The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated / O número relativo de linfócitos é menor quando o agente etiológico da doença de Pott é isolado com sucesso

Abstract Objective To describe the clinico-epidemiological, laboratory, and radiological characteristics of tuberculous spondylodiscitis in the Brazilian population, and to assess whether there are differences between patients in whom the etiological agent in Pott disease was isolated or not. Methods Patients diagnosed with tuberculosis (TB) of the spine (Pott disease) underwent follow-up between 2009 and 2019 at a quaternary hospital and were divided into 2 groups: successful isolation (SI) of the etiological agent (through bacilloscopy, culture, or positive molecular rapid test) and unsuccessful isolation (UI) of the etiological agent. Results From a total of 26 patients diagnosed with TB of the spine, 21 (80.7%) were male, with a mean age of 40 ± 22.5 years. The average lymphocyte counts were higher in the UI group (25.35 ± 13.08; p= 0.025) compared to the SI group (14.18 ± 7.48). Moreover, the monocyte/lymphocyte ratio was lower in the UI group (0.39 ± 0.22; p= 0.009) than in the SI group (0.89 ± 0.65). Relative lymphocyte counts higher than or equal to 16.7 had a sensitivity of 76.9% and specificity of 62.5% in the UI group. Values higher than or equal to 0.58 for the monocyte/lymphocyte ratio showed a sensitivity of 84.6% and specificity of 75.0% in the UI group. Conclusion No differences were observed regarding the clinico-epidemiological and radiological characteristics of the two experimental groups. However, the UI group had higher lymphocyte counts and a lower monocyte/lymphocyte ratio.

Resumo Objetivo Descrever as características clínico-epidemiológicas, laboratoriais e radiológicas da espondilodiscite tuberculosa na população brasileira e avaliar se há diferenças entre pacientes em que o agente etiológico da doença de Pott foi isolado ou não. Métodos Os pacientes diagnosticados com tuberculose (TB) da coluna (doença de Pott) foram acompanhados em um hospital quaternário entre 2009 e 2019 e divididos em 2 grupos: isolamento positivo (IP) do agente etiológico (por baciloscopia, cultura ou teste rápido molecular positivo) e isolamento negativo (IN) do agente etiológico. Resultados De um total de 26 pacientes com diagnóstico de TB da coluna, 21 (80,7%) eram do sexo masculino, e a média de idade era de 40 ± 22,5 anos. As contagens médias de linfócitos foram maiores no grupo IN (25,35 ± 13,08; p= 0,025) do que no grupo IP (14,18 ± 7,48). Além disso, a relação monócito/linfócito foi menor no grupo IN (0,39 ± 0,22; p= 0,009) do que no grupo IP (0,89 ± 0,65). O número relativo de linfócitos maior ou igual a 16,7 teve sensibilidade de 76,9% e especificidade de 62,5% no grupo IN. A razão monócito/linfócito maior ou igual a 0,58 teve sensibilidade de 84,6% e especificidade de 75,0% no grupo IN. Conclusão Não observamos diferenças em relação às características clínico-epidemiológicas e radiológicas entre os dois grupos experimentais. No entanto, o grupo IN apresentou maior número de linfócitos e menor razão monócito/linfócito.

Mal de Pott chez l'enfant : aspects épidémiologiques, cliniques et thérapeutiques en chirurgie pédiatrique à Cotonou

Introduction : Le mal de Pott est une forme grave de tuberculose extra-pulmonaire à cause du risque de lésions neurologiques. Patients et méthodes : Il s'est agi d'une étude rétrospective menée sur 10 ans (janvier 2006 à décembre 2015) dans le service de chirurgie pédiatrique du Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM). Nous avons étudié ses caractéristiques épidémiologiques, cliniques et thérapeutiques chez des sujets âgés de 0 à 15 ans. Résultats : Il a été colligé 20 cas, soit 2 cas/an. L'âge moyen des enfants était de 5,5 ans avec des extrêmes de 9 mois et 15 ans. Ceux de moins de 5 ans étaient les plus atteints (14 cas). Le sex-ratio était de 3. Les douleurs rachidiennes (10 cas) et les tuméfactions du dos (8 cas) étaient les principaux motifs de consultation. La fièvre et la douleur provoquée à la palpation des épineuses vertébrales étaient les signes cliniques les plus résents chacun dans 16 cas/20. Des signes neurologiques étaient notés dans 8 cas. Les signes radiographiques étaient dominés par l'ostéolyse vertébrale et le pincement de l'interligne articulaire. Il a été identifié 1 cas d'image en fuseau. Les lésions siégeaient essentiellement sur le rachis lombaire (8 cas). Le traitement était spécifique et orthopédique. L'évolution était favorable chez 16 patients après un recul moyen de 86 mois. Conclusion : Le mal de Pott est une affection qui doit être vite diagnostiquée et traitée afin d'en éviter les complications qui sont redoutables

Mal de Pott en un indígena colombiano / Pott´s disease in a Colombian indigenous man

Cada año mueren alrededor de dos millones de personas a causa de la tuberculosis y se estima que un tercio de la población mundial está infectada con el bacilo que la causa, pero solo entre 5 y 10 % desarrolla la enfermedad. El riesgo de que la enfermedad progrese al estado activo depende de factores endógenos y exógenos. Las comunidades indígenas son un grupo con un alto riesgo de infectarse y enfermar de tuberculosis; además de factores como el aislamiento geográfico, el abandono social y cultural y la desnutrición, se han identificado en ellos polimorfismos genéticos que los hacen más propensos a la infección. La tuberculosis vertebral es la forma más destructiva de la enfermedad y representa cerca de la mitad de los casos de tuberculosis esquelética. Se presenta el caso de un paciente indígena colombiano con tuberculosis vertebral y resultado negativo para HIV. El diagnóstico se basó en los hallazgos clínicos y en los estudios de imaginología, y se confirmó mediante la prueba molecular rápida Genotype MTBDR plus ® y de la reacción en cadena de la polimerasa PCR IS6110; el cultivo fue negativo a las 16 semanas de incubación. Se discuten brevemente la patogénesis, el diagnóstico y el tratamiento, y se comentan algunos aspectos relacionados con la situación de la tuberculosis en las comunidades indígenas colombianas.

Approximately 2 million people die each year from tuberculosis. One third of the world´s population is estimated to be infected with the tuberculosis bacillus, although only 5-10% will develop the disease in their lifetime. The disease progression risk depends on endogenous and exogenous factors. Indigenous communities are a high-risk group for infection and development of tuberculosis. In addition to factors such as geographical isolation, social and cultural neglect and malnutrition, susceptibility to genetic polymorphisms has been identified in them. Spinal tuberculosis is the most destructive form of the disease, which represents approximately half of all cases of skeletal tuberculosis. The case of an HIV negative, indigenous Colombian man is presented. His diagnosis was done based on clinical and image findings, and it was confirmed with the rapid molecular assay Genotype MTBDRplus ® and IS6110 PCR.The culture in solid media was negative after 16 weeks. We briefly discuss the pathogenesis, diagnosis and treatment. Finally, we comment on some aspects of the situation of tuberculosis among indigenous Colombian communities.

Spinal tuberculosis; A study of the disease pattern, diagnosis and outcome of medical management in Sri Lanka.

Background: Sri Lanka has an intermediate burden of tuberculous disease. Most patients with spinal tuberculosis (STB) are managed with medical treatment alone as advanced surgical facilities are not freely available. Objective: To describe the clinico-demographic and imaging pattern of STB and to assess the outcome of medical treatment in the local setting. Design: Descriptive case series. Methods: All patients diagnosed with definite or probable STB, had their symptomatology and investigations recorded. They were followed up with anti-TB treatment (ATT) according to standard guidelines. An initial six-week tapering course of steroid was given when there was an evidence of neural involvement. Results: Of 32 patients with STB, backache was the commonest presenting feature (92%). Nine had lower limb neurological deficits. Uni-focal upper lumbar involvement was the commonest disease pattern noted in the series. High ESR (84%) and Mantoux positivity (53%) were frequent. 72% had end-plate changes on imaging. 53% had paraspinal soft tissue components. The triad of backache, high ESR and end-plate and/or paraspinal disease on CT/MRI showed a diagnostic sensitivity of 81.2%. Response to ATT was satisfactory in 87%. Poor neurological response was seen among some with large paraspinal collections or extensive vertebral damage at diagnosis. Conclusion: This study showed that backache over one month, high ESR and specific CT/MRI features helped diagnosis of STB, in the absence of definitive evidence. Medical management alone, comprising a prolonged course of ATT with an initial steroid cover when indicated, appeared to be safe and effective in the local setting for uncomplicated STB.

Tuberculose vertébrale (Mal de Pott) : aspects épidémio-clinique, radiologique et évolutif au CHU du Point-G

La spondylodiscite tuberculeuse ou Mal de Pott est la forme la plus fréquente des tuberculoses ostéoarticulaires dans les pays à forte prévalence de tuberculose et de VIH/SIDA, mais le diagnostic de certitude reste difficile. Le but de ce travail était d'étudier les aspects épidémio clinique, radiologique et évolutif du Mal de Pott en l'absence de preuve bactériologique et histologique. Méthode : Il s'agit d'une rétrospective ayant porté sur des dossiers colligés dans le service de pneumophtisiologie du CHU de Point-G, de Janvier 2005 à Décembre 2009. Ont été retenus, tous les dossiers portant le diagnostic de tuberculose vertébrale probable et dont le traitement antibacillaire a été institué. Résultats : Au total, 178 cas de Mal de Pott ont été enregistrés sur 3560 cas de tuberculoses toutes formes soit 5%, avec une moyenne de 35± 6 cas par an. Nous avons noté une prédominance masculine (102 hommes contre 76 femmes) soit un sex-ratio de 1,3. L'âge moyen des patients était de 41 ± 15 ans. Les signes régulièrement retrouvés par leurs fréquences de plus de 80% sont : altération de l'état générale, asthénie, fièvre vespérale, la douleur rachidienne inflammatoire, VS élevée, spondylodiscite, retour à l'apyrexie, amélioration de l'état général. La sérologie VIH était positive dans 5,2% des 152 patients dépistés. Conclusion : Le Mal de Pott est en augmentation progressive. Le diagnostic est très souvent de présomption. Aussi, faut-il savoir débuter à temps un traitement antituberculeux, afin de minimiser les séquelles post-thérapeutiques

Frequency and magnetic resonance imaging patterns of tuberculous spondylitis lesions in adults

To find out the frequency and patterns of various lesions in tuberculous spondylitis in adults on magnetic resonance imaging [MRI]. Case series. Radiology Department, Military Hospital [MH] Rawalpindi, from September 2006 to March 2007. Patients with features suggestive of tuberculous spondylitis underwent plain T1-weighted and T2-weighted images and T1-weighted contrast enhanced images in both axial and sagittal sections. The data was analyzed in terms of frequency and patterns of various lesions of tuberculous spondylitis causing abnormal signals in spinal and paraspinal areas. Mean +/- standard deviation were calculated form numerical data using SPSS version 15. Out of 75 patients, 39 were females. The mean age was 42.4 years. Involvement occurred through SV1 vertebral levels. Most common involvement was seen in the thoracic vertebrae [40%] followed by lumbar vertebrae. The most common MRI feature was abnormal signal intensities appearing hypointense on T1W and hyperintense on T2W sequences with heterogeneous enhancement of the vertebral body in all patients. The characteristic findings of spinal tuberculosis included destruction of two adjacent vertebral bodies and opposing end plates, destruction of intervening disc, and occurrence of paravertebral and epidural abscesses. MR imaging of spinal tuberculosis, characteristically showed contiguous involvement of two vertebrae along with the intervening disc, skip lesions, and paraspinal collections and provides critical information about the involvement of spinal cord and the extent of the disease

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.

Traitement medical du mal de Pott: a propos des 18 cas

Introduction: la tuberculose vertebrale est de loin la localisation osteo-articulaire la plus frequente ; son traitement est de moins en moins chirurgical; la duree et les modalites du traitement medical restent cependant sujettes a discussion.Le but de ce travail est de proposer une attitude therapeutique standardisee pour le mal de Pott. Patients et methodes : Les acteurs rapportent une etude retrospective de 18 cas de mal de pott. Resultats : L'age moyen etait de 51 ans .Tous les malades ont beneficie d'un traitement medical ; aucune indication chirurgical n'a ete portee.l'imagerie par resonance magnetique et la biopsie sous scanner ont permis d'eviter les abords churirgicaux a visee diagnostic.La chimiotherapie consistait en une phase d'attaque comprenant quatre antituberculeux d'une duree moyenne de 5 mois ; suivi d'une phase d'entretien associant uniquement deux antituberculeux majeurs en prise quotidienne et d'une duree moyenne de 11 mois .Huit patients ont eu une immobilisation rachidienne. Apres un recul moyen de 36 mois l'evolution clinique et anatomique etait favorable pour tous les maladies. Aucune aggravation des troubles neurologiques n'a ete notee. Conclusion: traitement medical antituberculeux bien conduit est toujours efficace surtout si le diagnostic est assez precoce et permet ainsi d'eviter le recours a la chirurgie assez laborieuse et dont les resultats ne sont pas encourangeants

Tuberculosis vertebral en el adulto / Adult spinal tuberculosis

Se hizo una revisión sobre pacientes afectados por tuberculosis vertebral de febrero de 1987 a mayo de 1991, tratados en el Hospital de traumatología y Ortopedia "Lomas Verdes". De un total de 38 pacientes, se incluyó en la presente serie a 30, de uno y otro sexo y con edad mayor de 15 años. A 17 enfermos se les administró el tratamiento clásico con hidrazida del ácido isonicotínico (HAIN) y etambutol durante 18 meses, además de estreptomicina solamente los primeros dos meses. El llamado tratamiento corto, se aplicó durante un periodo de seis meses con pirazinamida, rifampicina y estambutol en ocho casos. Finalmente, el tratamiento para las recaídas consistió en un programa de HAIN y rifampicina durante 12 meses y se aplicó en otros cinco pacientes. Si los pacientes no trníasn destrucción ósea masiva, daño neurológico, ni fomación de abscesos o fístulas, se les aplicó tratamiento ortopédico conservador, que consistió en un corsé o reposo en cama durante un periodo de tres a cuatro meses. Este método se aplicó en 13 enfermos. En cambio, si existían las lesiones señaladas, se aplicó tratamiento quirúrgico que consistió en desbridamiento, descompresión y artrodesis anterior con injerto óseo autólogo de ilíaco. Este tratamiento quirúrgico primario se realizó en los restantes 17 enfermos, de los cuales 12 tenían paraplejía. Se requirió cirugía adicional en 12 de aquellos 17 enfermos, por destrucción masiva e inestabilidad espinal, que consistió en simple artrodesis posterior de dos y artrodesis con instrumentación de Luque en 10. Hubo mejoría del daño neurológico sólo en siete de los 12 pacientes. Por otra parte, hubo dos que presentaron daño neural después de la cirugía. El resultado global fue bueno en 23 casos (76 por ciento), regular en cinco y malo en dos. A mayor duración de la enfermedad la capacidad de recuperación de los enfermos fue menor.

Clinical Studies of Tuberculosis of the Spine

During the period from January 1967 to December 1977, 244 cases of tuberculosis of the spine were operated on at the Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea. We followed up 176 cases from 6 months to 10 years and the average period was one year and ten months. (Radical curettage and anterior interbody fusion 129 cases, posterior fusion 20 cases, curettage without bone graft 21 cases, and combined anterior and posterior fusion 6 cases.) The results of those studies are as follows: 1) The incidence of Pott's-parplegia was 25% (61 cases) of the total cases. 2) Almost 41 cases (66%) of the total cases of Pott's parplegia have recovered well enough to return after operation to their previous work. 3) In children (below 15 years of age) 50 cases (87.7%) had satisfactory results with bony fusion and in adults 93 cases (94.9%). 4) In children 44 cases (77%) had healing of radiological activity after operation and in adults 104 cases (87%). 5) The younger the spine, the lower the fusion rate. Combined anterior and posterior fusion is the choice of treatment for tuberculosis of the spine in children. 6) Postoperative complications occured in 38 cases (16%) including wound infection, postoperative pneumonia, postoperative pneoumothorax, postoperative atelectasis, paralytic ileus, meningitis, cystitis, and failure in bone graft.