosed through xpert mtbrif assay. Pathophysiology and treatment of spinal tuberculosis. However, current recommendationsfor this screening and treatment and their efficacy are still not well established in endemic regions. Ankylosing spondylitis diagnosis and treatment mayo clinic.
Paraspinal abscess secondary to tuberculous spondylitis. This assay would be particularly indicated when quick and sensitive diagnosis of tuberculosis is required. Unlike pyogenic osteomyelitis, tuberculosis spondylitis is characterized by a subacute course and lower disease activity. Sep 14, 2006 extraarticular manifestation of ankylosing spondylitis like apical fibrosis of the lung can mimic chronic tuberculosis.
Tuberculosis tb, consumption diagnosis and treatment. A diagnosis made other than by culture may only be classified as probable or presumed. Spinal tb is a very dangerous type of skeletal tb as it can. Tuberculous spondylitis diagnosed through xpert mtbrif assay in. Pdf spinal tuberculosis is a destructive form of tuberculosis. Learn more about symptoms, causes, risk factors, diagnosis, treatments, home. Spinal tb potts disease is the most common as well as one of the most dangerous forms of skeletal tb and accounts for 50% of all cases of skeletal tb. Several important recommendations are being promoted in this new edition. Albee treatment of tuberculous spondylitis 299 average of 2. The diagnosis of pulmonary tuberculosis depends on finding tubercle bacilli in the sputum, in the urine, in gastric washings, or in the cerebrospinal fluid. Vertebral localization represents of the cases of musculoskeletal tuberculosis and is mainly due to bk koch bacillus hematogenous dissemination in the vertebral system, but also by contiguous or lymphatic dissemination of pleural tuberculosis. Tuberculosis is found worldwide and is one of the most frequently encountered infectious diseases along with aids and malaria. Pyogenic spondylitis and tuberculous spondylitis are common causes of spinal infection. There are many strains of tuberculosis, which do not respond to most drugs for treating the disease.
Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Anamnesis and understanding of symptoms are also important for proper selecting paraclinical tests panel. How is pott disease tuberculous tb spondylitis diagnosed. Symptoms of pulmonary and extrapulmonary tb disease symptoms of pulmonary tb disease tb disease usually causes one or more of the symptoms symptoms. The impact of hiv has been greatest in countries of southern and eastern africa, where up to 40% of adults may be infected with hiv and where the incidence of tb has increased 45fold within 10 years. Ankylosing spondylitis radiology reference article.
Screening and treatment of latent tuberculosis infection ltbi is essential before the use of these drugs. Pyogenic spondylitis is a fatal neurological condition where there is infection and destruction of the spine and paraspinal structures. Common differential diagnosis includes pyogenic spondylitis, brucellar spondylitis, sarcoidosis, metastasis, multiple myeloma, and lymphoma table 3. Evidence of tb of the cervical lymph nodes or lymph nodes of the neck termed scrofula was found in the middle ages. Comparative studies of spontaneous spinal in fections performed in. Diagnosis dan penatalaksanaan spondilitis tuberkulosis. Tb disease should be suspected in persons who have the following symptoms. Five cases of combined ankylosing spondylitis and pulmonary tuberculosis are described among 84 adult male sanatorium inpatients between 20 and 57 years of age. Extrapulmonary tuberculosis eptb accounts for 1520% of tb cases. A thorough physical exam, including xrays, individual medical history, and a.
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