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.

Interferon-gamma release assay for detection of latent tuberculosis infection in casual and close contacts of tuberculosis cases.

The tuberculin skin test (TST) has many limitations for the diagnosis of latent tuberculosis (TB infection. The aim of this study in Egypt was to estimate the usefulness of an interferon-gamma release assay (IFN-gamma) assay for the detection of latent TB infection in contacts of active TB cases. A total of 116 participants were enrolled and divided into 3 groups: community controls, casual (laboratory and clinic) contacts and close (household) contacts. Subjects diagnosed with latent TB infection by TST were 11.5% of controls, 71.1% of casual contacts and 29.6% of close contacts. Subjects diagnosed as latent TB infection by IFN-gamma assay (QuantiFERON-TB Gold In-Tube) were 5.9% of controls, 31.0% of casual contacts and 33.3% of close contacts. The overall agreement between TST and IFN-gamma was 66.7% (kappa = 0.28). The IFN-gamma method could be more helpful than TST for detection of latent TB infection in contacts.

Interferon-gamma release assay for detection of latent tuberculosis infection in casual and close contacts of tuberculosis cases

The tuberculin skin test [TST] has many limitations for the diagnosis of latent tuberculosis [TB] infection. The aim of this study in Egypt was to estimate the usefulness of an interferon-gamma release assay [IFN-gamma] assay for the detection of latent TB infection in contacts of active TB cases. A total of 116 participants were enrolled and divided into 3 groups: community controls, casual [laboratory and clinic] contacts and close [household] contacts. Subjects diagnosed with latent TB infection by TST were 11.5% of controls, 71.1% of casual contacts and 29.6% of close contacts. Subjects diagnosed as latent TB infection by IFN-gamma assay [QuantiFERON-TB Gold In-Tube] were 5.9% of controls, 31.0% of casual contacts and 33.3% of close contacts. The overall agreement between TST and IFN-gamma was 66.7% [K= 0.28]. The IFN-gamma method could be more helpful than TST for detection of latent TB infection in contacts

An improved synthesis of 4-azido-4-deoxy- and 4-amino-4-deoxy-alpha,alpha-trehalose and their epimers.

The order of esterification of the eight hydroxyl groups of alpha,alpha-trehalose is HO-6.6' > HO-2.2' > HO-3.3' > HO-4.4'. Under the appropriate conditions of benzoylation, the heptabenzoate with HO-4' free was obtained in good yield (58%), along with the octabenzoate and the hexabenzoate having HO-4.4' free. The readily isolated heptabenzoate was a convenient starting material for the synthesis of 4-azido-4-deoxy- (84%) and 4-amino-4-deoxy-alpha-D-galactopyranosyl alpha-D-glucopyranoside, and the heptabenzoate of alpha-D-galactopyranosyl alpha-D-glucopyranoside with HO-4' free, which was used as a synthetic precursor of 4-azido-4-deoxy-alpha-D-glucopyranosyl alpha-D-glucopyranoside and its amino analogue.