Tuberculosis Spondylodiscitis Research Articles

Evaluation of Patients Diagnosed with Spondylodiscitis

Objective: Spondylodiscitis is an infectious disease that affects the vertebral body, intervertebral disc, and/or adjacent paraspinal tissue, and it is a significant cause of morbidity, especially in older individuals. This study aims to evaluate cases of spondylodiscitis followed at ** Hospital. Material and Method: Between January 2017 and December 2021, the medical records and electronic files of patients who began antimicrobial treatment with a diagnosis of spondylodiscitis at ** Hospital were retrospectively evaluated. Results: A total of 33 patients were included in the study, consisting of 17 females and 16 males. The average age of the patients was 56.0 ± 13.6 years. Twenty patients (60.6%) were hospitalized, while 13 patients (39.4%) were followed as outpatients. Spinal surgery due to discopathy was performed in 9 cases (27.3%), and 4 of these patients had a history of recurrent surgical interventions. The most commonly affected region was the lumbar vertebrae (44.1%). The lumbosacral region (20.6%) and thoracolumbar region (14.7%) followed as the second and third most affected areas, respectively. Brucellosis complications were present in 14 cases (42.4%) of spondylodiscitis. Pyogenic microorganisms and tuberculosis were responsible for the remaining 11 (33,3%), and 2 (6%) patients respectively. In 11 patients (33.3.%), the causative microorganism was identified in tissue/abscess/blood cultures as methicillin-sensitive Staphylococcus aureus (3), methicillin-resistant coagulase-negative Staphylococcus (1), methicillin-resistant S. aureus (1), methicillin-sensitive coagulase-negative Staphylococcus (1), Klebsiella pneumonia (2), Enterococcus faecalis (2), Acinetobacter spp. (1), Escherichia coli (1). Staphylococcus aureus (12%) was the most common pathogen among pyogenic microorganisms. In one case, the identified pathogen was Mycobacterium tuberculosis. One of the patients was considered to have tuberculosis spondylodiscitis based on histopathological evaluation. Conclusion: The fact that nearly half of spondylodiscitis cases observed in our hospital were complicated by brucellosis indicates the importance of evaluating patients presenting with back pain for brucellosis. Collaborative training programs with surgical specialities should be periodically repeated to prevent cases of spondylodiscitis that develop after spinal surgeries.

Tuberculous Spondylodiscitis or Pott's Disease: Diagnostic Problem of Patients Referred to the Reference Health Center (CSRef) Commune III of Bamako for Anti-Tuberculosis Treatment

Introduction: Tuberculosis is an infectious disease that can affect different organs. The spinal disorder is called tuberculous spondylodiscitis (Pott's disease). The objective: Was to elucidate the aspects taken into account by caregivers in the diagnosis of tuberculosis spondylodiscitis in patients referred to the reference health center of commune III of Bamako for anti-tuberculosis treatment. Methodology: This was a descriptive, retrospective study covering all patients referred to CSRef CIII from different health structures with the diagnosis of Pott's disease for treatment during the study period. Results: During the study period, we collected 156 patients. The male sex represented 54% with a sex ratio of 1.18. The average age was 39.3 years with extremes of 12 and 92 years. All patients presented with spinal pain, fever was present in 11.11% of patients and 2.7% had respiratory symptoms. Tuberculin IDR was positive in 95.8% and 2 patients were AFB sputum positive. X-ray (of the lumbar spine) was negative in 18%; there were images of degenerative lesions in 41.6% and only 40.2% of patients had presumptive radiological signs. CT was carried out in all patients revealing 33.33% of sequelae of fractures and degenerative lesions and 55.55% of presumptive signs of tuberculous spondylodiscitis. Only 41.66 of the cases were referred by specialist doctors. Conclusion: In our context, the diagnosis of Pott's disease seems to be based mainly on chronic spinal pain and positive IDR and is not often made by appropriate personnel.

Tuberculosis spondylodiscitis in a patient with psoriatic arthritis on targeted synthetic disease-modifying antirheumatic drugs – case report

Tuberculosis spondylodiscitis in a patient with psoriatic arthritis on targeted synthetic disease-modifying antirheumatic drugs – case report

Genitourinary tuberculosis in the structure of autopsy morphological findings in deceased patients at the late stages of HIV infection

Introduction. The problem of tuberculosis (TB) has not lost its significance due to the overlapping epidemic of HIV infection and the addition of specific lesions at its late stages. It is due to the lack of adherence to antiretroviral therapy in a large number of patients. The high mortality rate in HIV-associated TB requires an increase in the interest of all doctors for the early detection of various TB localizations against the background of HIV, allowing the patient to be cured. For urologists, information on the frequency of genitourinary TB in HIV patients is of interest to improve its diagnosis. Purpose of the study. To identify the proportion of genitourinary TB in the structure of the specific lesions in patients with HIV-associated TB. Materials and methods. The case-records of 115 deceased patients with a combination of HIV infection and TB were retrospectively analyzed using a continuous method. The number of men among them was 81.7 ± 3.6% (94). The average age of men was 37.1 ± 27.2 years, women — 31.9 ± 6.3 years. The research results were processed statistically. Results. The average period from the moment of HIV infection detection to the registration of a lethal outcome was 2.8 ± 1.3 years, from the moment of TB diagnosis — 6.96 ± 7.3 years. The majority of patients with HIV infection had a stage of secondary diseases (93.1 ± 2.4%). At the time of admission to the TB dispensary, the average CD4 + lymphocyte level was 131.06 ± 75.8 cells/pL, 10.03 ± 2.5%. Anti-retroviral therapy was observed only in 19 (16.5 ± 3.5%) patients. In deceased patients disseminated pulmonary TB was more often verified at autopsy — 52.2 ± 4.7%, miliary — 7.8 ± 2.5%, infiltrative — 11.3 ± 3.0%. In patients with disseminated and miliary pulmonary TB, foci of dropout were often observed in the spleen (71.7 ± 5.8% and 55.6 ± 16.6%) and liver (46.7 ± 6.4% and 33.3 ± 15,7%). The kidney damage occurred in 60.0 ± 6.3% of patients with disseminated and 44.4 ± 16.6% miliary pulmonary TB. Kidneys TB was confirmed by bacterioscopic urine examination in three cases only (2.6 ± 1.5%) during life. Prostate TB was confirmed by analysis of expressed prostatic secretion on Mycobacterium tuberculosis (2.6 ± 1.5%) and was combined with kidney TB. The lesions of the lymphatic system during life were exposed in 17.4 ± 3.5% of patients. A pathomorphological examination revealed TB of intrathoracic lymph nodes in 37.4 ± 4.5%, intra-abdominal lymph nodes — in 22.6 ± 3.9%, peripheral — 6.1 ± 2.2%, more often in miliary and disseminated pulmonary TB. TB meningitis was registered in 31 cases as well as meningoencephalitis in 32 patients during life and at autopsy, respectively. Intestinal TB was confirmed by autopsy in 9.6 ± 2.7% of patients; during life, it was accompanied by the detection of the pathogen in the feces. The pancreatic TB was detected in 2.6 ± 1.5%, TB spondylodiscitis in 1.7 ± 1.2%, myocardial TB in 0.9 ± 0.9% and pericardium TB in 0.9 ± 0.9% cases. Conclusion. Thus, generalized TB is diagnosed in patients in the late stages of HIV infection, in the structure of which kidney damage is in second place, yielded only to spleen damage. Obtaining this information should form the alertness of urologists in terms of detecting and diagnosing genitourinary TB in patients with HIV infection.

Multiple Spinal Metastasis of a Thyroid Carcinoma Mimicking Tuberculous Spondylodiscitis: A case report and Literature Review

Tuberculosis is a common disease in developing countries. It constitutes a major health problem. Several forms are described: Pleuro-pulmonary and extra-pulmonary forms. Osteoarticular tuberculosis represents 3 to 5% of all localizations. In case of no clinical improvement and worsening of symptoms, other diagnosis must be evoked, especially, tumoral causes. We describe the case of a woman who was treated for mediastinal lymph node tuberculosis with suspicion of tuberculosis spondylodiscitis, in whom preclinical investigations revealed a spinal metastasis of a papillary thyroid carcinoma. Keywords: Tuberculous Spondylodiscitis; Papillary Thyroid Carcinoma; Spinal Metastases; Surgery; Iodineradiation therapy; Radiotherapy

The impact of antibiotic pre-treatment on diagnostic yield of CT-guided biopsy for spondylodiscitis: A multi-centre retrospective study and meta-analysis.

Patients with suspected spondylodiscitis often undergo CT-guided biopsy to identify a causative microbiological organism. Antibiotic pre-treatment has been postulated as a cause for a negative biopsy, although previous clinical studies have been heterogenous with a meta-analysis suggesting no effect. The aim of this study was to assess the impact of antibiotic pre-treatment on microbiological yield. Retrospective review of consecutive adult patients undergoing CT-guided biopsy for suspected spondylodiscitis in two tertiary centres between 2010 and 2016. Demographic, procedural and clinical data were collected. Antibiotic pre-treatment was ascertained from patient drug charts. Over the 6-year period, 104 biopsies in 104 patients were included. 51% had a positive microbiological yield at CT-guided biopsy, with the most common isolated organism being Staphylococcus aureus (10.6%). Over two thirds of patients (69.3%) were off antibiotics at time of biopsy. There was no significant difference in microbiological yield in those patients on versus off antibiotics (48.2% vs 54.2%, P=0.55). 10.6% patients had a final diagnosis of Mycobacterium tuberculosis spondylodiscitis, and this organism was significantly associated with a positive microbiological yield (90.9% vs 46.2%, P=0.01). There was an inverse association between the presence of fever and sepsis with positive microbiological yield. CT-guided biopsy in suspected spondylodiscitis obtains a positive microbiological yield in about half of patients. This was significantly higher in patients diagnosed with tuberculosis spondylodiscitis, but there was no significant difference with antibiotic pre-treatment. Therefore, antibiotic pre-treatment should not preclude clinicians from pursuing a microbiological sample through CT-guided biopsy.

Benefits of Polymerase Chain Reaction Combined With Culture for the Diagnosis of Bone and Joint Infections: A Prospective Test Performance Study.

BackgroundThe microbiological diagnosis of bone and joint infections (BJI) currently relies on cultures, and the relevance of molecular methods is still debated. The aim of this study was to determine whether polymerase chain reaction (PCR) could improve the etiological diagnosis of BJI.MethodsA prospective study was conducted during a 4-year period at Lariboisiere University Hospital (Paris, France), including patients with suspicion of infectious spondylodiscitis, septic arthritis, prosthetic joint infections, and respective noninfected groups. Clinical and radiological data were collected at inclusion and during follow-up. All samples were analyzed by conventional cultures and 16S ribosomal deoxyribonucleic acid (rDNA) gene (16S-PCR). Specific cultures and PCR targeting Mycobacterium tuberculosis were also performed for spondylodiscitis samples. Case records were subsequently analyzed by an independent expert committee to confirm or invalidate the suspicion of infection and definitively classify the patients in a case or control group. The sensitivity of the combination of culture and PCR was compared with culture alone.ResultsAfter expert committee analysis, 105 cases of BJI cases and 111 control patients were analyzed. The most common pathogens of BJI were staphylococci (30%), M tuberculosis (19%), and streptococci (14%). Adding PCR enhanced the sensitivity compared with culture alone (1) for the diagnosis of M tuberculosis spondylodiscitis (64.4% vs 42.2%; P < .01) and (2) for nonstaphylococci BJI (81.6% vs 71.3%; P < .01). It is interesting to note that 16S-PCR could detect BJI due to uncommon bacteria such as Mycoplasma and fastidious bacteria.ConclusionsOur study showed the benefit of 16S-PCR and PCR targeting M tuberculosis as add-on tests in cases of suspected BJI.

Impact of HIV on spontaneous spondylodiscitis.

HIV predisposes patients to opportunistic infections. However, with the establishment of Highly Active Anti-Retroviral Therapy (HAART), patients' CD4 counts are maintained, as is a near normal life expectancy. This study aimed to establish the impact of HIV on the bacteriology of spondylodiscitis in a region in which tuberculosis (TB) is endemic, and to identify factors that might distinguish between them. Between January 2014 and December 2015, 63 consecutive cases of spontaneous spondylodiscitis were identified from a single-centre, prospectively maintained database. Demographics, presenting symptoms, blood results, HIV status, bacteriology, imaging, and procedure undertaken were reviewed and comparisons made of TB, non-TB, and HIV groups. There were 63 patients (22 male, 41 female) with a mean age of 42.0 years (11 to 78; sd 15.0). In total, 53 patients had tuberculous, nine bacterial, and one cryptococcal spondylodiscitis. There were 29 HIV-positive patients, 29 HIV-negative patients, and five patients with unknown HIV status. The local incidence of TB spondylodiscitis was 1.54/100 000 and that of non-TB spondylodiscitis was 0.29/100 000 per annum. TB patients were younger with similar clinical presentation and infective markers, but were more likely to have a paraspinal abscess. They were also less likely to have a hyperintense disc on MRI. There was no difference between the two HIV groups. In areas of endemic TB and HIV, TB remains the most common cause of spondylodiscitis at five times the rate of non-tuberculous causes. HIV managed with HAART increases the rate of infection but does not influence the bacteriology unless there is a low CD4. There was little to differentiate the groups. TB /HIV co-infected patients were younger than non-TB and HIV-negative patients. Non-TB patients were more likely to have disc hyperintensity on MRI and TB patients were more likely to have abscess formation, but as both groups exhibited these features, neither was diagnostic. Culture confirmation remains necessary. Cite this article: Bone Joint J 2019;101-B:617-620.

The Effects of Tumor Necrosis Factor Inhibitors in a Particular Association of Psoriatic Arthritis and Behcet Disease

The current case report presents a patient diagnosed with Behcet disease in concurrence with psoriatic arthritis, leading to a complex treatment, difficult management and challenging approach of both rheumatic disorders. After treatment with synthetic disease-modifying drugs and three different TNF inhibitors, the patient developed pulmonary tuberculosis, followed by tuberculosis spondylodiscitis, even after proper anti-tuberculosis therapy.

Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis.

Background:Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach.Settings and Design:A retrospective case study series in a tertiary level hospital.Aims:The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a “universal approach” in tubercular spondylodiscitis of variable presentation.Materials and Methods:The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period.Statistical Analysis Used:The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired t-test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis.Results:The mean number of vertebrae involved was 3.29 ± 0.86 (2–6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause.Conclusions:The procedure in safe and has satisfactory results in variable group affection of Pott's spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.

Asymptomatic tachycardia and acute pulmonary embolism in a case of tuberculosis spondylodiscitis.

Tachycardia, or elevated heart rate is one of the important clinical parameters considered when diagnosing pulmonary embolism (PE) based on Wells' criteria. However, tachycardia is not highly specific and commonly presents in many other conditions. A 29-year-old female with incomplete paraplegia secondary to tuberculosis (TB) spondylodiscitis presented with asymptomatic sinus tachycardia. The related medical conditions, including anaemia, acute coronary syndrome, hyperthyroidism and other infective causes had been ruled out. Deep venous thrombosis was not on the list of differentials as she showed improvements in neurological and mobility functions with no clinical signs of calf pain or swelling. She had moderate risk of acute PE based on Wells' criteria with positive D-dimer testing and computed tomography pulmonary angiography (CTPA) showing thrombus formation in the left-ascending pulmonary artery. Acute PE may present solely with asymptomatic sinus tachycardia in TB spondylodiscitis. This caveat should provide a high index of suspicion to prevent delay in diagnosis and prevention of more sinister complications. Early stratification based on Wells' criteria for a possible diagnosis of acute PE is proven to be a useful approach in conjunction with clinical features.

A Case of Tuberculosis Spondylodiscitis With Paraspinal Abscess in a 2-Year-Old Child.

In this article, we report a case of tuberculosis spondylodiscitis in a 2-year-old child. Imaging of her spine showed a paraspinal abscess. The diagnosis of spinal tuberculosis remains difficult, and we discuss its salient features and current management within the pediatric population.

Pott's disease in Moroccan children: clinical features and investigation of the interleukin-12/interferon-γ pathway.

Tuberculosis spondylodiscitis (TS), or Pott's disease, an extra-pulmonary form of tuberculosis (TB), is rare and difficult to diagnose in children. Some cases of severe TB in children were recently explained by inborn errors of immunity affecting the interleukin-12/interferon-gamma (IL-12/IFN-γ) axis. To analyse clinical data on Moroccan children with TS, and to perform immunological and genetic explorations of the IL-12/IFN-γ axis. We studied nine children with TS diagnosed between 2012 and 2014. We investigated the IL-12/IFN-γ circuit by both whole-blood assays and sequencing of the coding regions of 14 core genes of this pathway. A diagnosis of TS was based on a combination of clinical, biological, histological and radiological data. QuantiFERON(®)-TB Gold In-Tube results were positive in 75% of patients. Whole-blood assays showed normal IL-12 and IFN-γ production in all but one patient, who displayed impaired decreased response to IL-12. No candidate disease-causing mutations were detected in the exonic regions of the 14 genes. TS diagnosis in children remains challenging, and is based largely on imaging. Further investigations of TS in children are required to determine the role of genetic defects in pathways that may or may not be related to the IL-12/IFN-γ axis.

THU0293 Characteristics of Infectious Spndylodiscitis in Rheumatology

BackgroundInfectious spondylodiscitis is characterized by infection involving the intervertebral disc and adjacent vertebrae. Smaller studies indicate that the incidence of spondylodiscitis is increasing, possible related to expanding elderly and immunocompromised...

AB0851 Laboratory Abnormalities in Tuberculous Spondylodiscitis

BackgroundTuberculous spondylodiscitis still frequent in our country. Biologic aspects can help diagnosis in some cases.ObjectivesOur objective is to describe laboratory features of tuberculous spondylodiscitis among monocentric experience.MethodsThis is a retrospective...

AB0594 Infectious spondylodiscitis in elderly patients: a report of 22 cases

BackgroundInfectious Spondylodiscitis is rare among elderly people. Besides being life-threatening it has variable clinical presentations and insidious onset, leading to a delay in diagnosis and a difficulty in treatingObjectivesTo analyse...

Combined effect of Neridronate and specific antibiotic therapy in a case of tuberculous spondylodiscitis

Because of the increased incidence of tuberculosis (TB) in recent years, infective spondylitis is still a major problem in the world. In skeletal TB the spine is the most often involved and lumbosacral spine involvement is rare. Nowadays early diagnosis and new medical treatment can reduce the incidence of the serious skeletal sequelae and the number of surgery procedures in spinal TB. We present a case of TB spondylodiscitis characterized by a rapid and progressive clinical and radiological improvement after treatment with Neridronate and chemotherapic drugs. Our data suggest that in the treatment of the TB spondylodiscitis the combined use of these drugs is a good alternative to stimulate bone reparative process to the chemotherapy alone. To our knowledge this is first case of a patient with TB discitis treated with Neridronate. Further studies are necessary to confirm the effectiveness of Neridronate treatment added to antiTB drugs in spondylodiscitis.

Spondylodiscitis: diagnosis and treatment

Background We present our experience in the diagnosis and treatment of spondylodiscitis. Methods 27 patients with spondylodiscitis were studied. There were 15 men and 12 women, with ages ranging from 26 to 85 years. Of the 27 cases, there were 21 patients with pyogenic spondylodiscitis, 6 patients with tuberculosis spondylodiscitis, and 8 patients with diabetes mellitus complication. Two patients presented with tetraparesis, 13 with paraparesis, and 1 with hemiparesis. Seventeen patients underwent surgical treatment, among whom surgical intervention with instrumentation was performed on 5 patients, and emergency operation was performed on 6 patients. Results Fourteen patients were judged as “excellent,” 8 patients as “good,” and 4 patients as “no change.” One patient died because of infection by penicillin-resistant Staphylococcus pneumoniae. Conclusion It is very difficult to diagnose spondylodiscitis at the first medical examination. Most spondylodiscitis patients often first visit a department of internal medicine. We strongly recommend that all doctors, especially doctors examining diabetes mellitus patients daily, should be well informed of spondylodiscitis in order to improve its diagnosis.