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.

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.

Spinal tuberculosis in non-HIV-infected patients: 10 year experience of a medical center in central Taiwan.

BACKGROUND/PURPOSE: Tuberculosis (TB) is an endemic disease in Taiwan and it usually affects the lung. Spinal TB accounts for 1-3% of all TB infections. The purpose of this study was to investigate the clinical manifestations, management, outcomes and drug susceptibility of Mycobacterium tuberculosis in non-HIV-infected patients with spinal TB. METHODS: From January 1998 to December 2007, we retrospectively reviewed the medical charts of adult patients with a diagnosis of spinal TB. Only those with positive culture results and/or characteristic pathologic findings were enrolled. Demographic data, clinical manifestations and susceptibility to anti-TB drugs were reviewed and analyzed. RESULTS: During the study period, 38 patients (23 men, 15 women) with spinal TB were identified and the mean age was 68 years. The median duration of symptoms was 60 days (range, 3-720 days). Amongst the 38 patients, back pain (100%) was the most common clinical symptom, followed by weakness (53%) and numbness (26%). The lumbar spine (15 patients, 39%) was the most commonly involved site, followed by the thoracic spine (14 patients, 37%). Concomitant pulmonary TB was found in 12 patients (32%). Three patients (8%) had concurrent bacterial or fungal infections. Almost all of the patients (35 patients, 92%) were successfully treated with surgery and anti-TB medications. The erythrocyte sedimentation rate was followed up in 16 patients before and after therapy and a significant decline was observed after treatment (p = 0.004). No mortality was related to spinal TB. CONCLUSION: Insidious clinical course and ambiguous manifestations of spinal TB often delay and hinder the accuracy of diagnosis of spinal TB. In addition to pyogenic osteomyelitis, spinal TB should be included in the differential diagnosis especially in elderly patients with chronic back pain accompanied by elevated erythrocyte sedimentation rate, and those living in the TB endemic area.

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.