Candidate Biomarkers to Distinguish Spinal Tuberculosis From Mechanical Back Pain in a Tuberculosis Endemic Setting (original) (raw)
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BMJ case reports, 2013
Chronic back pain is an extremely common complaint. All primary care physicians will be on the lookout for the 'red flags' that suggest serious pathology. The diagnosis of spinal infection with tuberculosis (TB) is uncommon and often not considered, especially in areas where the rate is very low such as the south west of England. We describe a patient presenting to the emergency department with severe pain, immobility and with a sensory deficit level. Unfortunately, given the favourable results for early medical treatment for spinal TB, this patient presented late and had a very poor outcome.
Early diagnosis of spinal tuberculosis
Journal of the Formosan Medical Association, 2016
Spinal tuberculosis (STB) is a common manifestation of extrapulmonary tuberculosis (TB). STB accounts for around 2% of all cases of TB and around 15% of extrapulmonary TB cases. The World Health Organization has proposed a global strategy and targets for TB prevention, care, and control after 2015. Under this strategy, patients will receive standard care according to the recommendations and guidelines after confirmation of STB diagnosis. However, current recommendations and guidelines focus on disease and medication therapy management, and recommendations for early detection or decision-making algorithms regarding STB are lacking. In this review, we identified five key components for early diagnosis: (1) risk factors for STB; (2) common symptoms/signs of STB; (3) significant neuroradiological findings of STB; (4) significant laboratory findings of STB, including positive interferon-g release assays and nonpyogenic evidence in initial laboratory data; and (5) significant clinical findings of STB. Individualized consideration for each patient with STB is essential, and we hope that the algorithm established in this review will provide a valuable tool for physicians who encounter cases of STB.
Microbiological diagnosis of spinal tuberculosis
International Orthopaedics, 2012
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.
Multiplex PCR as a novel method in the diagnosis of spinal tuberculosis–a pilot study
Acta Neurochirurgica, 2017
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.
Asian Journal of Medical Sciences, 2022
Background: Spinal tuberculosis (TB) is the most common of musculoskeletal TB. The diagnosis of spinal TB is difficult due to the non-specific symptoms. Clinical assessment, along with radiological features and biopsy, plays an important role in early diagnosis of spinal TB. Aims and Objectives: The aims of this study were to analyze clinical, radiological, and pathological features for early diagnosis of spinal TB and to identify other pathological conditions mimicking spinal TB. Materials and Methods: The present prospective study includes 110 patients. All patients were clinically and radiologically examined. The patients underwent percutaneous biopsy of the involved region and tissue samples were subjected to histopathological examination (HPE) and cartridge-based nucleic acid amplification test (CBNAAT) for definitive diagnosis of spinal TB. Results: Out of 110 cases, male preponderance (65.5%) was seen in comparison to females (34.5%). Dorsal spine (53.7%) and lumbar spine (41.3%) were the most common site of involvement. One hundred patients were confirmed as spinal TB by histopathology and molecular diagnosis. Histopathology alone could make diagnosis in 40 cases while molecular diagnosis in 100 cases and 10 cases were non-tuberculous in etiology (metastatic deposits of carcinoma in five cases, pyogenic spondylodiscitis in three cases and primary neoplastic lesion in two cases, one case of giant cell tumor, and one case of hemangioma each). Conclusion: Spinal TB is a deep-seated and paucibacillary condition difficult to diagnose due to inadequate sample. Therefore, multipronged approach by direct smear examination, HPE, and molecular diagnosis is required for early diagnosis. Culture is the gold standard for diagnosis while CBNAAT is highly sensitive and specific that enables rapid detection of tubercular bacilli and should be considered as first-line test.
Current difficulties in the diagnosis and management of spinal tuberculosis
Postgraduate Medical Journal, 2006
Background: The diagnosis of spinal tuberculosis (ST) is difficult and it commonly presents at an advanced stage. The management and follow up is complicated by a lack of guidance on the appropriate use and interpretation of spinal magnetic resonance studies (MR). Aims: A retrospective study was performed at a UK centre to identify the demographic and presenting features of a spinal TB population, their response to treatment, and the value of follow up MR studies. Patients and Results: Twenty one patients were identified with mean symptom duration of 11 (1.5-36) months having been assessed by a health practitioner on 3.2 (0-10) occasions before referral for investigation for ST. Twenty were born outside the UK. Their mean duration of residence in the UK was 6.67 (0.75-20) years, and six (32%) were resident for more than 10 years. Most (85.7%) did not have a medical history and one was HIV positive. Back pain, neurological, and constitutional symptoms were found in 100%, 29%, and 38% respectively. Musculoskeletal and neurological signs were found in 29% and 19% respectively. Spinal MR performed between 6 and 12 months suggests that six months of chemotherapy (for a fully sensitive organism) may not be sufficient to achieve disease resolution. Conclusions: Awareness of the demographic, clinical, and laboratory features of an ST population may facilitate earlier diagnosis. Guidance is required on the appropriate use and interpretation of MRI in the follow up of these patients.
Malaysian Orthopaedic Journal, 2011
Objective: The aim of this study was to evaluate the role of polymerase chain reaction (PCR) in the diagnosis of spinal tuberculosis after 2 weeks of preoperative anti-tuberculosis treatment and to compare PCR to the Löwenstein-Jensen Culture (LJC) and histopathological examination (HPE) methods. Methods: Twenty-five patients were included in this study. Sixteen patients were diagnosed and treated for spinal tuberculosis based on clinical and radiological evidence. Nine patients were controls. The LJC method and HPE of the specimen were performed according to hospital protocol. PCR was performed using primer encoding insertion of sequences IS6110 for mycobacterium tuberculosis complex. Clinical findings and radiological features were the gold standard for comparison. Results: PCR results were 15 positive and one negative. The sensitivity and specificity of PCR was 94% and 100% respectively (with 95% confidence interval [CI] 67% to 99% and 63% to 100%, respectively). HPE results showed 13 were positive and 3 negative in the spinal tuberculosis group; for the control group, all were negative. Sensitivity and specificity value of HPE was 82 % and 100% respectively (with 95% confidence interval [CI] 54% to 95% and 63% to 100%, respectively). Use of LJC showed only one was positive and 15 were negative in the spinal tuberculosis group whole all nine in the control group were negative. Sensitivity and specificity value of LJC was 6% and 100% respectively (with 95% confidence interval [CI] 0.3% to 32% and 63% to 100%, respectively). Conclusion: Our findings showed that the PCR for Mycobacterium tuberculosis is reliable as a method for diagnosis of spinal tuberculosis, even after of 2 weeks of anti-TB treatment, with an overall sensitivity of 94% and specificity of 100%.
Spinal Cord, 2008
A retrospective chart review at the major provincial public hospital serving patients with spinal injuries/pathology. Objectives and setting: To determine the incidence of spinal tuberculosis (Tb) and establish the profile of these patients treated at King George V Hospital (KGV) in KwaZulu-Natal, South Africa. Methods: A total of 525 medical records for the period March 2005 to April 2006 were reviewed. Data from 104 files of Tb spine cases were categorized according to demographic details, medical conditions and length of stay in hospital. The South African midyear 2006 census was used to calculate associations and risk rates for race, gender, adulthood, urbanization and employment and analyzed using the STATA version 9.0 statistical package. Results: About 90% of the patients were African and 10% from other races. Females comprised 58% of the patients. The incidence of Tb spine is 1.02 per 100 000 and 3.13 per 100 000 for Africans and other races, respectively. The incidence rate is 1.17 per 100 000 females and 0.916 per 100 000 males. All the participants had a history of pulmonary Tb and 28% were human immunodeficiency virus positive. Thoracic spine was affected in 42% of the cases. About 32% presented with incomplete paraplegia. The average length of stay at this hospital for these patients was 41 days. Conclusions: About 20% of all patients seen for spinal conditions at KGV over the past year presented with Tb spine. A higher association between living in an urban area, adulthood (age 18 þ), being non-Black patients and the occurrence of spinal Tb was observed.
Serum and CSF cytokines and matrix metalloproteinases in spinal tuberculosis
Inflammation Research, 2014
Aims and objectives Both pro-inflammatory and antiinflammatory cytokines play key roles in the pathogenesis of various forms of tuberculosis. In this study, we evaluated the role of various cytokines and matrix metalloproteinases (MMPs) in patients with spinal tuberculosis. Materials and methods In this prospective study, we enrolled 55 histopathologically/microbiologically confirmed patients with spinal tuberculosis. We also included 55 control subjects. Blood and cerebrospinal fluid (CSF) were collected both from cases and controls. Tumor necrosis factor (TNF)-a, interferon (IFN)-c, interleukin (IL)-1b, IL-6, IL-8, IL-10, matrix metalloproteinases MMP-2 and MMP-9 were measured by enzyme-linked immunosorbent assay (ELISA). Disability and outcome were measured by modified Barthel Index (MBI). Measured inflammatory parameters were correlated with the outcome after 6 months of follow-up. Results We observed that serum and CSF cytokines and MMPs were significantly higher in patients with spinal tuberculosis than in controls (p \ 0.001). Spearman's rank order correlation test for correlation of baseline MBI (measure of disability) and cytokine/MMP levels showed that baseline MBI had significant negative correlation with serum levels of IFN-c (r =-0.517; p \ 0.001), IL-1b (r =-0.355; p = 0.008), IL-6 (r =-0.306; p = 0.023), IL-8 (r =-0.275; p = 0.042), MMP-9 (r =-0.311; p = 0.021) and CSF levels of TNF-a (r =-0.327; p = 0.015); whereas baseline MBI had a positive correlation with the serum level of anti-inflammatory cytokine IL-10 (r = 0.327; p = 0.015). Poor outcome, after 6 months, was associated with higher serum TNF-a (p = 0.015) and IFN-c (p = 0.021) and CSF MMP-9 (p = 0.006) and a lower serum IL-10 (p = 0.018) level. Conclusions To conclude, in patients of spinal tuberculosis, poor outcome is associated with higher proinflammatory serum TNF-a and IFN-c, and CSF MMP-9 levels, and a lower anti-inflammatory serum IL-10 level.