Modern opportunities of etiologic diagnosis of tuberculous spondylitis (Pott’s disease) in patients with combined viral infections

Abstract

Purpose. Improvement of algorithms of etiologic diagnostics of tuberculous spondylitis in modern realities of mycobacteria drug resistance and combined viral infections.Materials and methods. Laboratory results of diagnostic materials obtained from 300 patients diagnosed with tuberculous spondylitis were analyzed; patients were divided into groups according to the presence of HIV and hepatitis C virus (HCV): 20% of patients had no viral infections, 8% of patients were infected with HCV only, 6% were infected with HIV only; 66% of patients were infected with both HIV and HCV. The surgical bone material was examined by the classical triad of etiologic diagnostics of tuberculosis – microscopy, culture on solid growth media and molecular genetic methods (PCR).Results. Molecular genetic methods are the most informative methods for diagnosing tuberculous spondylitis – the detection rate of MBT is 83%(p< 0.001). Thesemethodsshouldbethemainonesinthestudyofbiologicalmaterialfrompatientsdiagnosedwithtuberculousspondylitis, while bacteriological methods should be used to verify the diagnosis. MBTs isolated from patients with co-infections are characterized by a wide spectrum of drug resistance: the presence of HIV in patients with tuberculous spondylitis 4.16 times (95% CI 2.11-7.67) increased the chance that mycobacteria in the focus of lesions are resistant to at least rifampicin and isoniazid, and the presence of HCV – 2.29 times (95% CI 1.364.86). Therefore, if viral infections are present in a patient with TC, he/she should be considered as a patient at risk of MDR/XDR TB and an appropriate chemotherapy regimen should be administered even in the absence of bacteriologic results.