The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study.

We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.

Hepatitis A seroprevalence in children and young adults in Istanbul, Turkey: seroprevalence change and associated factors.

Hepatitis A is a widespread infectious disease. The prevalence of the disease is closely related to socioeconomic status (SES) and environmental factors. Understanding its prevalence is essential for instituting appropriate precautions. The aim of this study was to determine the prevalence of hepatitis A and evaluate the associated demographic features in children and young adults in Istanbul. In total, 630 individuals between the ages of 5-24 were included in the study. They were classified into four age groups (5-9, 10-14, 15-19 and 20-24 years). The seropositivity of hepatitis A in the whole study population was 40%. Age-specific prevalence was 11.4% in children 5-9 years old, 29% in those 10-14 years old, 49.7% in those 15-19 years old and 69% in those 20-25 years old. Seropositivity was associated with increasing age, low SES, large family size, low maternal educational level, use of unsafe drinking water and living in regions with poor infrastructure and incomplete urbanization. When we compared our results with previous seroprevalence studies performed in Istanbul, we found an epidemiological shift towards increasing age. Factors associated with changes in prevalence were urbanization and associated infrastructure improvement, knowledge of the disease by the population, use of good hygiene and use of vaccination in those at high risk.