Evaluation of an enzyme-linked immunospot assay for the immunodiagnosis of atypical spinal tuberculosis (atypical clinical presentation/atypical radiographic presentation) in China

BACKGROUND: Atypical spinal tuberculosis (TB) usually presents in a slowly indolent manner with nonspecific clinical presentations making the diagnosis a great challenge for physicians. New technologies for the detection of atypical spinal TB are urgently needed. The aim of this study was to assess the diagnostic value of an enzyme-linked immunospot (ELISPOT) assay in clinically suspected cases of atypical spinal TB in China. METHODS: From March 2011 to September 2012, a total of 65 patients with suspected atypical spinal TB were enrolled. In addition to conventional tests for TB, we used ELISPOT assays to measure the IFN-I response to ESAT-γ and CFP-10 in T-cells in samples of peripheral blood mononuclear cells. Patients with suspected atypical spinal TB were classified by diagnostic category. Data on clinical characteristics of the patients and conventional laboratory results were collected. RESULTS: Out of 65 patients, 4 were excluded from the study. 18 (29.5%) subjects had cultureconfirmed TB, 11 (18.0%) subjects had probable TB, and the remaining 32 (52.5%) subjects did not have TB. Generally, the features of atypical spinal TB include the following aspects: (1) worm-eaten destruction of vertebral endplate; (2) destruction of centricity of the vertebral body or concentric collapse of vertebral body; (3) tuberculous abscess with no identifiable osseous lesion; (4) contiguous or skipped vertebral body destruction. 26 patients with atypical spinal TB had available biopsy or surgical specimens for histopathologic examination and 23 (88.5%) specimens had pathologic features consistent with TB infection. The sensitivities of the PPD skin test and ELISPOT assay for atypical spinal TB were 58.6% and 82.8%, and their specificities were 59.4% and 81.3%, respectively. Malnutrition and age were associated with ELISPOT positivity in atypical spinal TB patients. CONCLUSIONS: The ELISPOT assay is a useful adjunct to current tests for diagnosis of atypical spinal TB.

Bone tuberculosis in Roman Period Pannonia (western Hungary)

The purpose of this study was to analyse a skeleton (adult female, 25-30 years) that presented evidence of tuberculous spondylitis. The skeleton, dated from the Roman Period (III-VI centuries), was excavated near the town of Győr, in western Hungary. The skeleton was examined by gross observation supplemented with mycolic acid and proteomic analyses using MALDI-TOF/TOF tandem mass spectrometry. The biomolecular analyses supported the morphological diagnosis.

Espondilitis tuberculosa ("Mal de Pott"): presentación de un caso y revisión bibliográfica / Tuberculous spondylitis (Pott's disease): case report and review of the literature

Tuberculosis of the spine (Pott' disease), is an uncommon evento of extrapulmonary tuberculosis and usually occurs in the absence of extraspinal infection. We report a 24 year-old-man assisted in Córdoba, City (Argentina). Patient arrived at the hospital with mild lumbar pain, thigh's hyperesthesia an patellar hyporreflexia, both in the right side, without general manifestations. X-ray and CT scanning showed severe structural domage of vertebral bodies of the fourth, an fifth lumbar (L4, L5) and first sacral (S1) vertebrae. In addition, paraspinal abscess with extension up to psoas muscle was observed. Mycobacterium tuberculosis was isolated by culture of specimens obtained by aspiration from affected area, fourty days after admission. Patient was treated for nine months with four drugs (Isoniazid, Rifampicine, Pyrazinamide and Ethambutol). Then, the spine was surgically stabilized. During a follw-up of ten years, patient improved progressively. We point out that Pott' disease should be suspected in all cases with vertebral osteomyelitis and negative bacteriological test for common bacteria.

Mal de Pott: uma doença milenar em um novo século / Pott's disease: an ancient disease in a new century

A tuberculose espinhal, também conhecida como Mal de Pott ou Doença de Pott, caracteriza-se como a forma mais frequente de tuberculose extrapulmonar. Apresentamos aqui o caso de uma paciente encaminhada ao Serviço de Neurologia do Hospital de Clínicas de Porto Alegre com um quadro de dois meses de evolução, apresentando sintomas de compressão medular. O diagnóstico de tuberculose espinhal foi realizado por punção guiada por tomografia computadorizada e a paciente foi submetida à drenagem do abscesso. Concomitantemente, foi iniciado o tratamento com RHZ e a paciente evoluiu com melhora dos sintomas neurológicos. Esse caso ilustra que mesmo pacientes com alterações neurológicas importantes devido à tuberculose medular podem apresentar melhora significativa com tratamento.

Spinal tuberculosis, also known as Pott's disease, is the most common form of extra-pulmonary tuberculosis. We report on a patient referred to the Division of Neurology of Hospital de Clínicas de Porto Alegre presenting with spinal cord compression symptoms for two months. The diagnosis of spinal tuberculosis was rapidly done by a computerized tomography guided biopsy. The patient was submitted to abscess surgical draining and complementary RHZ treatment, with recovery of neurological symptoms. This case illustrates that even patients with severe neurological deficits due to spinal tuberculosis may have a good outcome with the appropriate treatment.

Tuberculosis de la columna cervical. Reporte de un caso y revisión de la literatura / Tuberculosis of the cervical spine. Case report and review of the literature

La tuberculosis (Tb) osteoarticular más frecuente es el Mal de Pott (1 por ciento de todas las Tb), que es la afección de la columna vertebral, en especial a nivel de las regiones lumbar y dorsal. La porción cervical se afecta entre el 3.5 y 7 por ciento de los casos. Se informa el caso de un paciente masculino adulto, con datos de parestesias en miembro superior izquierdo, omalgia y dolor torácico, después de studios de imagen se realiza corporectomía de C5 y C6, se administró tratamiento con antifímicos y tuvo buena evolución. Se revisa la literatura