Pott's disease in Abidjan: experience of the department of rheumatology of university teaching hospital of Cocody: about 420 cases.

INTRODUCTION: Pott's disease continues to be rife primarily in ivorian's setting. This large-scale study presents the Ivorian experience in the management of this disease. AIM: To determine the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of Pott's disease in Abidjan and to identify the factors associated with neurological compressions. METHODS: Retrospective and analytical study of 420 files of patients suffering from presumptive or confirmed Pott's disease, hospitalized in the rheumatology department of Cocody University Hospital from January 2010 to December 2019. RESULTS: The hospital frequency of tuberculous spondylodiscitis was 10.2%. Our study population consisted of 223 men and 197 women with an average age of 43.8 ± 15.5 years. A tuberculosis history and a notion of tuberculosis contagion were noted in 4.3% and 13.8% of cases respectively. The mean diagnostic time was 9.67 ± 10.11 months. The main clinical data were spinal syndrome (98.80%) and also tuberculous impregnation signs (84.76%). Neurological complications were noted in 11.66% of cases. Bacilloscopy and PCR BK were positive in 33.71% and 57.14% of cases respectively. Computed tomography was the most requested and performed diagnostic imaging (92.86%). The associated tuberculous targets (11.2%) were visceral (78.70%), in particular pulmonary (75.67%). The mean duration of anti-tuberculosis treatment was 12.42 months with a cure of 97.14% of patients. Diagnostic delay (P = 0.01), gibbosity (P = 0.009), and presence of soft tissue abscesses (P = 0.004) were significantly associated with neurological compressions. CONCLUSION: Pott's disease is common in Abidjan and affects young adults. It manifests as a spinal syndrome with tuberculous impregnation signs. Computed tomography was the most performed diagnostic imaging. The factors associated with neurological compressions are: diagnostic delay, gibbosity and soft tissue abscesses.

Trends and prospects in spinal tuberculosis research: a future-oriented approach.

PURPOSE: Tuberculosis is one of the oldest diseases in human history, and spinal tuberculosis (STB) is the most common form of extrapulmonary tuberculosis. A large number of research has been conducted in this field. However, there has been no bibliometric analysis performed in recent years in STB. The aim of this study was to analyze trends and hotspots in research on STB. METHODS: Publications regarding STB between 1980 and 2022 were extracted from the Web of Science database. CiteSpace (V5.7.R2) and VOSviewer (1.6.10) were used to perform global analyses of the number of publications, countries, institutions, authors, journals, keywords, and cited references. RESULTS: A total of 1262 articles were published between 1980 and 2022. We observed rapid growth in the number of publications since 2010. Spine had the highest number of publications (47, 3.7%). Zhang HQ and Wang XY were key researchers. The Central South University published the most papers (90, 7.1%). China was the leading contributor in this field with 459 publications and 29 H-index. National partnerships are dominated by the USA, and there is a lack of active cooperation between other countries and authors. CONCLUSION: research on STB has achieved great progress, with an increasing number of publications since 2010. Surgical treatment and debridement are current research hots pots, and diagnosis, drug resistance, and kyphosis are likely research frontiers. Cooperation between countries and authors needs to be further strengthened.

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.

A Comparative Study of Diagnosis and Treatment of Pott's Spine Amongst Specialists and Super Specialists in India.

Background and Objective: There is a paucity of guidelines about the diagnosis and management of Pott's spine. In this study, we report the pattern of practice of diagnosis and treatment of Pott's spine among the specialists and super-specialists in India. Subject and Methods: Response to a 22-item questionnaire regarding the diagnosis and treatment of Pott's spine has been reported. The responses were compared between medical and surgical specialists, residents and consultants, and specialists and super-specialists. There were 84 responders: 42 physicians and 42 surgeons; 48 residents and 36 faculty or consultants; 53 specialists and 31 super-specialists. Results: Thirty-eight responders rarely recommended biopsy whereas others recommended biopsy more frequently, especially the surgeons (P < 0.007). Twenty-five responders recommended immobilization even in an asymptomatic patient whereas 38 would immobilize those with neurological involvement only. All but 4 responders would repeat imaging at different time points. The response of medical treatment was judged at 1 month by 53, and 3 months by 26 responders. Surgery was recommended in a minority of patients-in those with neurological involvement or abscess. Surgeons more frequently biopsied, immobilized the patients, and recommended surgery compared to the physicians. The residents also recommended biopsy and recommended immobilization more frequently compared to consultants or faculty members. Super-specialists more frequently recommended biopsy compared to specialists. Conclusion: There is marked variation in investigations and treatment of Pott's spine patients, suggesting the need for consensus or evidence-based guidelines.

Loss to long-term follow-up in children with spinal tuberculosis: a retrospective cohort study at a tertiary hospital in the Western Cape, South Africa.

Introduction: children with spinal tuberculosis (TB) are at risk of kyphotic deformity both during and after the active phase of the disease. Management guidelines include follow-up until skeletal maturity. Little is known about adherence to this recommendation. This study aimed to investigate loss to long-term spine clinic follow-up (LTFU) among children with spinal TB at a tertiary hospital in the Western Cape Province, South Africa. Methods: this retrospective cohort study included all children diagnosed with spinal TB at Tygerberg Hospital between January 2012 and December 2015. Spine clinic follow-up was investigated for five years following diagnosis. Relevant surgical interventions and re-presentation were evaluated until 31st December 2020. Results: thirty-two children, median age 6 years (range 1-14 years), were diagnosed with spinal TB and intended for spine clinic follow-up. Twenty-seven (84%) children were LTFU within five years of diagnosis with 16 (50%) LTFU within 10.5 months. Among children in follow-up, one child had further surgery for progression of deformity two years from diagnosis and one child had further surgery for new-onset neurological deficit eight years from diagnosis. Conclusion: most children with spinal TB did not receive the recommended follow-up until skeletal maturity. Without further data on these children, the clinical significance of this LTFU could not be evaluated. Further studies are needed to investigate sequelae during skeletal maturation in the context of current management for paediatric spinal TB.

Diagnostic yield of image-guided biopsy in patients with suspected infectious spondylodiscitis : a prospective study from a tuberculosis-endemic country.

AIMS: The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. METHODS: A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis. RESULTS: The final diagnosis was tuberculous spondylodiscitis in 250 patients (88%) and pyogenic spondylodiscitis in 22 (7.8%). Six (2.1%) had a noninfectious condition-mimicking infectious spondylodiscitis, and six (2.1%) had no definite diagnosis and improved without specific treatment. The diagnosis was made by image-guided biopsy in 152 patients (56%) with infectious spondylodiscitis. Biopsy was contributory in identifying 132/250 patients (53%) with tuberculous spondylodiscitis, and 20/22 patients (91%) with pyogenic spondylodiscitis. Histological examination was the most sensitive diagnostic modality, followed by Xpert MTB/RIF assay. CONCLUSION: Image-guided biopsy has a reasonably high diagnostic yield in patients with suspected infectious spondylodiscitis. A combination of histological examination, Xpert MTB/RIF assay, bacterial culture, and sensitivity provides high diagnostic accuracy in a country in which TB is endemic. Cite this article: Bone Joint J 2022;104-B(1):120-126.

Analysis of Clinical Characteristics of 556 Spinal Tuberculosis Patients in Two Tertiary Teaching Hospitals in Guangxi Province.

Spinal tuberculosis (STB), which accounts for half of musculoskeletal tuberculosis, is among the leading causes of extrapulmonary tuberculosis. Guangxi Province, located in southern China, is among the most severely affected provinces in China. In this study, we collected and analyzed data from 2 Class-A tertiary teaching hospitals in Nanning City, Guangxi Province, from 2011 to 2019, with the aim of providing reference points for the prevention, diagnosis, treatment, and prognosis analysis of STB, using the epidemiological characteristics of 556 STB cases. Our results revealed that males had a slightly higher incidence (50.17%) compared to females (49.83%), with 64.93% of cases falling between the ages of 18 and 45 years. Cases from rural communities accounted for 63.49% of the reviewed cases. The average time between onset of symptoms and hospitalization was 18.0 months (range: 1 day-220 months). The most commonly reported symptoms were lower back pain (78.60%), radicular pain (51.98%), and systemic toxemia (43.53%). Additionally, 53.98% of the reviewed cases had varying degrees of neurological impairment. The main pathological lesion locations were the lumbar spine (43.53%) and thoracic spine (32.55%). Among them, 72.66% of cases involved at least 2 vertebral segments, and 62.77% of cases presented with paravertebral abscesses. Among the cases reviewed, 90.65% underwent antituberculosis chemotherapy prior to surgery. Following treatment, the cure rate was 78.41%, while 3.78% of patients had postoperative relapse. There were cases of concomitant illnesses among the cases reviewed, 40.65% of patients also had pulmonary tuberculosis, 15.29% had hepatitis B, 13.30% had diabetes, and 7.91% had hypertension. Our results still demonstrate that spinal tuberculosis remains a serious public health problem in Guangxi Province. Thus, preventive measures should be directed towards rural residents with comorbidities such as the elderly and diabetic.

Cervical spine TB - Current concepts in management.

OBJECTIVE: Cervical tubercular disease (CTB) is a rare pathology and constitutes 3-5% of all spinal TB. It includes atlantoaxial TB and sub-axial TB. As the literature evidence on this subject is scarce, majority of issues concerning CTB are still controversial. The current narrative review comprehensively discusses the various aspects related to CTB. Literature search: An elaborate search was made using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis, on pubmed and google (scholar.google.com) databases on 2 December 2020. We identified crucial questions regarding CTB and included relevant articles pertaining to them. RESULTS: The initial search using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis yielded 4128, 76, 3 and 9 articles on 'pubmed' database, respectively. A similar search using the aforementioned keywords yielded 1,96,000, 2130, 117 and 728 articles on 'google scholar' database. The initial screening resulted in the identification of 178 articles. Full manuscripts were obtained for these articles and thoroughly scrutinised at the second stage. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 41 articles were included. CONCLUSION: AATB and SACTB constitute 0.3 to 1% and 3% of spinal TB, respectively. The incidence of neuro-deficit in CTB is significantly more than other spinal TB. The general principles of management of CTB are similar to spinal TB elsewhere and medical therapy remains the cornerstone. Surgery is advocated in specific scenarios involving gross neuro-deficit, later stages of disease with significant bony/ligamentous disruptions, altered sagittal balance, drug resistance, and poor response to medications. The surgical approaches for AATB include anterior-alone, posterior-alone and combined approaches, although posterior access is the most preferred. Most of the studies on SACTB have supported the role of anterior approach. Additionally, posterior stabilisation may be necessary in specific scenarios. The overall long-term outcome in CTB is favourable.

Postoperative clinicoradiological outcome of pott's spine.

Introduction: Tuberculosis (TB) is one of the main diseases impacting humanity. Fifty percent of all the cases of skeletal TB belong to spinal TB (STB), and it is also the most common form of TB. In India, patients usually present late after the onset of neurological symptoms, for which surgical management is essential for recovery. In our study, we have evaluated the outcome of forty patients of STB who underwent posterior decompression and instrumentation. Methods: Forty patients with STB who underwent posterior decompression and instrumentation were reviewed. All cases were followed up for 18 months. The groups were compared by parameters such as improvement in pain, improvement in kyphosis, and neurological recovery. Visual Analog Scale (VAS) score and american spinal cord injury assosciation (ASIA) score are used for the assessment. Results: VAS score was significantly decreased postoperatively (mean: 1.28) as compared to preoperative values (mean: 7.25). Erythrocyte sedimentation rate (ESR) was significantly decreased postoperatively (mean: 30.95) as compared to preoperative values (76.15). Cobb's angle was significantly decreased immediate postoperatively (mean: 7.8) as compared to preoperative values (mean: 24.8). There was no deterioration of neurological symptoms in any of the patients. Conclusion: Surgical intervention in Pott's spine with posterior decompression and stabilization, whenever indicated, gives good improvement in pain, decreases kyphotic deformity, and in most cases, also improves neurology.

RésuméIntroduction: La tuberculose (TB) est l'une des principales maladies affectant l'humanité. Cinquante pour cent de tous les cas de tuberculose squelettique appartiennent à la colonne vertébrale TB (STB), et c'est aussi la forme la plus courante de TB. En Inde, les patients se présentent généralement tardivement après l'apparition des symptômes neurologiques, pour lesquels la prise en charge chirurgicale est essentielle à la guérison. Dans notre étude, nous avons évalué les résultats de quarante patients de STB qui ont subi une décompression et instrumentation. Méthodes: Quarante patients atteints de STB qui ont subi une décompression postérieure et une instrumentation ont été revu. Tous les cas ont été suivis pendant 18 mois. Les groupes ont été comparés par des paramètres tels que l'amélioration de la douleur, l'amélioration de la la cyphose et la récupération neurologique. Le score de l'échelle visuelle analogique (EVA) et le score de l'association américaine des lésions de la moelle épinière (ASIA) sont utilisés pour l'évaluation. Résultats: Le score EVA était significativement diminué en postopératoire (moyenne : 1,28) par rapport aux valeurs préopératoires (moyenne : 7,25). La vitesse de sédimentation des érythrocytes (VS) était significativement diminuée en postopératoire (moyenne : 30,95) par rapport aux valeurs préopératoires (76,15). L'angle de Cobb était significativement diminué en postopératoire immédiat (moyenne : 7,8) par rapport aux valeurs préopératoires (moyenne : 24,8). Il n'y avait pas détérioration des symptômes neurologiques chez l'un des patients. Conclusion: Intervention chirurgicale dans le rachis de Pott avec décompression postérieure et la stabilisation, chaque fois qu'elle est indiquée, améliore la douleur, diminue la déformation cyphotique et, dans la plupart des cas, améliore également la neurologie.

Development and validation of a novel predictive model and web calculator for evaluating transfusion risk after spinal fusion for spinal tuberculosis: a retrospective cohort study.

OBJECTIVES: The incidence and adverse events of postoperative blood transfusion in spinal tuberculosis (TB) have attracted increasing attention. Our purpose was to develop a prediction model to evaluate blood transfusion risk after spinal fusion (SF) for spinal TB. METHODS: Nomogram and machine learning algorithms, support vector machine (SVM), decision tree (DT), multilayer perceptron (MLP), Naive Bayesian (NB), k-nearest neighbors (K-NN) and random forest (RF), were constructed to identified predictors of blood transfusion from all spinal TB cases treated by SF in our department between May 2010 and April 2020. The prediction performance of the models was evaluated by 10-fold cross-validation. We calculated the average AUC and the maximum AUC, then demonstrated the ROC curve with maximum AUC. RESULTS: The collected cohort ultimately was consisted of 152 patients, where 56 required allogeneic blood transfusions. The predictors were surgical duration, preoperative Hb, preoperative ABL, preoperative MCHC, number of fused vertebrae, IBL, and anticoagulant history. We obtained the average AUC of nomogram (0.75), SVM (0.62), k-NM (0.65), DT (0.56), NB (0.74), MLP (0.56) and RF (0.72). An interactive web calculator based on this model has been provided ( https://drwenleli.shinyapps.io/STTapp/ ). CONCLUSIONS: We confirmed seven independent risk factors affecting blood transfusion and diagramed them with the nomogram and web calculator.

Efficacy and safety of short-term chemotherapy for patients with spinal tuberculosis undergoing surgery in Chinese population: a meta-analysis.

OBJECTIVE: The aim of this meta-analysis was to systematically evaluate the clinical efficacy and safety of short-course chemotherapy (≤ 6 months) compared with the standard therapy (9-18 months) for patients with spinal tuberculosis (TB) undergoing surgery in Chinese population. METHODS: In this meta-analysis, we searched electronic databases in the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang data to determine the equivalence of short-course therapy (group A) and standard therapy (group B) for the drug therapy of TB in Chinese population up to December 24, 2019. Weighted mean difference (WMD), odds risk (OR), and their 95% confidence interval (CI) were calculated. All analyses of relevant outcome indicators were managed by using the Review Manager (RevMan) 5.2 software. RESULTS: This meta-analysis included six trials published involving 851 patients (group A, 397; group B, 454) with spinal TB. Results showed there were no significant differences between group A and group B in clinical cure rate (OR = 0.61; 95% CI 0.19-2.00, p > 0.05), change of erythrocyte sedimentation rate (ESR) (WMD = - 0.75; 95% CI - 3.33 to 1.83; p > 0.05) and bone graft fusion rate (OR = 2.32; 95% CI 0.36-14.81, p > 0.05). Meanwhile, there were fewer side effects (OR = 0.37; 95% CI 0.24-0.58, p < 0.05) in group A compared with group B. CONCLUSIONS: The results of this meta-analysis showed that for patients with spinal TB undergoing surgery in Chinese population, short-course chemotherapy could be equivalent to the standard chemotherapy in terms of efficacy and have less side effects than the latter.

Consumption of spine by tuberculosis in the era of directly observed treatment, short-course and genomic diagnosis.

BACKGROUND: Extra Pulmonary Tuberculosis (EPTB) is a significant health problem in both developing and developed countries. Spinal tuberculosis (STB) is one of the significant forms of EPTB lacking epidemiological data. The present study was conducted to study the clinical, radiological, microbiological and histopathological features, treatment and outcome of Spinal tuberculosis. METHODS: This study was conducted for a duration of 19 years, from 2000 to 2018 at the department of Neuromicrobiology, NIMHANS, Bengaluru. It comprised of 252 patients with STB. All patients were diagnosed with the clinical features and confirmed by radiological, microbiological and histopathological findings. RESULTS: Results were tabulated and statistically studied. The most common age group is 30-40 years with male preponderance. Most patients presented with motor paraplegia/para paresis (99.6%). Thoracic spine was the most common vertebra affected (47.62%). The commonest imaging feature is soft tissue collection (81.74%). Most common histopathological feature was necrotising granulomatous inflammation (65.87%). Microbiology reports showed growth of Mycobacterium tuberculosis (MTB) in 29.76%, Ziehl Neelsen (ZN) smear showed acid fast bacilli (AFB) in 25.79%. Anti tubercular drugs and surgery were advised in 55.55% patients and only anti TB drugs for 39.28%. The entire course of anti tubercular treatment (ATT) was completed in 60.71% and 4.76% were defaulters. CONCLUSION: Spinal tuberculosis is a global disease, timely diagnosis with clinical, imaging, microbiological, histopathological features and complete course of anti-tubercular treatment along with symptomatic treatment appears to be safe and effective.

Proximal junctional kyphosis post tuberculous spine corrective surgery in paediatric patients.

STUDY DESIGN: Retrospective case series. Proximal junctional kyphosis (PJK) is a well-recognised post-operative complication of deformity correction surgery. Our local tuberculosis (TB) endemic is responsible for severe kyphotic deformities. The most challenging is in the paediatric environment where powerful instrumentation is used in immature spines with more flexible disco-ligamentous structures than adults. OBJECTIVE: To establish the incidence of PJK and management thereof in our paediatric TB spine patients undergoing corrective surgery. METHODS: Twenty-seven consecutive paediatric patients undergoing fusion surgery for TB spine with 2-year follow-up were identified from our prospectively maintained database. Age at surgery was 8.0 years (2.5-17 ± 3.98) with 14 under the age of 7. Only anterior surgery was performed in 1, posterior only in 13 and combined in 13 with a total of 5 (1-11) levels fused. RESULTS: Nine (33.3%) patients developed PJK (progression by > = 10°) with an average progression of 16.2°(11-26 ± 5.42) compared the overall cohorts change of 5.1°(- 26-15 ± 9.24). Although not reaching statistical significance, there was a trend to higher incidence of PJK when instrumented, 8/20 (40%) compared to 1/7 (14.3%), more so in posterior only surgery compared to combined, 6/13 (46.2%) compared to 3/13 (23.1%) and when the UIV was at T7 or above, 7/17 (41.2%) compared to 2/10 (20%). There was a higher PJK rate when the number of levels fused was > = 6, 7/12 (58.3%) compared to 2/10 (p = 0.014), when the kyphotic correction was more than 39º, 5/8 (62.5%) compared to 4/19 (21.1%) (p = 0.07) and when < = 7 years old, 7/14 (50%) compared to 2/13 (15.4%) (p = 0.05). Two of the nine PJK cases required revision for junctional failure. CONCLUSION: In paediatric TB kyphosis correction, there was a 33% incidence of PJK with 2/9 requiring revision surgery for proximal failure. Our data suggest that this incidence of PJK was related to the magnitude of correction, the number of levels fused with a trend of increase in higher UIVs, posterior approach and instrumentation.This suggests that in young children, one should be cautious of overzealous kyphosis correction due to the risk of catastrophic proximal junctional failure.

The prevalence, diagnosis and surgical risk factors of spinal tuberculosis in children.

OBJECTIVE: To date, the burden of childhood spinal TB in China has not been estimated, and current treatment is hindered by a lack of evidence. This study aimed to review our experience of childhood spinal TB. METHODS: We reviewed the medical records of paediatric patients (≤15 years) admitted for spinal TB (confirmed or possible) at Shandong Provincial Chest Hospital from January 2006 to December 2019. Demographic, clinical, laboratory and radiological data were collected from medical records and analysed retrospectively. RESULTS: Seventy-two patients were diagnosed with spinal TB. 45 were male (62.5%), and 27 female (37.5%), with a mean age of 8.42 ± 4.47 (SD) years. During this 14-year period, the overall prevalence of spinal TB among childhood TB was 4.5%. T-SPOT.TB, AFB smear, mycobacterial culture, TB RT-PCR and biopsies were positive in 29.6%, 14.3%, 23.3%, 43.8% and 88.5% of assayed patients, respectively. The overall surgical rate of the studied patients was 40.3%. The requirement of surgery in childhood spinal TB was associated with pulmonary TB (OR = 4.000, 95% CI: 1.197, 13.367). CONCLUSION: Spinal TB in children cannot be neglected. It remains a severe problem to public health, and more attention should be paid to initiating treatment early.

OBJECTIF: A ce jour, la charge de la tuberculose (TB) vertébrale infantile en Chine n'a pas été estimée et le traitement actuel est entravé par un manque de données. Cette étude visait à passer en revue notre expérience de la TB vertébrale infantile. MÉTHODES: Nous avons examiné les dossiers médicaux des patients pédiatriques (≤15 ans) admis pour une TB vertébrale (confirmés ou possibles) au Shandong Provincial Chest Hospital de janvier 2006 à décembre 2019. Les données démographiques, cliniques, de laboratoire et radiologiques ont été recueillies à partir des dossiers médicaux et analysées rétrospectivement. RÉSULTATS: Soixante-douze patients ont reçu un diagnostic de TB vertébrale. 45 étaient de sexe masculin (62,5%) et 27 de sexe féminin (37,5%), avec un âge moyen de 8,42 ± 4,47 (DS) ans. Au cours de cette période de 14 ans, la prévalence globale de la TB vertébrale dans la TB infantile était de 4,5%. T-SPOT.TB, frottis de BAR, culture mycobactérienne, RT-PCR, TB et biopsies étaient positifs chez 29,6%, 14,3%, 23,3%, 43,8% et 88,5% des patients testés, respectivement. Le taux chirurgical global chez les patients étudiés était de 40,3%. La nécessité d'une intervention chirurgicale dans la TB vertébrale infantile était associée à la TB pulmonaire (OR: 4,000, IC95%: 1,197 - 13,367). CONCLUSION: La TB vertébrale chez l'enfant ne peut pas être négligée. Elle demeure un grave problème de santé publique et il faudrait accorder plus d'attention à l'initiation précoce du traitement.

Profile of osteoarticular tuberculosis in children.

OBJECTIVE: To determine clinical profile of osteoarticular tuberculosis (TB) in children. METHODS: Cross-sectional analysis from 2007 to 2013. All patients diagnosed with bone TB, spinal TB or TB abscesses were included. RESULTS: Out of 1318 children with TB, 39 (2.96%) had osteoarticular TB, of which 16 (42%) had osteomyelitis, 8 (20.5%) had spinal involvement, 7 (17.9%) had TB synovitis, 2 (5.1%) had psoas abscess and 6 (15.4%) had abscesses. The mean age of presentation was 7.1 ± 3.5 years (range 2-14 years). Of the 33 cases in which a culture was done, 25 (64%) showed a positive culture. Drug sensitivity tests were done in 21 patients of which 10 (47.6%) tested were drug resistant, of which 4 (36.4%) were multidrug resistant (MDR), 2 (18.2%) were extensively drug resistant (XDR), 3 were pre-XDR (27.3%) and 1 was polyresistant (9.1%). Nine (23.1%) patients had TB in the past with a treatment duration of 8.3 ± 5.3 months. Contact with a TB patient had occurred in 10 (25.6%) cases. Associated pulmonary TB were seen in 6 (15.39%) and TB meningitis were seen in 1 (2.6%) patients. Surgical intervention was needed in 11 (28.2%) patients of which 5 (45.5%) underwent curettage, drainage was done in 1 (9.1%), arthrotomy in 4 (36.4%) and spinal surgery in 1 (9.1%) patient. CONCLUSION: Drug resistant osteoarticular TB is an emerging problem in children.

Characteristics and Management of Spinal Tuberculosis in Tuberculosis Endemic Area of Guizhou Province: A Retrospective Study of 597 Patients in a Teaching Hospital.

BACKGROUND: Tuberculosis (TB) is an endemic disease in Guizhou. Spinal TB accounts for approximately 50% cases of skeletal TB. The purpose of this study was to investigate the characteristics and management of patients treated for spinal TB in a certain hospital and to provide guidance for the prevention and treatment of spinal TB. METHODS: The clinic records of all patients diagnosed with spinal tuberculosis in a teaching hospital between January 2010 and December 2018 were collected. The epidemiology, clinical characteristics, imaging and laboratory findings, treatment methods, and prognosis were recorded and analyzed. RESULTS: During this nine-year period, 597 patients with spinal TB were identified. There were 313 males and 284 females with an average age of 43 years. The largest number of patients fell in the age group of 21-30 years; mean time from symptom onset to diagnosis in the hospital was 17 months. Back pain was the main clinical manifestation (89.34%). The most common imaging technique was computed tomography (CT, 96.80%), followed by magnetic resonance imaging (MRI, 84.01%). Majority of the lesions involved the lumbar spine (47.30%), followed by the thoracic spine (40.95%). 178 (29.82%) patients in this study had varying degrees of neurological impairment. 22.78% of the patients selected conservative treatment, and surgical treatment was performed in 483 patients (80.90%). CONCLUSIONS: The incidence of spinal TB was generally on the rise throughout the study period. After diagnosed with spinal TB, all patients got appropriate treatment and achieved good efficacy, but most of the patients did not pay much attention to the disease and receive timely treatment. Thus, it is essential to strengthen the TB preventive strategies, improve the health awareness of residents and universal resident health examination.

Changes in the medical burden of pyogenic and tuberculous spondylitis between 2007 and 2016: A nationwide cohort study.

BACKGROUND: This nationwide study aimed to compare the medical burdens of pyogenic spondylitis (PS) and tuberculous spondylitis (TS) between 2007 and 2016 in Korea. METHODS: We used a national database managed by the National Health Insurance Service (NHIS) with data from the years 2007 and 2016. A total of 9655 newly diagnosed patients with PS or TS were correspondingly enrolled in the PS or TS group. Chi square test analyses were used to compare the PS and TS groups. RESULTS: The overall incidence of infectious spondylitis during the study period was 9655 persons. The PS and TS groups consisted of 7305 and 2350 cases, respectively. Individual medical costs in the PS group (USD 10,049 ± 94 vs. USD 16,672 ± 17,729, P < 0.001) and the TS group (USD 4882 ± 6869 vs. USD 8531 ± 10,709, P < 0.001) both increased. The total medical cost for the PS group increased significantly between 2007 and 2016 in Korea (USD 24,428,560 vs. USD 81,044,196, P < 0.001). In contrast, the total medical cost for the TS group decreased between 2007 and 2016 in Korea (USD 8,573,038 vs. USD 4,879,520, P < 0.001). CONCLUSION: This nationwide study shows that the total medical cost of PS has increased and that the total medical cost of TS has decreased between 2007 and 2016 in Korea.

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study.

Tuberculosis (TB) is the leading cause of death among infectious diseases. China has a high burden of TB and accounted for almost 13% of the world's cases of multi-drug resistant (MDR) TB. Spinal TB is one reason for the resurgence of TB in China. Few large case studies of MDR spinal TB in China have been conducted. The aim of this research was to observe the epidemiological characteristics of inpatients with MDR spinal TB in six provinces and cities of China from 1999-2015. This is a multicentre retrospective observational study. Patients' information was collected from the control disease centre and infectious disease database of hospitals in six provinces and cities in China. A total of 3137 patients with spinal TB and 272 patients with MDR spinal TB were analysed. The result showed that MDR spinal TB remains a public health concern and commonly affects patients 15-30 years of age (34.19%). The most common lesions involved the thoracolumbar spine (35.66%). Local pain was the most common symptom (98.53%). Logistic analysis showed that for spinal TB patients, reside in rural district (OR 1.79), advanced in years (OR 1.92) and high education degree (OR 2.22) were independent risk factors for the development of MDR spinal TB. Women were associated with a lower risk of MDR spinal TB (OR 0.48). The most common first-line and second-line resistant drug was isoniazid (68.75%) and levofloxacin (29.04%), respectively. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR spinal TB treatment, improved infection control and better clinical outcome. Chemotherapy and surgery can yield satisfactory outcomes with timely diagnosis and long-term treatment. These results enable a better understanding of the MDR spinal TB in China among the general public.

TUBERCULOSIS CAUSED BY MYCOBACTERIUM ORYGIS IN A GREATER ONE-HORNED RHINOCEROS (RHINOCEROS UNICORNIS): FIRST REPORT IN THE WESTERN HEMISPHERE.

Mycobacterium orygis, a newly identified member of the Mycobacterium tuberculosis complex, has been isolated predominantly from hoofstock in eastern Africa and the Arabian Peninsula, and sporadically in cattle (Bos taurus indicus), rhesus monkeys (Macaca mulatta), humans, and a greater one-horned rhinoceros (Rhinoceros unicornis) in South Asia. In rhinoceros, tuberculosis typically presents as a chronic progressive respiratory disease. The report describes the postmortem diagnosis of tuberculosis caused by Mycobacterium orygis in a greater one-horned rhinoceros with hind limb paresis due to neural granulomatosis. Serologic assays for detection of antibodies to M. tuberculosis complex proteins before culture results allowed for appropriate herd management protocols to be initiated. Mycobacterium genus-specific polymerase chain reaction assays with direct sequencing allowed timely confirmation of the serologic results. This is the first isolation of M. orygis in the western hemisphere, showing the need for mycobacterial testing of rhinoceros before international shipments and the urgency for validated antemortem M. tuberculosis complex screening assays in rhinoceros species.

[Clinical Features and Prognosis Factors of Spinal Tuberculosis in Northern Tunisia: A Case Series of 60 Patients]. / Profil clinique et facteurs pronostiques du mal de Pott au nord de la Tunisie : à propos de 60 cas.

Spondylodiscitis is a common but potentially serious form of extra-pulmonary tuberculosis. Very few descriptions are known from Tunisia. We have conducted a retrospective study including 60 cases of spinal tuberculosis, performed over a period of 20 years (1996-2016). The diagnosis was retained on bacteriological, radiological and anatomopathologic evidence. Sixty cases including 31 women and 29 men of spinal tuberculosis were involved. The mean age was 54.4 ±â€…21.3 years. The delay from onset to diagnosis was 6 months (1-14). Lumbar region was the most common infection site (68%). The magnetic resonance imaging has confirmed spinal infection in all cases. The percutaneous image guided spinal biopsy was conclusive in 24/42 cases (57.1%). All patients were put under anti-tuberculosis treatment with total treatment duration of 14 months. Fourteen patients underwent surgical act. The outcome was favorable in 42 cases (7%). Advanced age ≥ 65 years (P = 0.026), radiological evidence of spinal cord compression (P = 0.033) or abscess (P = 0.024), hyperleucocytosis higher than 11,500 elements/mm3 (0.031), or fractures on bone imaging (P = 0.018) and vertebral deformity (P < 0.001) were strongly linked to a bad outcome. Early diagnosis and treatment onset may ensure better outcomes and reduce neurological complications and vertebral deformity.

La spondylodiscite est une forme fréquente et potentiellement grave de tuberculose extrapulmonaire. Elle n'a été que peu décrite en Tunisie. Nous avons mené une étude rétrospective portant sur 60 cas de spondylodiscite tuberculeuse (SPDT) colligés sur une période de 20 ans (1996­2016) dans un centre hospitalier universitaire au nord de la Tunisie. Le diagnostic a été retenu sur des preuves bactériologiques, anatomopathologiques et radiologiques. Il s'agit de 31 femmes et de 29 hommes âgés en moyenne de 54,4 ±â€…21,3 ans. Le délai moyen de diagnostic était de six mois (1­14 mois). L'étage lombaire était le plus touché (68 %). L'imagerie par résonance magnétique était évocatrice du diagnostic dans tous les cas. La ponction-biopsie discovertébrale a permis de porter le diagnostic dans 24/42 cas (57,1 %), fondé sur des preuves histologiques. Tous les patients ont reçu un traitement antituberculeux d'une durée moyenne de 14 mois, associé à un geste interventionnel dans 14 cas. L'évolution était favorable dans 42 cas (70 %). Les facteurs de mauvais pronostic étaient l'âge avancé de plus de 65 ans (p = 0,026), la présence de signes radiologiques de compression médullaire (p = 0,033) ou d'abcès paravertébral (p = 0,024), l'hyperleucocytose initiale supérieure ou égale à 11 500 éléments/mm3 (p = 0,031), la présence de fracture vertébrale (p = 0,018) et d'une déformation vertébrale (p < 0,001). La SPDT est une maladie insidieuse dont le diagnostic et le traitement précoces sont la clé pour éviter les complications neurologiques et ostéoarticulaires.