Cases Of Skeletal Tuberculosis Research Articles

Vertebral destruction in an 11-month-old child with spinal tuberculosis: a case report and review of literature

BackgroundThe incidence of tuberculosis is increasing especially in endemic countries. Spinal tuberculosis represents nearly the 50% of reported cases of skeletal tuberculosis. This is the youngest case of spinal tubercular disease that has been reported. The objective of this report is to describe a spinal tuberculosis case in an infant in thoracic spine, in order to show the importance of early diagnosis in this population, to limit the progression of this highly destructive disease and reduce the severe sequelae that this disease is associated.Case presentationAn 11-month-old infant previously healthy born in the northeast Mexico. Physical examination revealed a mass lesion in the dorsal region, fixed to deep planes, indurated. Neurological examination found Frankel C paraparesis showing muscle strength 2/5 on the Lovett scale in both lower extremities, anal reflex present, and preserved sensitivity.In the magnetic resonance of the spine, hyperintensities in the vertebral bodies of D6-D9 were observed in the T2 with destruction of the D7 and D8 bodies. A thoracotomy was performed with total mass resection with corpectomy of vertebrae D7 and D8, medullary decompression, and placement of fibula allograft between vertebrae D6 and D9. In the histopathological sample, a chronic granulomatous inflammatory process associated with acid-fast bacilli was observed, in addition to presenting a positive result in quantitative real-time PCR GeneXpert MTB/RIF sensitive to rifampicin. Twelve months later, he presented 5/5 muscular strength, without alterations in sensitivity, in addition to presenting ambulation onset at 18 months of age.ConclusionThe spinal tuberculosis is a disease that occurs in endemic countries. A prompt diagnosis is necessary to limit the progression of a highly destructive disease. In addition, the fact of presenting at an early age produces hard making decisions for the adequate treatment of the disease and reduces the adverse effects of these procedures.

A Case of Skeletal Tuberculosis in a Man from the Site of Đurine Ćelije on Rudnik

A Case of Skeletal Tuberculosis in a Man from the Site of Đurine Ćelije on Rudnik

A Case of Calvarial Tuberculosis in an Elderly Male Patient

Tuberculosis (TB) is still endemic in developing countries like Pakistan. Tuberculosis affecting bones account for 1% of all TB infections. Calvarial tuberculosis, a rare manifestation of extra-pulmonary TB, accounts for 0.2%-1.3% of all cases of skeletal TB. Even in developing countries where TB is endemic, cases with this type of TB are not commonly seen. The most commonly involved sites are the frontal and parietal bones, with destruction of both the inner and outer table. Proper diagnosis and timely management help in improving prognosis. Here we describe the case of a 70-year-old male patient with pulmonary and extrapulmonary (calvarial) tuberculosis. The diagnosis was established on histopathological examination with demonstration of Acid-Fast Bacilli (AFB) and typical features seen on computed tomography (CT) scan.

Postoperative clinicoradiological outcome of pott's spine.

Introduction:Tuberculosis (TB) is one of the main diseases impacting humanity. Fifty percent of all the cases of skeletal TB belong to spinal TB (STB), and it is also the most common form of TB. In India, patients usually present late after the onset of neurological symptoms, for which surgical management is essential for recovery. In our study, we have evaluated the outcome of forty patients of STB who underwent posterior decompression and instrumentation.Methods:Forty patients with STB who underwent posterior decompression and instrumentation were reviewed. All cases were followed up for 18 months. The groups were compared by parameters such as improvement in pain, improvement in kyphosis, and neurological recovery. Visual Analog Scale (VAS) score and american spinal cord injury assosciation (ASIA) score are used for the assessment.Results:VAS score was significantly decreased postoperatively (mean: 1.28) as compared to preoperative values (mean: 7.25). Erythrocyte sedimentation rate (ESR) was significantly decreased postoperatively (mean: 30.95) as compared to preoperative values (76.15). Cobb's angle was significantly decreased immediate postoperatively (mean: 7.8) as compared to preoperative values (mean: 24.8). There was no deterioration of neurological symptoms in any of the patients.Conclusion:Surgical intervention in Pott's spine with posterior decompression and stabilization, whenever indicated, gives good improvement in pain, decreases kyphotic deformity, and in most cases, also improves neurology.

Diagnostic Challenges and Clinical Profile of Spine Tuberculosis – An Experience from Medium Sized Health Care Center, South India

Introduction: Skeletal tuberculosis accounts for 10-35% of Extra-Pulmonary Tuberculosis (EPTB) and 3% of all cases of tuberculosis. Spine is involved in about 50% cases of skeletal tuberculosis. The diagnosis of Spine TB in the developing world until recently has been carried out by clinical presentation and neuro imaging modalities like X-ray/CT/MRI. Until the molecular era, the diagnostic tests at laboratories had mostly remained less contributory with low reliability and accuracy. The objective of the study was to review the spinal cases of TB and present an overview of the different methods of microbiological diagnosis in patients with Spine TB at our center. Methodology: Retrospective study (April 2016 – April 2019) of all consecutive patients suspected with pyogenic or Spine TB was undertaken with relevant clinical details. With the radiological screen the probable TB patients were sampled (tissue, pus, abscess fluids and exudates) and were processed for ZN stain, Culture (conventional), Xpert RIF/MTB assay (at reference lab) and Histopathology. Anti-Tubercular Therapy (ATT) was administered to all definitive cases with or without surgery. Results: A total of 26 patients of Definite TB were identified out of 42 suspected. The mean age was47 years (14-78 range). Fever (n=17) and pain (n=18) were most common symptoms reported by over 80% of the patients. The twenty-six patients characteristically had positive radiological changes in MRI. Lumbar (n=6) and thoracic (n=6) vertebrae were equally involved and over 50% (n=14) had two or more vertebral involvement. All 26 spine samples were negative for Acid Fast Bacilli (AFB) by ZN staining. Individually, the positive detection rate by Xpert MTB/RIF was 88% (n=23), by HPE was 65% (n=17) and by culture was 42% (n= 11) respectively. Xpert MTB/RIF was 82.3% sensitive and 64% specific when compared with Histopathological Evidence (HPE) alone and the sensitivity and specificity rose up 81% on comparing with cross HPE and or culture. Conclusion: Improved case detection of Spine TB was noted by using Xpert MTB/RIF assay at our center. We recommend Xpert MTB/RIF molecular test as the first-line investigation at laboratories for all the suspected cases of Spine TB and for confirmation when the clinical and MRI findings are inconclusive or unavailable. Staining and culture have proved less contributory. Age-old Histopathological evidence may no longer be viewed as a reference standard and needs more evaluation. Small and medium sized hospitals may gradually scale-down the Spine TB processing by AFB stain, and consider establishing on-site molecular infrastructure.

Epidemiology of skeletal tuberculosis in Beijing, China: a 10-year retrospective analysis of data.

Skeletal tuberculosis (STB) is one of the most common forms of extrapulmonary tuberculosis; however, limited epidemiological data are available on this public health concern worldwide, especially in developing countries. The aims of this study were to analyze the epidemiological characteristics of STB cases and to identify risk factors associated with drug resistance among STB cases in China. We included STB inpatients at Beijing Chest Hospital from January 2009 through December 2018. The multiple demographic and clinical variables of patients were collected from the hospital's electronic patient record. In total, 3086 STB patients were hospitalized in Beijing Chest Hospital. Of these cases, 1988 (64.4%) were spinal TB cases, 991 (32.1%) were joint TB cases, and 107 (3.5%) were concurrent spinal-joint TB cases. The most frequent localization of the infections in joints included the knee (21.5%), hip (17.9%), and elbow (10.3%). For spinal TB, lumbar, thoracic, and cervical spinal TB were present in 51.7%, 40.6%, and 4.4% of cases, respectively. Positive cultures were reported in only 16.0% of STB cases. When patients aged ≥ 60 years old were used as the control group, youths (< 18 years old) were less likely to have spinal TB (aOR, 0.29; 95% CI, 0.21-0.41). The prevalence of MDR-TB was 12.5% among the STB cases, and more female cases were afflicted with drug-resistant STB than with drug-susceptible STB (aOR, 0.50; 95% CI, 0.27-0.94). In addition, patients aged < 18 years had significantly higher odds of having drug-resistant STB compared with those aged ≥ 60 years (aOR, 20.778; 95% CI, 4.49-96.149). In conclusion, our data demonstrate that spinal TB is the most frequent form of STB in China. The youths are less likely to have spinal TB compared with elderly patients, while the patients aged < 18 years have significantly higher odds of having drug-resistant STB than elderly patients.

Characteristics and Management of Spinal Tuberculosis in Tuberculosis Endemic Area of Guizhou Province: A Retrospective Study of 597 Patients in a Teaching Hospital.

Background Tuberculosis (TB) is an endemic disease in Guizhou. Spinal TB accounts for approximately 50% cases of skeletal TB. The purpose of this study was to investigate the characteristics and management of patients treated for spinal TB in a certain hospital and to provide guidance for the prevention and treatment of spinal TB. Methods The clinic records of all patients diagnosed with spinal tuberculosis in a teaching hospital between January 2010 and December 2018 were collected. The epidemiology, clinical characteristics, imaging and laboratory findings, treatment methods, and prognosis were recorded and analyzed. Results During this nine-year period, 597 patients with spinal TB were identified. There were 313 males and 284 females with an average age of 43 years. The largest number of patients fell in the age group of 21–30 years; mean time from symptom onset to diagnosis in the hospital was 17 months. Back pain was the main clinical manifestation (89.34%). The most common imaging technique was computed tomography (CT, 96.80%), followed by magnetic resonance imaging (MRI, 84.01%). Majority of the lesions involved the lumbar spine (47.30%), followed by the thoracic spine (40.95%). 178 (29.82%) patients in this study had varying degrees of neurological impairment. 22.78% of the patients selected conservative treatment, and surgical treatment was performed in 483 patients (80.90%). Conclusions The incidence of spinal TB was generally on the rise throughout the study period. After diagnosed with spinal TB, all patients got appropriate treatment and achieved good efficacy, but most of the patients did not pay much attention to the disease and receive timely treatment. Thus, it is essential to strengthen the TB preventive strategies, improve the health awareness of residents and universal resident health examination.

Improved Case Detection Using Xpert Mycobacterium tuberculosis/Rifampicin Assay in Skeletal Tuberculosis

Background: In India, musculoskeletal tuberculosis (TB) accounts for 10%–25% of extrapulmonary TB. Data on drug-resistant skeletal TB are lacking. At present, the diagnosis is based mainly on radiological techniques. Laboratory confirmation of skeletal TB is delayed as 6–8 weeks are required for culture results. Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay is a fully automated test which simultaneously detects MTB and RIF resistance within 3 h. Hence, this study was done to compare the yield of case detection using Xpert assay in comparison with culture in specimens received from clinically suspected skeletal TB cases. Methods: Retrospective analysis of microscopy, culture and Xpert assay results was carried out on specimens received in laboratory from skeletal TB cases from January 2016 to December 2017. Results: Of the 201 patients analysed, majority of the specimens were obtained from the spine (55.72%). MTB was detected in 48.68% of tissue and 24% of pus specimens. Xpert assay was detected MTB in 67 (33.33%) specimens of which 53 (47.32%) were from the spine. Culture was detected MTB in 66 (32.83%) specimens. Xpert assay was detected two specimens more than culture. One specimen was positive by only culture. RIF-resistant MTB was detected in 10 (14.92%) specimens by Xpert assay. Conclusion: The spine is the most common site involved. Tissue specimen is better for early diagnosis. High RIF resistance in skeletal TB is an alarming situation. Ability of Xpert MTB/RIF assay for rapid and simultaneous detection of MTB and RIF resistance in comparison with culture makes it a useful diagnostic tool in skeletal TB.

The Epidemiology of Skeletal Tuberculosis in Northeast of Iran: A Review of 229 Cases.

The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1% of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56.3% were male. The mean age of the patients was 44.0±17.7 (range 7-87). All of the patients were new cases. Most of the patients (56.8%) were from the rural areas and most were diagnosed by the private healthcare system (63.8%). The highest rate of skeletal TB was seen in 2013 (15.3%). Spinal TB (81.2%) scored the highest rate and pain (96.9%) was the most prevalent symptom of skeletal TB. The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed.

Musculoskeletal Tuberculosis: Two Year Experience at a Tertiary Care Teaching Hospital of Northern India and Review of Literature

Background: The aim of this study was to evaluate the present trend of osteo-articular tuberculosis at a teaching hospital in North India. Methods: All the cases of skeletal tuberculosis that were diagnosed and managed either on outdoor or in-hospital stay basis over a period of two years were evaluated with respect to age, gender, anatomical location of lesion, laboratory parameters (ESR, Mantoux test, HIV screening), concomitant skeletal tuberculous lesions, associated pulmonary tuberculosis, and other associated clinical features. Results: A total of 84 skeletal tuberculous lesions in 80 patients were enrolled for the study. The age of the patients ranged from 2 to 70 years with a mean of 29.1±19.1 years. 55% patients were in second and third decade of life and 63.7% were males. ESR was elevated in 61.25% and 56.25% tested positive for Mantoux skin test. 21.25% patients had associated active or healed focus of tuberculosis in the lungs. Spine was the most common site involved (58.75%) followed by hip (13.1%), knee (8.3%), foot (4.7%) and shoulder joint (3.5%). Lumbar spine was the most common site affected in the spine followed by lower dorsal spine. 3.75% cases had multifocal skeletal tuberculous lesions. Conclusion: Prevalence of osteo-articular tuberculosis continues to be high in North India with the disease predominantly affecting young population. Spine is the most common site for skeletal tuberculosis followed by hip, knee, foot and shoulder. Lumbar region followed by lower dorsal spine is much more affected. Multifocal skeletal lesions incidence is lower than expected. And one-fifth of the patients have associated pulmonary tubercular lesion.

Evidence of tuberculosis among children in medieval (13th–15th century) Wrocław: A case study of hip joint tuberculosis in a juvenile skeleton excavated from the crypt of the St. Elizabeth church

Paleopathological examinations of the skeletal remains of people who died centuries ago are material source of knowledge about health and diseases in the past. In this article, a case of skeletal tuberculosis from historical (13th–15th c.) Wrocław, Poland has been presented. The juvenile skeleton excavated from grave No 93, from the crypt located under the church of St. Elizabeth, displayed pathological lesions within the right hip joint resulting from a chronic inflammation, which might have been assigned to signs typical for skeletal tuberculosis. The results of macroscopic and radiological analyses appeared to be consistent, and allowed to determine a reliable diagnosis of this paleopathological case.

A case of skeletal tuberculosis and psoas abscess: disease activity evaluated using 18 F-fluorodeoxyglucose positron emission tomography-computed tomography

BackgroundPsoas abscess complicating tuberculous spondylitis is a rare morbidity in extrapulmonary tuberculosis. There are no established guidelines for evaluating the clinical response of psoas abscess. Although several studies have shown that positron emission tomography-computed tomography with 18 F-fluorodeoxyglucose can play a potential role in diagnosing multifocal tuberculosis and monitoring the clinical response of pulmonary tuberculosis, to our knowledge, this is the first report demonstrating that positron emission tomography-computed tomography is useful for evaluating local inflammation and disease activity of a tuberculous psoas abscess.Case presentationWe report a case of multifocal bone and lymph node tuberculosis with concomitant lumbar psoas abscess in a 77-year-old man, along with a literature review. An initial positron emission tomography-computed tomography scan showed intense 18 F-fluorodeoxyglucose accumulation in the sternum, ribs, vertebrae, and lymph nodes. The patient was successfully treated with antitubercular agents and computed tomography-guided drainage therapy. A follow-up positron emission tomography-computed tomography after abscess drainage and 9 months of antitubercular drug treatment revealed that the majority of lesions improved; however, protracted inflammation surrounding the psoas abscess was still observed. These results indicate that disease activity of psoas abscess can remain, even after successful drainage and antitubercular medication regime of appropriate duration.ConclusionWe have successfully followed up the extent of skeletal tuberculosis complicated with psoas abscess by positron emission tomography-computed tomography. In this patient, positron emission tomography-computed tomography is useful for evaluating the disease activity of tuberculous psoas abscess and for assessing the appropriate duration of antitubercular drug therapy in psoas abscess.

Spinal TB

Spine is the most commonest site of skeletal system accounting for about 50% skeletal tuberculosis cases. This article describes the role of CT and MRI in evaluating a case of spinal tuberculosis.

Calvarial Tuberculosis: A rare localisation of a common disease

Calvarial tuberculosis (TB) is a rare manifestation of extra-pulmonary TB, scantily reported in literature and accounting for 0.2% -1.3% of all cases of skeletal TB. The incidence of calvarial TB is rare, even in developing countries where TB is endemic. We describe a case of skull TB in a 16 year old male presenting as scalp swelling with a sinus in the occipital region. The diagnosis was established on histo-pathological examination with demonstration of Acid Fast Bacilli.

New skeletal tuberculosis cases in past populations from Western Hungary (Transdanubia)

The distribution, antiquity and epidemiology of tuberculosis (TB) have previously been studied in osteoarchaeological material in the eastern part of Hungary, mainly on the Great Plain. The purpose of this study is to map the occurrence of skeletal TB in different centuries in the western part of Hungary, Transdanubia, and to present new cases we have found. Palaeopathological analysis was carried out using macroscopic observation supported by radiographic and molecular methods. A large human osteoarchaeological sample ( n = 5684) from Transdanubian archaeological sites ranging from the 2nd to the 18th centuries served as a source of material. Spinal TB was observed in seven individuals (in three specimens with Pott's disease two of which also had cold abscess) and hip TB was assumed in one case. The results of DNA for Mycobacterium tuberculosis were positive in seven of the eight cases identified by paleopathology, and negative in the assumed case of hip TB. However, the molecular results are consistent with highly fragmented DNA, which limited further analysis. Based on the present study and previously published cases, osteotuberculosis was found in Transdanubia mainly during the 9th–13th centuries. However, there are no signs of TB in many other 9th–13th century sites, even in those that lie geographically close to those where osteotuberculous cases were found. This may be due to a true absence of TB caused by the different living conditions, way of life, or origin of these populations. An alternative explanation is that TB was present in some individuals with no typical paleopathology, but that death occurred before skeletal morphological features could develop.

Spinal tuberculosis among human immunodeficiency virus–negative patients in a Kenyan tertiary hospital: a 5-year synopsis

Background contextSpinal tuberculosis (TB) accounts for more than half of all cases of skeletal TB. Although Kenya has one of the highest burdens of TB, data on spinal TB in this country remain scarce. PurposeTo highlight the clinical presentation and management of this condition in our setup. Study designRetrospective study. SettingKenyatta National Hospital in Kenya. Patient sampleOne hundred twenty-nine patients. Outcome measuresPatients' condition after intervention and duration of hospital stay. MethodsThis study involved review of patients admitted to our hospital between 2004 and 2009 with a diagnosis of spinal TB. ResultsThe most common presenting complaints were back pain in 100 patients (77.5%) and limb weakness in 94 patients (72.9%), whereas the most frequent physical examination finding was gibbus deformity in 85 patients (65.8%). Most (79 patients, 61.2%) had severe motor and sensory impairment graded as either American Spinal Injury Association (ASIA) A or ASIA B. Imaging revealed multiple vertebrae disease in 90 patients (79.6%). Of these, the most common was two vertebrae disease in 77 patients (68.1%). All patients were managed using anti-TB drugs and analgesics; however, 33 (25.6%) required adjunctive operative management. Mean hospital stay was 53.3 days. Marked clinical improvement was seen in 91 patients (70.0%) within 6 months of treatment. ConclusionPatients with spinal TB in our setting tended to present late and with advanced disease. Therefore, a high index of suspicion should be maintained and appropriate chemotherapy started as early as possible.

A case of skeletal tuberculosis from Roman Towcester

AbstractAn adult male from a Roman inhumation cemetery at Towcester, Northamptonshire, displays clear evidence of Pott's disease of the spine. This short report has been prompted by the fact that relatively few cases of skeletal tuberculosis have been identified from Roman contexts in Britain. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Two cases of shoulder joint tuberculosis

Because of its rarity in Scandinavia, we report 2 cases of skeletal tuberculosis affecting the shoulder joint.

A Follow-up Study of the Initial Group of Cases of Skeletal Tuberculosis Treated with Streptomycin, 1946-1948

The effect of antimierobial therapy in this series of patients reflects itself in a lowered rate of tubereulous relapse, a lower death rate from tuberculosis, a greater chance for survival, and a high rate of funetional recovery and return to productive activity. Streptomycin alone, given for more than sixty days, appears to have had a significant effect in reducing the relapse rate of all tuberculous lesions. Sixty-four per cent of the entire group of patients who received a single initial or multiple short courses of treatment with streptomycin for 120 days or less had no subsequent relapse and did not die from tuberculosis. Based upon these findings and reports from other series, it is to be expected that adjunct treatment for skeletal tuberculosis with longer courses of antimicrobial therapy and combinations of such agents should demonstrate a further improvement in the rates of relapse and mortality from tuberculosis, in clinical response, and in an earlier and increased rate of return to productive activity for the patient.