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1.
Clin Infect Dis ; 67(1): 89-98, 2018 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-29340585

RESUMO

Background: Mycobacterium tuberculosis is a major cause of myelopathy and radiculopathy in settings with a high prevalence of tuberculosis/human immunodeficiency virus (HIV) coinfection. However, a paucity of publications exists on the spectrum of neurological and magnetic resonance (MR) imaging findings of spinal tuberculosis in these populations. Methods: We conducted a retrospective study of adults with spinal tuberculosis at a referral center in South Africa for patients with spinal disease without bony involvement seen at plain film radiography. We report the clinical, laboratory and spinal MR imaging findings, compare HIV-infected and HIV-uninfected patients, and correlate clinical and cerebrospinal fluid findings with those of MR imaging. Results: Of 274 patients, 209 (76%) were HIV infected and 49 (18%) were HIV uninfected. Radiculomyelitis occurred in 77% (n = 210), and spondylitis in 39% (n = 106). Subdural abscess (n = 42) and intramedullary tuberculoma (n = 33) were common. In 24% of HIV-infected and 14% of HIV-uninfected patients, spinal disease manifested as a paradoxical tuberculosis reaction, frequently following tuberculous meningitis. The triad of neurological deficit, fever, and back pain was similar in patients with spondylitis (24%), epi/subdural abscess without bony disease (14%), meningoradiculitis (17%), and isolated myelitis (17%) . Conclusions: Radiculomyelitis is a common manifestation of spinal tuberculosis in settings with high tuberculosis/HIV prevalence, often presenting as a paradoxical reaction. We describe a high frequency of rarely reported spinal tuberculosis manifestations, suggesting that these are more common than implied by the literature.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Doenças da Medula Espinal/microbiologia , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/patologia , Adulto , Coinfecção/complicações , Coinfecção/microbiologia , Coinfecção/virologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/microbiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite/microbiologia , Mielite/patologia , Radiografia , Estudos Retrospectivos , África do Sul , Tuberculose da Coluna Vertebral/líquido cefalorraquidiano
2.
Inflamm Res ; 64(2): 97-106, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25503789

RESUMO

AIMS AND OBJECTIVES: Both pro-inflammatory and anti-inflammatory cytokines play key roles in the pathogenesis of various forms of tuberculosis. In this study, we evaluated the role of various cytokines and matrix metalloproteinases (MMPs) in patients with spinal tuberculosis. MATERIALS AND METHODS: In this prospective study, we enrolled 55 histopathologically/microbiologically confirmed patients with spinal tuberculosis. We also included 55 control subjects. Blood and cerebrospinal fluid (CSF) were collected both from cases and controls. Tumor necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-1ß, IL-6, IL-8, IL-10, matrix metalloproteinases MMP-2 and MMP-9 were measured by enzyme-linked immunosorbent assay (ELISA). Disability and outcome were measured by modified Barthel Index (MBI). Measured inflammatory parameters were correlated with the outcome after 6 months of follow-up. RESULTS: We observed that serum and CSF cytokines and MMPs were significantly higher in patients with spinal tuberculosis than in controls (p < 0.001). Spearman's rank order correlation test for correlation of baseline MBI (measure of disability) and cytokine/MMP levels showed that baseline MBI had significant negative correlation with serum levels of IFN-γ (r = -0.517; p < 0.001), IL-1ß (r = -0.355; p = 0.008), IL-6 (r = -0.306; p = 0.023), IL-8 (r = -0.275; p = 0.042), MMP-9 (r = -0.311; p = 0.021) and CSF levels of TNF-α (r = -0.327; p = 0.015); whereas baseline MBI had a positive correlation with the serum level of anti-inflammatory cytokine IL-10 (r = 0.327; p = 0.015). Poor outcome, after 6 months, was associated with higher serum TNF-α (p = 0.015) and IFN-γ (p = 0.021) and CSF MMP-9 (p = 0.006) and a lower serum IL-10 (p = 0.018) level. CONCLUSIONS: To conclude, in patients of spinal tuberculosis, poor outcome is associated with higher pro-inflammatory serum TNF-α and IFN-γ, and CSF MMP-9 levels, and a lower anti-inflammatory serum IL-10 level.


Assuntos
Citocinas , Metaloproteinase 2 da Matriz , Metaloproteinase 9 da Matriz , Tuberculose da Coluna Vertebral/sangue , Tuberculose da Coluna Vertebral/líquido cefalorraquidiano , Adulto , Citocinas/sangue , Citocinas/líquido cefalorraquidiano , Feminino , Humanos , Masculino , Metaloproteinase 2 da Matriz/sangue , Metaloproteinase 2 da Matriz/líquido cefalorraquidiano , Metaloproteinase 9 da Matriz/sangue , Metaloproteinase 9 da Matriz/líquido cefalorraquidiano , Metaloproteinases da Matriz , Adulto Jovem
3.
Medicine (Baltimore) ; 99(21): e20012, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481268

RESUMO

INTRODUCTION: Paradoxical reaction in tuberculosis (TB) is defined as the reappearance of general symptoms, aggravation of pre-existing diseases, or appearance of new lesions despite adequate anti-TB therapy. It may result from the hyperactivity of the immune response, resulting in an intense inflammation. There are few cases of vertebral TB reported as paradoxical reaction, mainly among immunocompetents patients. PATIENT CONCERNS: We describe a male immunocompetent patient with confirmed pulmonary and meningeal TB. He was readmitted after 60 days of adequate treatment, with vertebral TB and paravertebral abscess, despite clinical improvement of the other locations. We defined as an uncommon case of a paradoxical reaction, confirmed by nuclear magnetic resonance and molecular rapid test for TB. DIAGNOSIS: Mycobacterium tuberculosis (MTB) was detected in cerebrospinal fluid by molecular rapid test (Gene Xpert MTB/ rifampicina method). Sputum research and culture were positive for the same agent. Lumbosacral spine nuclear magnetic resonance revealed bone destruction from T8 to T11, and a paravertebral collection was found. Gene Xpert MTB/rifampicina and culture were positive for M tuberculosis in the drained material of the paravertebral abscess. INTERVENTIONS: The paravertebral abscess was drainage by tomography-guided. Treatment with 4 anti-TB drugs was extended for 60 days and 2 anti-TB drugs was maintained for 10 months. There was a complete clinical improvement. OUTCOME: After draining the paravertebral abscess, the patient progressively improved and was discharged for outpatient follow-up. He was on antituberculous drugs for 1 year; subsequently, complete resolution of the infection was reported. CONCLUSION: Paradoxical reaction may be a difficult diagnosis in immunocompetent patient. Vertebral TB as a paradoxical reaction is an uncommon presentation. Therapeutic failure or resistance to treatment should be ruled out to confirm the diagnosis of paradoxical reaction.


Assuntos
Antituberculosos/efeitos adversos , Imunocompetência/efeitos dos fármacos , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose da Coluna Vertebral/etiologia , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Sacro/diagnóstico por imagem , Sacro/patologia , Tuberculose Meníngea/complicações , Tuberculose Pulmonar/classificação , Tuberculose da Coluna Vertebral/líquido cefalorraquidiano
4.
Rev Neurol (Paris) ; 156(6-7): 661-4, 2000 Jul.
Artigo em Francês | MEDLINE | ID: mdl-10891803

RESUMO

A 38 year-old woman, without previous medical history, presented, since 1993, several paraplegic fits carrying herself progressively through to a severe paraplegia. Diagnoses successively proposed were spinal cord compressions by slipped discs, spinal cord infarct and multiple sclerosis. In November 1998, the patient presented back pain and fever. Spinal cord magnetic resonance imaging (MRI) revealed a mildly enlarged dorsal cord with signal abnormalities. The lesions were isointense on T1-weighted images, hyperintense on T2-weighted images and showed a ringlike contrast enhancement. A lumbar puncture showed a trouble cerebrospinal fluid (CSF) with leucocytes 600/mm(3) (85 p.100 polynuclear), protein 6.7 g/l, glucose 0.26 g/l, chloride 109 mmol/l. The patient was first treated with parenteral unspecific antibiotherapy. Microbiological studies of blood and CSF were negative. CSF examination with polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis. Clinical (pain and fever) symptoms and CSF abnormalities decreased after antituberculous treatment. However, paraparesis remain severe. Spinal tuberculous localizations often lead to diagnostic and therapeutic errors. Improvement of spinal cord MRI sequences and using of PCR technics in CSF would contribute to reduce these difficulties.


Assuntos
Paraplegia/etiologia , Tuberculose da Coluna Vertebral/complicações , Adulto , Antituberculosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada/uso terapêutico , Feminino , Fosfomicina/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Tuberculose da Coluna Vertebral/líquido cefalorraquidiano , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/tratamento farmacológico , Tuberculose da Coluna Vertebral/patologia
5.
Bone Joint J ; 96-B(10): 1366-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25274923

RESUMO

The lack of an accurate, rapid diagnostic test for mycobacterium tuberculosis (TB) is a major handicap in the management of spinal TB. GeneXpert, a new, rapid molecular diagnostic test is recommended as the first line investigation for suspected pulmonary TB in areas with a high prevalence of HIV or drug resistance, yet it has not been validated for the diagnosis of musculoskeletal TB. The aim of this study was to assess the accuracy of GeneXpert in diagnosing spinal TB. A prospective clinical study of 69 consecutive adults with suspected spinal TB was conducted at a tertiary hospital in an area with the highest incidence and prevalence of TB in the world. GeneXpert was used on tissue samples of the enrolled patients and its diagnostic accuracy compared with a reference standard of tissue in liquid culture. A total of 71 spine samples from 69 patients (two re-biopsies) were included in the study. The GeneXpert test showed a sensitivity of 95.6% and specificity of 96.2% for spinal TB. The results of the GeneXpert test were available within 48 hours compared with a median of 35 days (IQR 15 to 43) for cultures. All cases of multi-drug resistant TB (MDR TB) were diagnosed accurately with the GeneXpert test. The MDR TB rate was 5.8%.


Assuntos
Líquido Cefalorraquidiano/microbiologia , DNA Bacteriano/análise , Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase/métodos , Vértebras Torácicas , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose da Coluna Vertebral/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , África do Sul/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/líquido cefalorraquidiano , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose da Coluna Vertebral/líquido cefalorraquidiano , Tuberculose da Coluna Vertebral/epidemiologia
7.
Probl Tuberk ; (5): 22-4, 2001.
Artigo em Russo | MEDLINE | ID: mdl-11588953

RESUMO

The paper presents the results of examination of spinal fluid in tuberculous spondylitis (n = 83), its sequelae (n = 58), spinal osteomyelitis (n = 25) for the levels of tuberculosis antibodies (TAb) by applying the routine enzyme immunoassay, specially adapted to this biological object, and immunoglobulins. A relationship was found between TAb detection and the rate of the process and the severity of a spinal cord lesion. Forty one patients had severe spinal cord disorders (paraplegia and deep paraparesis). To detect TAb in CF is shown to be of differential diagnostic value. There is new evidence for impaired blood-brain and immunological barriers in active tuberculosis in the spine with spinal cord compression.


Assuntos
Tuberculose da Coluna Vertebral/imunologia , Adulto , Anticorpos Antibacterianos/análise , Diagnóstico Diferencial , Humanos , Técnicas Imunoenzimáticas , Imunoglobulina A/sangue , Imunoglobulina A/líquido cefalorraquidiano , Imunoglobulina G/sangue , Imunoglobulina G/líquido cefalorraquidiano , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Compressão da Medula Espinal/etiologia , Tuberculose da Coluna Vertebral/líquido cefalorraquidiano , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/diagnóstico
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