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Hoffman CJ, France T, Cram T, Bodmer JL, Sanders JS. Pediatric Multidrug-Resistant Disseminated Tuberculosis Presenting as Small Finger Tuberculous Osteomyelitis: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00023. [PMID: 38306445 DOI: 10.2106/jbjs.cc.23.00445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
CASE We report a case in the United States of a 12-year-old girl with multidrug-resistant tuberculous (MDR-TB) osteomyelitis of the hand managed with surgical debridement and second-line anti-TB therapy. The disease course was complicated by dissemination and multifocal progression. CONCLUSION Despite early intervention, multidrug resistance makes TB treatment challenging and facilitated progression to disseminated disease in this case. We review the difficulties in diagnosis and treatment of pediatric MDR-TB.
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Affiliation(s)
- Clayton J Hoffman
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Thomas France
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tyler Cram
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jenna L Bodmer
- Department of Pathology, Children's Hospital Colorado, Aurora, Colorado
| | - Julia S Sanders
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
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2
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du Cros P, Greig J, Alffenaar JWC, Cross GB, Cousins C, Berry C, Khan U, Phillips PPJ, Velásquez GE, Furin J, Spigelman M, Denholm JT, Thi SS, Tiberi S, Huang GKL, Marks GB, Turkova A, Guglielmetti L, Chew KL, Nguyen HT, Ong CWM, Brigden G, Singh KP, Motta I, Lange C, Seddon JA, Nyang'wa BT, Maug AKJ, Gler MT, Dooley KE, Quelapio M, Tsogt B, Menzies D, Cox V, Upton CM, Skrahina A, McKenna L, Horsburgh CR, Dheda K, Marais BJ. Standards for clinical trials for treating TB. Int J Tuberc Lung Dis 2023; 27:885-898. [PMID: 38042969 PMCID: PMC10719894 DOI: 10.5588/ijtld.23.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.
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Affiliation(s)
- P du Cros
- Burnet Institute, Melbourne, VIC, Monash Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - J Greig
- Burnet Institute, Melbourne, VIC, Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - J-W C Alffenaar
- Sydney Infectious Diseases Institute (Sydney ID), and, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Westmead Hospital, Sydney, NSW
| | - G B Cross
- Burnet Institute, Melbourne, VIC, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C Cousins
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Berry
- Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - U Khan
- Interactive Research and Development Global, Singapore City, Singapore
| | - P P J Phillips
- UCSF Center for Tuberculosis, Division of Pulmonary and Critical Care Medicine, and
| | - G E Velásquez
- UCSF Center for Tuberculosis, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA
| | - M Spigelman
- Global Alliance for TB Drug Development, New York, NY, USA
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - S S Thi
- Eswatini National TB Control Program, Mbabane, Kingdom of Eswatini
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, GlaxoSmithKline, London, UK
| | - G K L Huang
- Burnet Institute, Melbourne, VIC, Northern Health Infectious Diseases, Northern Health, Melbourne, VIC
| | - G B Marks
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - L Guglielmetti
- Médecins Sans Frontières (MSF), Paris, Sorbonne Université, Institut national de la santé et de la recherche médicale, Unité 1135, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries, Paris, France
| | - K L Chew
- Department of Laboratory Medicine, National University Hospital, Singapore City, Singapore
| | - H T Nguyen
- Research Department, Friends for International TB Relief, Ha Noi, Vietnam
| | - C W M Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore City, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore City, Institute of Healthcare Innovation & Technology, National University of Singapore, Singapore City, Singapore
| | - G Brigden
- The Global Fund, Geneva, Switzerland
| | - K P Singh
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia, Victorian Infectious Disease Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), TTU-TB, Borstel, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J A Seddon
- Department of Infectious Disease, Imperial College London, London, UK, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - B-T Nyang'wa
- Public Health Department, Operational Center Amsterdam (OCA), MSF, Amsterdam, The Netherlands
| | - A K J Maug
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - M T Gler
- De La Salle Medical and Health Sciences Institute, Dasmariñas, the Philippines
| | - K E Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Quelapio
- Tropical Disease Foundation, Makati City, Manila, the Philippines, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - B Tsogt
- Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - D Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute & McGill International TB Centre, Montreal, QC, Canada
| | - V Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - C M Upton
- TASK Applied Science, Cape Town, South Africa
| | - A Skrahina
- The Republican Scientific and Practical Center for Pulmonology and TB, Minsk, Belarus
| | - L McKenna
- Treatment Action Group, New York, NY
| | - C R Horsburgh
- Departments of Global Health, Epidemiology, Biostatistics and Medicine, Schools of Public Health and Medicine, Boston University, Boston MA, USA
| | - K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - B J Marais
- Sydney Infectious Diseases Institute (Sydney ID), and, The Children's Hospital at Westmead, Sydney, NSW, WHO Collaborating Centre in Tuberculosis, The University of Sydney, Sydney, NSW, Australia
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3
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Naser N, Abdulla H, Kadhem H. Extra-long treatment of MDR-TB osteomyelitis of humerus due to neurotoxicity from the 2nd-line drugs: a case report. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:41. [PMID: 37333427 PMCID: PMC10262133 DOI: 10.1186/s43162-023-00225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/03/2023] [Indexed: 06/20/2023] Open
Abstract
Infection with tuberculosis (TB) still considered a leading infectious cause of death, osteomyelitis TB rare entity, and being extraspinal MDR-TB make it very rare case; most of experience in treating osteomyelitis TB was derived from pulmonary TB experience, and we present a case of humerus MDR-TB that was treated for 5 years, with several interruption due to side effect and other causes.
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Affiliation(s)
- Naser Naser
- Pulmonary Medicine Unit, Department of Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain
| | - Habib Abdulla
- Pulmonary Medicine Unit, Department of Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain
| | - Husain Kadhem
- Pulmonary Medicine Unit, Department of Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain
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Kilinc F, Setzer M, Behmanesh B, Jussen D, Geßler F, Prinz V, Czabanka M. Surgical management and clinical outcome of cervical, thoracic and thoracolumbar spinal tuberculosis in a middle-European adult population. Sci Rep 2023; 13:7000. [PMID: 37117321 PMCID: PMC10147912 DOI: 10.1038/s41598-023-34178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/25/2023] [Indexed: 04/30/2023] Open
Abstract
Spinal tuberculosis is due to globalization no longer a disease limited to developing nations. It remains in Germany a rarity and still a difficult diagnosis. Here we analyzed patients with spinal tuberculosis treated at our neurosurgical department. According to the infected anatomic segment, patients were assigned in one of three groups. Surgery was performed when neurological deficit due to mechanical compression, deformity, instability, severe pain, necrotic bone or failure to respond to anti-tuberculous treatment were observed. We identified 34 patients with spinal tuberculosis who underwent surgical treatment. In the cervical spinal tuberculosis group, there were 15 cases (46.9%) In most cases treatment consisted of spinal instrumentation. In the thoracic group, 10 cases (29.4%) were observed. The treatment was performed by dorsolateral spinal instrumentation. For the thoracolumbar group, 9 cases (26.4%) were observed. In most cases dorsolateral spinal instrumentation was performed. One patient in the first group and one patient in the third group relapsed after operation. A second surgery was necessary. Patients with chronic back pain, immigration background and/or neurological deficit spinal TB should be considered as a differential diagnosis. Combined surgical intervention and medical treatment is associated with a favorable outcome.
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Affiliation(s)
- Fatma Kilinc
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany
| | - Daniel Jussen
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Florian Geßler
- Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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5
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Spekker O, Hunt DR, Király K, Kis L, Madai Á, Szalontai C, Molnár E, Pálfi G. Lumbosacral tuberculosis, a rare manifestation of Pott's disease - How identified human skeletons from the pre-antibiotic era can be used as reference cases to establish a palaeopathological diagnosis of tuberculosis. Tuberculosis (Edinb) 2023; 138:102287. [PMID: 36450192 DOI: 10.1016/j.tube.2022.102287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
The macromorphological examination of identified human osteological collections from the pre-antibiotic era (e.g., Terry Collection) can provide invaluable information about the skeletal manifestations of tuberculosis (TB) in individuals who did not receive pharmaceutical therapy. With analysis of such collections, new diagnostic criteria for TB can be recognised which can be used in palaeopathological interpretation. The aim of our paper is to provide a reference and aid for the identification of TB in past populations by demonstrating and discussing in detail the vertebral alterations indicative of one of its rare skeletal manifestations, lumbosacral TB. These changes were detected in two individuals from the Terry Collection (Terry No. 760 and Terry No. 1093). These two case studies furnish palaeopathologists with a stronger basis for diagnosing lumbosacral TB in skeletons which exhibit similar vertebral lesions from osteoarchaeological series. To illustrate this, an archaeological case from Hungary (KK146) is also presented, displaying vertebral alterations resembling that of the two cases from the Terry Collection. Through the demonstrated case studies, we can derive a better insight into the disease experience of people who lived in the past and suffered from TB.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - David R Hunt
- Northern Virginia District Office of the Chief Medical Examiners, 10850 Pyramid Place, Manassas, VA, 20110, USA.
| | - Kitty Király
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Móra Ferenc Museum, Roosevelt tér 1-3, H-6720, Szeged, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Ágota Madai
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Anthropology, Hungarian National History Museum, Ludovika tér 2-6, H-1083, Budapest, Hungary.
| | - Csaba Szalontai
- National Institute of Archaeology, Hungarian National Museum, Múzeum körút 14-16, H-1088, Budapest, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
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6
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Asmiragani S, Risantoso T, Yudistira A, Satriawan E, Lesmana A, Pribadi A, Siahaan LD. Rare Cases of Multidrug-resistant Tuberculous Spondylitis in Saiful Anwar General Hospital: A Case Series. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Ten percent of all tuberculosis patients may develop skeletal involvement, and the spine is the most common anatomical location. Tuberculous spondylitis is further complicated by the fast-acid bacilli resistance to the usual chemotherapy regimen (multidrug-resistant/MDR) and its complications. In this case series, we would like to present three MDR tuberculous spondylitis cases effectively treated with tailored chemotherapy regimens and surgical interventions.
CASE REPORT: A series of three patients with MDR tuberculous spondylitis is presented. All three patients presented with back pain, lump, and weakness of both lower extremities. These cases were resolved with a combination of surgical intervention and tailored chemotherapy regiment after MDR resistant detected. Two cases were resolved completely, and only one patient had residual paresthesia on his legs.
CONCLUSION: A combination of MDR antituberculous chemotherapy and surgical intervention leads to an excellent outcome, in which the patient can perform regular daily tasks without pain, even in complicated MDR tuberculous spondylitis cases.
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7
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Peloquin CA, Davies GR. The Treatment of Tuberculosis. Clin Pharmacol Ther 2021; 110:1455-1466. [PMID: 33837535 DOI: 10.1002/cpt.2261] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/24/2021] [Indexed: 12/18/2022]
Abstract
Tuberculosis (TB) remains a leading cause of infectious death worldwide, and poverty is a major driver. Clinically, TB presents as "latent" TB and active TB disease, and the treatment for each is different. TB drugs can display "early bactericidal activity (EBA)" and / or "sterilizing activity" (clearing persisters). Isoniazid is excellent at the former, and rifampin is excellent at the latter. Pyrazinamide and ethambutol complete the first-line regimen for drug-susceptible TB, each playing a specific role. Drug-resistant TB is an increasing concern, being met, in part, with repurposed drugs (including moxifloxacin, levofloxacin, linezolid, clofazimine, and beta-lactams) and new drugs (including bedaquiline, pretomanid, and delamanid). One challenge is to select drugs without overlapping adverse drug reaction profiles. QTc interval prolongation is one such concern, but to date, it has been manageable. Drug penetration into organism sanctuaries, such as the central nervous system, bone, and pulmonary TB cavities remain important challenges. The pharmacodynamics of most TB drugs can be described by the area under the curve (AUC) divided by the minimal inhibitory concentration (MIC). The hollow fiber infection model (HFIM) and various animal models (especially mouse and macaque) allow for sophisticated pharmacokinetic/pharmacodynamic experiments. These experiments may hasten the selection of the most potent, shortest possible regimens to treat even extremely drug resistant TB. These findings can be translated to humans by optimizing drug exposure in each patient, using therapeutic drug monitoring and dose individualization.
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Affiliation(s)
- Charles A Peloquin
- College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Geraint R Davies
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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8
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Heyde CE, Lübbert C, Wendt S, Rodloff A, Völker A, von NHDH. Spinal Tuberculosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:74-83. [PMID: 33477180 DOI: 10.1055/a-1285-4994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Tuberculosis is one of the most common infectious diseases worldwide. The frequency in Germany is low, however, an increase has been observed in the past few years. The incidence of extrapulmonary manifestation accounts for up to 10 to 20%. In 50% of these cases the spinal column is affected. Although literature reveals worldwide experiences in the treatment, in Germany spinal tuberculosis remains a rarity. Different pitfalls and specific characteristics regarding diagnosis and therapy are to consider. Therefore, a presentation of these specifics and their discussion based on the available literature will be presented. The purpose is to achieve an increase in awareness regarding this, in our latitudes, rare disease.
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Affiliation(s)
- Christoph Eckhard Heyde
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Christoph Lübbert
- Department of Oncology, Gastroenterology, Hepatology, Respiratory Medicine, Infectiology, Infectious Disease and Tropical Medicine Section, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Sebastian Wendt
- Department of Oncology, Gastroenterology, Hepatology, Respiratory Medicine, Infectiology, Infectious Disease and Tropical Medicine Section, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Arne Rodloff
- Institute of Medical Microbiology and Infection Epidemiology, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Anna Völker
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Nicolas H der Höh von
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
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Drug resistant TB spine in a two year old child: A case report. Indian J Tuberc 2020; 67:374-377. [PMID: 32825872 DOI: 10.1016/j.ijtb.2019.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022]
Abstract
Spinal tuberculosis (TB) is a disease of high morbidity that is associated with deformity and neurological sequelae, especially in growing children. Children diagnosed with spinal TB need to be monitored closely for clinical improvements. Previous history of antituberculous therapy (ATT), poor adherence to previous ATT, contact with persons having known drug-resistant (DR) TB, or clinical worsening despite regular ATT are strong indicators for the diagnosis of DR TB of the spine. We report a case of spinal DRTB in a two year old child with no previous history of ATT and contact with a person on irregular treatment for drug sensitive TB that did not show regression of the spinal lesions despite standard ATT.
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10
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Pawar A, Manwani C, Thete R, Bapat M, Peshettiwar V, Gore S. Endoscopic Decompression Can Be Effective for Diagnosing and Treating Tubercular Spondylodiskitis with Early Epidural Spinal Compression: A Retrospective Study of 18 Cases. Asian Spine J 2018; 12:803-809. [PMID: 30213161 PMCID: PMC6147883 DOI: 10.31616/asj.2018.12.5.803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/09/2018] [Indexed: 12/05/2022] Open
Abstract
Study Design Retrospective study. Purpose In this study, we describe an endoscopic method of effectively treating tubercular lumbar spondylodiskitis with early onset epidural spinal cord compression in the lumbar spine on magnetic resonance imaging (MRI). Overview of Literature Percutaneous aspiration and biopsy of spondylodiskitis under ultrasonography and computer tomography scan invariably provides an inadequate diagnosis. Methods From May 2015 to May 2017, 18 patients presented with intractable back pain and were diagnosed with tubercular spondylodiskitis on MRI; these patients were enrolled in this study. The goal was to confirm the pathogen on biopsy, drain the abscess, and perform debridement. Chemotherapy was started after histologic diagnosis, and data collected included blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and repeat MRI after 3 months. Results Mean duration of surgery was 52 minutes. Mean follow-up was 17 months. The average preoperative Visual Analog Scale score of 8 (range, 6–10) decreased to 3 (range, 1–8) postoperatively. Tubercular spondylodiskitis was observed in 14 cases; two cases were pyogenic, and the biopsy was inconclusive in two cases. After adequate chemotherapy, no recurrences were noted. Conclusions We hereby conclude that endoscopic biopsy and drainage can provide a better diagnosis and decrease pain in a predictable manner.
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Affiliation(s)
- Abhijit Pawar
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Chirag Manwani
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Raghavendra Thete
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Mihir Bapat
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Vishal Peshettiwar
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Satishchandra Gore
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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11
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Arockiaraj J, Michael JS, Amritanand R, David KS, Krishnan V. The role of Xpert MTB/RIF assay in the diagnosis of tubercular spondylodiscitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:3162-3169. [PMID: 28391384 DOI: 10.1007/s00586-017-5076-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/23/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aims to assess the accuracy of the Xpert MTB/RIF assay in the diagnosis of tubercular spondylodiscitis and to identify its role in detecting Rifampicin resistance in patients with infective spondylodiscitis. METHODS A retrospective study including 348 patients suspected to have infective spondylodiscitis was done. Tissue/pus samples obtained were sent for culture, histopathology and Xpert MTB/RIF assay. All patients who were confirmed to have tubercular spondylodiscitis and those patients who were suspected on clinico-radiological basis were also treated with anti-tuberculous chemotherapy for a period of 9 months. The efficacy of the Xpert MTB/RIF assay was assessed in terms of sensitivity and specificity when compared to culture, histopathology, and Composite reference standard (CRS). RESULTS During this study period of 24 months, a total of 348 patients were treated for infective spondylodiscitis. 254 patients were treated for tuberculosis following a smear positivity, culture positivity, and histopathology report or empirically based on clinico-radiological findings. The sensitivity and specificity of the Xpert MTB/RIF assay when compared to culture were 88.4 and 63.7%, respectively. When compared to both culture and histopathology reports it was 80.9 and 80.6%. The sensitivity and specificity of the Xpert MTB/RIF assay when compared to composite reference standard were 71.2 and 100%, respectively. The sensitivity of the assay to detect Rifampicin resistance was 100%. The prevalence of Rifampicin resistance was 5.1%. CONCLUSION This study recommends Xpert MTB/RIF assay for early detection of Mycobacterium tubercular spondylodiscitis and Rifampicin resistance.
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Affiliation(s)
- Justin Arockiaraj
- Department of Orthopaedics, Spinal Disorders Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
| | - Joy S Michael
- Department of Microbiology, Christian Medical College, Ida Scudder Road, Vellore, 632004, India
| | - Rohit Amritanand
- Department of Orthopaedics, Spinal Disorders Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Kenny Samuel David
- Department of Orthopaedics, Spinal Disorders Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Venkatesh Krishnan
- Department of Orthopaedics, Spinal Disorders Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
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