Randomized controlled trial of vitamin d supplementation on toll-like receptor-2 (tlr-2) and toll-like receptor-4 (tlr-4) in tuberculosis spondylitis patients.

BACKGROUND: Tuberculosis spondylitis accounts for approximately 50% of all cases of skeletal tuberculosis. Vitamin D plays a role in the immune system. Vitamin D helps in the activation of TLR-2 and TLR-4, which play a role in the process of tuberculosis infection. The objective of this study was to investigate the effect of oral supplementation with vitamin D on TLR-2 and TLR-4 levels in tuberculosis spondylitis patients. METHODS: The true Experiment Design Pretest-Posttest with Control Group (Pretest-Posttest with Control Group) was used for this research. TLR-2 and TLR-4 were measured by ELISA. Repeated ANOVA, ANOVA tests, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. RESULT: In the dose groups of 10,000 IU and 5000 IU, significant increases in the levels of vitamin D, TLR-2, and TLR-4 were observed at weeks 4 and 8 (p < 0.05). In the control group, there was no significant increase. CONCLUSIONS: Vitamin D supplements can significantly increase TLR-2 and TLR-4 levels. Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels > 50 ng/dl to optimally act as an immunomodulator.

A Case Report of a Tragic Story of Pott's paraplegia Cured after Four Years.

Pott's disease is a form of spondylodiscitis caused by mycobacterium tuberculosis. It is a serious form of spinal infections that can lead to terrible disabilities in case of undiagnosed and treated early. To document a case of Pott's paraplegia cured after four years. This report details the case of a patient with an undiagnosed case of spinal tuberculosis in a 55-year-old man who had complained of lower back pain and tenderness over the course of several months. The case progressed to the point that he had difficulty standing and numbness, then weakness, of the lower limbs. This patient was only treated with analgesics and antibiotics. Herbal remedies, massage and amulets also played a major role in his treatment. The patient remained bed-bound and paraplegic for four years, after which, he was referred for a thoracolumbar Magnetic Resonance Imaging (MRI) and was diagnosed with tuberculous spondylodiscitis. The patient underwent decompression surgery and started anti-tuberculous drugs. He regained his ability to walk. His lifestyle has improved and he has been living independently for eight years. In conclusion, diagnosis and correct treatment can result in a patient who was previously handicapped becoming independent once again. Medical imaging using MRI can play an essential role in the diagnosis of spinal lesions, including those present in cases of Pott's disease.

A male adult skeleton from the Han Dynasty in Shaanxi, China (202 BC-220 AD) with bone changes that possibly represent spinal tuberculosis.

Bioarchaeological data for tuberculosis (TB) have been published very sporadically in China or the rest of East Asia. To explore the history of TB in this area, 85 skeletons excavated from the Liuwei Cemetery in Shaanxi, China (202 BC-220 AD) were macroscopically examined to record TB related bone changes. These skeletons represented inhabitants of Maolingyi, an urban area that had a high population density during the Han Dynasty (202 BC-220 CE). Seventeen of the 85 skeletons had spines that were well enough preserved to observe evidence of spinal disease. Among them, a male skeleton aged around 30 years (M34-E) manifested multiple lytic lesions in the eleventh thoracic to second lumbar vertebral bodies (T11 to L2). TB was considered a possible diagnosis for the spinal lesions observed, with differential diagnoses of brucellosis and typhoid. The dense population and overcrowding in urban Maolingyi were considered the potential social risk factors for TB found at this site. The findings of this study contribute to limited knowledge about the history of TB in East Asia and suggest a relationship between population density and the spread of TB in Maolingyi at that time. However, the lack of published bioarchaeological data of TB in East Asia hinders understanding the transmission of TB within Asia and its link to the rest of the world. Further intensive review of archaeological skeletons in Asia is urgently needed. 。, 。85, 17, 。, 30、、。, 。, 。、, , 。, 。, 。.

A paleopathological approach to early human adaptation for wet-rice agriculture: The first case of Neolithic spinal tuberculosis at the Yangtze River Delta of China.

The earliest evidence of human tuberculosis can be traced to at least the early dynastic periods, when full-scaled wet-rice agriculture began or entered its early developmental stages, in circum-China countries (Japan, Korea, and Thailand). Early studies indicated that the initial spread of tuberculosis coincided with the development of wet-rice agriculture. It has been proposed that the adaptation to agriculture changed human social/living environments, coincidentally favoring survival and spread of pathogenic Mycobacterial strains that cause tuberculosis. Here we present a possible case of spinal tuberculosis evident in the remains of a young female (M191) found among 184 skeletal individuals who were Neolithic wet-rice agriculturalists from the Yangtze River Delta of China, associated with Songze culture (3900-3200 B.C.). This early evidence of tuberculosis in East Asia serves as an example of early human morbidity following the adoption of the wet-rice agriculture.

[Feasibility study of preoperative percutaneous catheter drainage in the treatment of lumbar tuberculosis with psoas abscess].

OBJECTIVE: To investigate the effect of preoperative percutaneous drainage in lumbar tuberculosis with psoas abscess, through compare the clinical efficacy of two different methods. METHODS: Thirty-six patients with lumbar tuberculosis complicated with psoas abscess in corresponding with the inclusion criteria were admitted in Zhejiang Province Traditional Chinese Medicine Hospital from January 2015 to January 2017. The patients were divided into group A and group B according to the different therapeutic methods. All patients were given the standard anti tuberculosis treatment, and percutaneous catheter drainage was used in group A after admission immediately for psoas abscess before operation, while group B with no special treatment. At 3 weeks after anti tuberculosis treatment, 2 patients were excluded in group B, which had to postpone operation because of no reduction in erythrocyte sedimentation rate(ESR) and C reactive protein(CRP). Finally 34 patients were enrolled in this study. There were 18 cases in group A, including 10 males and 8 females, aged from 24 to 73 years old with an average of(42.5±10.2) years. There were 16 cases in group B, including 9 males and 7 females, aged from 23 to 75 years old with an average of(42.3±9.8) years. All patients were treated with posterior pedicle screw fixation, anterior debridement and bone graft fusion. Anterior surgery bleeding volume, operation time, anterior incision length, postoperative anus exhaust time, VAS score, Cobb angle, ESR, CRP changes and postoperative sinus formation were compared between two groups. RESULTS: All patients were followed up for 6 to 21 months with an average of 13 months. At the last follow-up, no mixed infection, tuberculosis recurrence, pedicle screw loosening and nail withdrawal were found. The average operative time, anterior surgery bleeding volume and anterior incision length of group A were less than that of group B(P<0.05). Postoperative anal exhaust time of group A was lower than that of group B(P<0.05). Improvement degree of ESR, CRP at 3 weeks after anti tuberculosis and 1 week after operation, group A was better than group B(P<0.05), and there was no significant difference between two groups in 1 month and 6 months after operation(P>0.05). There was 1 case sinus formation in group A and 5 cases in group B, there was significant difference in sinus formation rate between two groups (P<0.05). VAS score and Cobb angle at 1 month after operation was obvious improved(P<0.05), but there was no significant difference between two groups (P>0.05). Spinal cord nerve injury was obvious improved after operation, but there was no significant difference between two groups. CONCLUSIONS: Preoperative percutaneous catheter drainage is a safe and feasible method for the treatment of lumbar tuberculosis with psoas abscess. It can increase the effect of anti tuberculosis before operation, reduce the surgical trauma and reduce the incidence of postoperative complications. It can be recommended in clinical application.

Feasibility study of preoperative percutaneous catheter drainage in the treatment of lumbar tuberculosis with psoas abscess / 中国骨伤

OBJECTIVE@#To investigate the effect of preoperative percutaneous drainage in lumbar tuberculosis with psoas abscess, through compare the clinical efficacy of two different methods.@*METHODS@#Thirty-six patients with lumbar tuberculosis complicated with psoas abscess in corresponding with the inclusion criteria were admitted in Zhejiang Province Traditional Chinese Medicine Hospital from January 2015 to January 2017. The patients were divided into group A and group B according to the different therapeutic methods. All patients were given the standard anti tuberculosis treatment, and percutaneous catheter drainage was used in group A after admission immediately for psoas abscess before operation, while group B with no special treatment. At 3 weeks after anti tuberculosis treatment, 2 patients were excluded in group B, which had to postpone operation because of no reduction in erythrocyte sedimentation rate(ESR) and C reactive protein(CRP). Finally 34 patients were enrolled in this study. There were 18 cases in group A, including 10 males and 8 females, aged from 24 to 73 years old with an average of(42.5±10.2) years. There were 16 cases in group B, including 9 males and 7 females, aged from 23 to 75 years old with an average of(42.3±9.8) years. All patients were treated with posterior pedicle screw fixation, anterior debridement and bone graft fusion. Anterior surgery bleeding volume, operation time, anterior incision length, postoperative anus exhaust time, VAS score, Cobb angle, ESR, CRP changes and postoperative sinus formation were compared between two groups.@*RESULTS@#All patients were followed up for 6 to 21 months with an average of 13 months. At the last follow-up, no mixed infection, tuberculosis recurrence, pedicle screw loosening and nail withdrawal were found. The average operative time, anterior surgery bleeding volume and anterior incision length of group A were less than that of group B(0.05). There was 1 case sinus formation in group A and 5 cases in group B, there was significant difference in sinus formation rate between two groups (0.05). Spinal cord nerve injury was obvious improved after operation, but there was no significant difference between two groups.@*CONCLUSIONS@#Preoperative percutaneous catheter drainage is a safe and feasible method for the treatment of lumbar tuberculosis with psoas abscess. It can increase the effect of anti tuberculosis before operation, reduce the surgical trauma and reduce the incidence of postoperative complications. It can be recommended in clinical application.

Isoliquiritigenin attenuates spinal tuberculosis through inhibiting immune response in a New Zealand white rabbit model

Spinal tuberculosis (ST) is the tuberculosis caused by Mycobacterium tuberculosis (Mtb) infections in spinal curds. Isoliquiritigenin 4,2′,4′-trihydroxychalcone, ISL) is an anti-inflammatory flavonoid derived from licorice (Glycyrrhiza uralensis), a Chinese traditional medicine. In this study, we evaluated the potential of ISL in treating ST in New Zealand white rabbit models. In the model, rabbits (n=40) were infected with Mtb strain H37Rv or not in their 6th lumbar vertebral bodies. Since the day of infection, rabbits were treated with 20 mg/kg and 100 mg/kg of ISL respectively. After 10 weeks of treatments, the adjacent vertebral bone tissues of rabbits were analyzed through Hematoxylin-Eosin staining. The relative expression of Monocyte chemoattractant protein-1 (MCP-1/CCL2), transcription factor κB (NF-κB) p65 in lymphocytes were verified through reverse transcription quantitative real-time PCR (RT-qPCR), western blotting and enzyme-linked immunosorbent assays (ELISA). The serum level of interleukin (IL)-2, IL-4, IL-10 and interferon γ (IFN-γ) were evaluated through ELISA. The effects of ISL on the phosphorylation of IκBα, IKKα/β and p65 in NF-κB signaling pathways were assessed through western blotting. In the results, ISL has been shown to effectively attenuate the granulation inside adjacent vertebral tissues. The relative level of MCP-1, p65 and IL-4 and IL-10 were retrieved. NF-κB signaling was inhibited, in which the phosphorylation of p65, IκBα and IKKα/β were suppressed whereas the level of IκBα were elevated. In conclusion, ISL might be an effective drug that inhibited the formation of granulomas through downregulating MCP-1, NF-κB, IL-4 and IL-10 in treating ST.

Case reports on integrated management of tubercular disease.

BACKGROUND: Host immunity plays an important role in prevention of disease as is evident by the increased incidence of Tuberculosis (TB) in immuno-compromised population of HIV infected, diabetes inflicted, immune-suppressant therapy and elderly people. Rising incidence of antibiotic resistance has led to resurgence of TB of epidemic proportions. Integrated treatment with add on homeopathy in addition to anti-tuberculosis treatment (ATT) appears to improve outcome in TB. The intervention has been integrated treatment with homeopathy regime, which is using a patient specific, disease specific and supportive medicine simultaneously, all individualized for the patient and the disease. CASES: CASE 1: Pott's spine with paravertebral abscess, not responding to ATT. Addition of homeopathy led to fall in temperature, improved appetite, increase in weight and reduction of abscess. CASE 2: Recurrent sub-acute intestinal obstruction. The patient could not tolerate ATT but responded to homeopathy by reduction of abdominal pain and distension, vomiting, loose stools and queasiness. CASE 3: Pulmonary TB, treated with both ATT and homeopathy from beginning, led to rapid recovery and shortened treatment time. CONCLUSION: The addition of homeopathy to ATT is patient friendly, cost effective and appears to reduces the duration of treatment. Its role as immuno-modulatory therapy should be evaluated and explored.

Immunotherapy for non-responders among patients of spinal tuberculosis.

BACKGROUND: Combined chemo- and immunotherapy are the major advancement in the treatment of tuberculosis. Immunotherapy supposedly increases cure rate while reducing the duration of treatment and tissue damage. Non-responders are those patients of tuberculosis who do not respond to anti-tubercular therapy (ATT) in the desired manner despite the mycobacteria showing sensitivity to the given drugs. The role of immunotherapy in the treatment of this particular subset of patients has been investigated scarcely. METHODS: The present study included a retrospective review of prospectively collected clinico-radiological data of 14 non-responder patients who were taking ATT for spinal tuberculosis for a mean duration of 10.3 months. An immunotherapeutic regime comprising of single intramuscular injection of vitamin D 600,000IU, 3 days course of oral albendazole 200mg daily, salmonella vaccine 0.5ml intramuscular and influenza vaccine 0.5ml intramuscular were added to ATT. The vaccines and the course of oral albendazole were repeated after a month. RESULTS: Before immunotherapy, seven patients were partially dependent while other seven were completely dependent on others for activities of daily living. All except one patient after treatment became independent till last follow-up (p value <0.01). Post immunotherapy, ATT was continued for mean duration of 4.9 months with mean follow-up of 22.4 months. All patients showed good clinical response within 2-6 weeks after the initiation of immunotherapy. CONCLUSIONS: The crux to success of the immunotherapy regime is its potential to restore the existing Th1 Th2 imbalance and to provide substitute to the anergic and dysfunctional immune cells.

Unusual spinal tuberculosis in an Avar Age skeleton (Csongrád-Felgyo, Ürmös-tanya, Hungary): A morphological and biomolecular study.

The paleopathological analysis of a well-preserved young adult female skeleton from the AD 7-8th century (Avar Age) in Hungary revealed multiple lytic lesions in all of the thoracic and lumbar vertebral bodies. The lesions were characterized by smooth marginal zones and space-occupying mass appearance. The considerable loss of spongy bone in the thoracolumbar vertebrae resulted in angular deformity and fusion, characteristic of the healing stage of TB. Osteolytic lesions were also observed on the vertebral processes, ribs and sternum. On the endocranial surface, abnormal blood vessel impressions were revealed, indicating some kind of meningitis. The X-ray and CT analysis of the affected bones detected abnormal structures and cystic zones of destruction. The lesions were however not always bordered by areas of increased density, which is typical in cystic TB. Vertebral remains were also subjected to biomolecular analysis in two different laboratories, which attested the presence of Mycobacterium tuberculosis complex (MTBC) DNA and supported the paleopathological diagnosis of TB. Spoligotyping analysis confirmed the presence of MTBC DNA and more specifically an infection caused by bacteria belonging to the M. tuberculosis lineage. This case study provides new data for the paleoepidemiology of TB in this geographical area and historical period, and draws attention to the great variability of TB lesions in the human skeleton.

7000 year-old tuberculosis cases from Hungary - Osteological and biomolecular evidence.

This study derives from the macroscopic analysis of a Late Neolithic population from Hungary. Remains were recovered from a tell settlement at Hódmezovásárhely-Gorzsa from graves within the settlement as well as pits, ditches, houses and as stray finds. One of the most important discoveries from these remains was evidence of tuberculosis. Pathological analysis of the seventy-one individuals revealed numerous cases of infections and non-specific stress indicators on juveniles and adults, metabolic diseases on juveniles, and evidence of trauma and mechanical changes on adults. Several cases showed potential signs of tuberculosis and further analyses were undertaken, including biomolecular studies. The five individuals were all very young adults and included a striking case of Hypertrophic Pulmonary Osteopathy (HPO) with rib changes, one case with resorptive lesions on the vertebrae, two cases with hypervascularisation on the vertebrae and periosteal remodelling on the ribs, and one case with abnormal blood vessel impressions and a possible lesion on the endocranial surface of the skull. The initial macroscopic diagnosis of these five cases was confirmed by lipid biomarker analyses, and three of them were corroborated by DNA analysis. At present, these 7000-year-old individuals are among the oldest palaeopathological and palaeomicrobiological cases of tuberculosis worldwide.

Diagnostic value of enzyme-linked immunospot assay using CFP10/ESAT6 fusion protein as antigen in spinal tuberculosis.

OBJECTIVE: To establish a method of detecting spinal tuberculosis (TB) infection by enzyme-linked immunospot (ELlSPOT) assay and evaluate the value of CFP10/ESAT6 fusion protein for diagnosis of spinal TB. METHODS: Suspected spinal TB patients were prospectively recruited in two hospitals (First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; Nanfang Hospital, Southern Medical University) from May 2012 to December 2013. Data on clinical characteristics of the patients and conventional laboratory results were collected. Compare and analyze the positive detection rate in spinal TB diagnosis by different methods including ELISPOT detection and conventional detection methods. RESULTS: 47 patients with spinal TB had available biopsy or surgical specimens for histopathological examination and 41 specimens had pathological features consistent with a diagnosis of TB infection. Among the spinal TB patients and non-TB disease patients,the overall sensitivity, specificity, positive predictive value, and negative predictive value of the ELISPOT assay in spinal TB diagnosis were 82.7%,87.2%,89.6%, and 79.1%,respectively; the 4 indexes of the PPD skin test were 61.5%, 46.2%, 60.4%, and 47.4%, respectively;those of the antibody detection were 55.8%, 61.5%, 65.9%, and 51.1%. The positive rate of ELISPOT was significantly higher than those of PPD skin test and antibody detection test (82.7% vs. 61.5%, Χ² =5.786, P=0.016; 82.7% vs. 55.8%, Χ² =8.847, P=0.003), but not significantly different from the positive rate of pathological examination (82.7% vs. 87.2%, Χ² =0.396, P=0.529). Moderate agreement was found between pathological examination and the ELISPOT assay (87.2%, Κ=0.498, P=0.001). CONCLUSION: With high sensitivity and specificity, the ELISPOT assay using CFP10/ESAT6 fusion protein as antigen is an effective technique for auxiliary diagnosis of spinal TB.

Diagnostic value of enzyme-linked immunospot assay using CFP10/ESAT6 fusion protein as antigen in spinal tuberculosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To establish a method of detecting spinal tuberculosis (TB) infection by enzyme-linked immunospot (ELlSPOT) assay and evaluate the value of CFP10/ESAT6 fusion protein for diagnosis of spinal TB.</p><p><b>METHODS</b>Suspected spinal TB patients were prospectively recruited in two hospitals (First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; Nanfang Hospital, Southern Medical University) from May 2012 to December 2013. Data on clinical characteristics of the patients and conventional laboratory results were collected. Compare and analyze the positive detection rate in spinal TB diagnosis by different methods including ELISPOT detection and conventional detection methods.</p><p><b>RESULTS</b>47 patients with spinal TB had available biopsy or surgical specimens for histopathological examination and 41 specimens had pathological features consistent with a diagnosis of TB infection. Among the spinal TB patients and non-TB disease patients,the overall sensitivity, specificity, positive predictive value, and negative predictive value of the ELISPOT assay in spinal TB diagnosis were 82.7%,87.2%,89.6%, and 79.1%,respectively; the 4 indexes of the PPD skin test were 61.5%, 46.2%, 60.4%, and 47.4%, respectively;those of the antibody detection were 55.8%, 61.5%, 65.9%, and 51.1%. The positive rate of ELISPOT was significantly higher than those of PPD skin test and antibody detection test (82.7% vs. 61.5%, Χ² =5.786, P=0.016; 82.7% vs. 55.8%, Χ² =8.847, P=0.003), but not significantly different from the positive rate of pathological examination (82.7% vs. 87.2%, Χ² =0.396, P=0.529). Moderate agreement was found between pathological examination and the ELISPOT assay (87.2%, Κ=0.498, P=0.001).</p><p><b>CONCLUSION</b>With high sensitivity and specificity, the ELISPOT assay using CFP10/ESAT6 fusion protein as antigen is an effective technique for auxiliary diagnosis of spinal TB.</p>

Novel alternative therapy for spinal tuberculosis during surgery: reconstructing with anti-tuberculosis bioactivity implants.

Accompanied with the worsening of the pulmonary tuberculosis bacterium (TB) epidemic, the incidence of spinal TB has increased in recent years. Spinal reconstruction and stabilisation, and bone defect repair play a crucial role in the surgical treatment of spinal TB. Unfortunately, the existing materials have not completely met the requirements for spinal TB reconstruction due to their diverse deficiencies. Therefore, there is an urgent need to develop novel reconstructing implants. Poly-DL-lactide (PDLLA) and nano-hydroxyapatite (nHA) are two promising drug delivery systems (DDS) and materials for bone repair, which could help us to overcome the difficulties in spinal TB reconstruction in the future. In this article, we discuss the properties of PDLLA and nHA, two potential drug delivering and bone repair materials for spinal TB reconstruction. We also presented two alternatives for spinal TB in future. Two strategies have the potential for treating spinal TB in the future. One such strategy consists of mixing anti-TB drugs, PDLLA with nHA to fabricate a novel three-dimensional (3D) porous scaffold via 3D printing (3DP) technology. Another is preparing a novel titanium mesh implant coated with drugs/PDLLA/nHA composites by solvent evaporation and low-temperature drying technology. These two hypotheses have recently been tested in a laboratory setting by our team.

Drug susceptibility testing guided treatment for drug-resistant spinal tuberculosis: a retrospective analysis of 19 patients.

Spinal tuberculosis is the most common manifestation of extrapulmonary tuberculosis. However, there have been few reports on the topic of drug-resistant spinal tuberculosis. The aim of this study was to investigate the efficacy and safety of treatment with a combination of surgery and individual chemotherapy guided by drug susceptibility testing for drug-resistant spinal tuberculosis. We retrospectively analyzed 19 patients with drug-resistant spinal tuberculosis. After surgery, individual chemotherapy was tailored for each patient according to his or her drug resistance profile and previous history of chemotherapy. The patients were followed up clinically and radiologically for an average period of 36 months. Among 19 drug-resistant spinal tuberculosis cases, 16 were multidrug-resistant tuberculosis (MDR-TB), and 3 were non-MDR-TB. The patients with MDR-TB and non-MDR-TB had undergone previous chemotherapy for an average of 12.50 ± 2.00 months (0-55 months) and 5.50 ± 1.20 months (0-60 months), respectively. A total of 16 patients underwent open operations, and the other 3 had percutaneous drainage and local chemotherapy. Patients received individual chemotherapy for an average of 24 months postoperatively. All patients had been cured at the final follow-up. Drug-resistant spinal tuberculosis is mainly acquired through previous irregular chemotherapy and the spread of drug-resistant strains. Treatment with a combination of surgery and individual chemotherapy is feasible in the treatment of severe complications and the prevention of acquired drug resistance.

Drug resistance patterns in 111 cases of drug-resistant tuberculosis spine.

PURPOSE: We report the largest study conducted till date of drug resistant tuberculosis in spine analyzing the drug susceptibility patterns in 111 cases of proven drug resistance. METHODS: An observed cross-sectional study was conducted. Six-hundred and eighty-six patients with positive cultures underwent sensitivity testing to 13 commonly used anti-tubercular drugs using BACTEC MGIT-960 system. RESULTS: Females (60.3%) outnumbered males (39.6%). Only three patients (2.7%) were found HIV positive, and none of these had AIDS. Forty-four (39.6%) patients had taken AKT in the past for some form of tuberculosis. Eight (7.2%) patients had history of treatment default. The drug sensitivity testing revealed 87 (78.3%) cases of multi drug resistance (resistance to both isoniazid and rifampicin) and 3 (2.7%) cases of XDR-TB spine. Of the individual drugs, widespread resistance was present to both isoniazid (92.7%) and rifampicin (81.9%), followed by streptomycin (69.3%). Least resistance was found to kanamycin, amikacin and capreomycin. CONCLUSION: It is recommended to do routine biopsy, culture and drug sensitivity testing in all patients of tuberculosis spine to guide selection of appropriate second-line drugs when required. In cases of non availability of drug susceptibility testing despite repeated attempts, it is suggested to use data from large series such as this to plan best empirical chemotherapy protocol.

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.

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 Gyor, 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.

Multidrug-resistant tuberculosis of the spine in children--characteristics from a high burden setting.

BACKGROUND: Few studies have described children with spinal multidrug-resistant tuberculosis (MDR-TB). Treatment involves surgery and medical care with long courses of drug therapy. METHODS: Hospital and laboratory records at Brooklyn Chest and Tygerberg Children's Hospitals, Cape Town, South Africa, were analysed (January 2004 until December 2010) searching for children treated for MDR spinal TB. RESULTS: Of the 11 children identified, 4 were excluded. Of the 7 remaining, 5 were boys; median age: 8 years, median delay to treatment initiation: 36 weeks. Among them one child died, five have completed treatment and one is near the end of therapy. Medications were well-tolerated and although two of the surviving children have spinal deformity, none have significant neurological deficit. CONCLUSIONS: The diagnosis of spinal MDR-TB is often delayed in children, frequently leading to advanced disease and severe vertebral damage. Children tolerate therapy well and, once identified, it is a condition that can be treated successfully.

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.