Mal de pott en la provincia del Chaco / Pott’s disease in the province of Chaco

Introducción: la tuberculosis es la séptima causa de muerte mundial. Menos del 1% de los pacientes tiene compromiso raquídeo. El objetivo del estudio fue investigar la frecuencia del mal de Pott en la provincia e identificar pautas para regiones similares. Materiales y Métodos: Rastreo de pacientes internados por tuberculosis entre 1996 y 2014, en Hospitales provinciales de cabecera. Revisión de historias de casos raquídeos. Clasificaciones de Frankel y del GATA. Datos de censos nacionales. Revisión bibliográfica. Resultados: Catorce casos: 8 varones/6 mujeres. Edad promedio: 35.4 años (rango 3.8-63). Seguimiento: 2.8 años (1 mes-15 años); un óbito posoperatorio inmediato. Siete pacientes provenían de Departamentos con baja carga de morbilidad de tuberculosis. Síntomas iniciales: déficit neurológico (9 casos), dolor axial o radicular puro (4 casos) y deformidad vertebral pura (1 caso). Frankel al ingreso: E (5 casos), D (2), C (2) y A (5). Localizaciones: torácica, 5; toracolumbar, 6; lumbar, 1; múltiple 2 pacientes. Distribución étnica: 5 caucásicos, 5 aborígenes, 3 criollos, 1 mestizo. Según la Clasificación del GATA: 1 lesión de tipo IB; 4 de tipo II; 8 de tipo III; 1 caso inclasificable. Los pacientes de etnia originaria tuvieron cuadros neurológicos y lesiones GATA más graves. Doce fueron operados; 5 presentaron deformidad secuelar, sin diferencias entre doble instrumentación, instrumentación posterior aislada o sin instrumentación. Al seguimiento: 8 pacientes asintomáticos, 4 fallecidos y 2 con síntomas moderados; no hubo deterioros neurológicos y solo 5 mejorías. Conclusiones: En pacientes de etnia originaria son más frecuentes las formas graves, las presentaciones avanzadas y de tratamiento quirúrgico habitual. La mortalidad es alta.

Introduction: tuberculosis is the seventh leading cause of death. Spinal involvement represents <1% of cases. The objective was to investigate the frequency of Pott´s disease in our province, to typify its profile and to identify guidelines for similar regions. Methods: Identification of all tuberculosis admissions from 1996 to 2014 in the main referral hospitals of our province. Medical records review of all cases with spinal involvement. Frankel and GATA classifications. Data from last national census. Literature review. Results: Fourteen cases: 8 males/6 females. Average age: 35.4 years (range 3.8-63). Follow-up: 2.8 years (range 1 month-15 years); one immediate postoperative death. Seven patients came from low tuberculosis burden Departments. Initial symptoms: neurological impairment (9 cases), pure axial and/or radicular pain (4 cases) and pure spine deformity (1 patient). Initial Frankel: E, 5 cases; D, 2; C, 2; and A, 5 patients. Localization: thoracic, 5; thoraco-lumbar, 6; lumbar, 1; multiple 2 patients. Ethnic distribution: 5 caucasians, 5 natives, 3 creoles, 1 mestizo. According to GATA classification: 1 type IB lesion; 4 type II; 8 type III; one unclassifiable case. Native patients had more severe neurological and GATA lesions. Twelve patients were operated on; 5 had residual deformities without differences among double instrumentation, isolated posterior instrumentation and no instrumentation. At follow-up: 8 asymptomatic cases, 4 deceased and 2 patients with moderate symptoms. No neurological worsening was observed; only 5 patients improved. Conclusions: Severe forms, and advanced and common surgical presentations are more frequent in native patients. Mortality is high.

Tuberculosis vertebral o mal de Pott en una paciente adulta / Spinal tuberculosis or Pott´s disease in an adult patient

Se describe el caso de una paciente de 47 años de edad, atendida en la Consulta de Medicina Interna del Policlínico "Esteban Caballero", perteneciente al área de salud Matías del municipio de Tercer Frente de Santiago de Cuba, quien presentó dolores de moderada intensidad en la región dorsolumbar, que no se aliviaban con analgésicos. Los estudios ecográfico y radiográfico de la columna vertebral confirmaron el diagnóstico de mal de Pott. Se indicó tratamiento específico y la afectada evolucionó satisfactoriamente.

The case of a 47 years patient assisted in the Internal Medicine Service of "Esteban Caballero" Polyclinic is described, belonging to Matías health area of Tercer Frente municipality in Santiago de Cuba who presented pains of moderate intensity in the dorsolumbar region that were not relieved with analgesics. The echographic and radiographic studies of the spine confirmed the diagnosis of Pott´s disease. Specific treatment was indicated and the patient had a satisfactory clinical course.

Mal de Pott: uma revisão bibliográfica dos últimos 5anos / Pott’s Disease: a bibliographic review from the last 5 years

Na revisão de literatura, o mal de Pott (MP) é um tipo de tuberculoseextrapulmonar que afeta a coluna vertebral. É uma doença negligenciada,subdiagnosticada e muitas vezes abordada tardiamente.Os malefícios desta moléstia podem ser para toda a vida. Sua tríadeclínica inclui gibosidade, abscesso e paraplegia, sendo-lhe a dor crônicanas costas altamente sugestiva. O padrão-ouro do diagnósticoé a ressonância nuclear magnética com biopsia guiada por tomografiacomputadorizada, seguida de cultura das amostras. Existemdiversos diagnósticos diferenciais, o que corrobora com o seu subdiagnóstico.Há muitas controvérsias quanto à sua terapêutica, emespecial quanto à sua duração e à inclusão de tratamento cirúrgico.Concluímos que ainda são necessários mais trabalhos sobre o tema,pois essa doença continua a ser negligenciada...

Pott’s Disease (PD) is a type of extra-pulmonary tuberculosis thataffects the vertebral spine. It’s a neglected, under-diagnosed andfrequently lately approached disease. The sequels of this illnessmay become a lifelong condition. It has three main symptoms thatinclude gibbosity, abscess and paraplegia. The chronic backacheis highly suggestive of PD. The diagnostic gold-standard exam ismagnetic resonance images (MRI) including a biopsy guided by acomputed tomography (CT) exam, followed by culture. The differentialdiagnosis of PD is vast, which contributes to its under-diagnosis.There are many controversies regarding the treatment, speciallyabout its duration and the addition of surgical debridement.We concluded that more studies are needed about PD because it isstill a neglected disease...

Mal de Pott: a propósito de un caso

La tuberculosis continúa siendo un problema de salud pública a pesar de los múltiples esfuerzos realizados para su control. En Panamá, aunque con menor incidencia que en el adulto, se siguen presentando casos de tuberculosis infantil. Los datos son inespecíficos y existe baja probabilidad de recuperar el bacilo , por lo que el diagnóstico resulta difícil y debe basarse en una alta sospecha diagnóstica y nexo epidemiológico.

Tuberculosis remains a public health problem despite many efforts to control it. In Panama, although to a lesser extend than in adults, there continue to be cases of childhood tuberculosis. Clinical data are nonspecific and there is low probability of recovering the bacillus, so diagnosis is difficult and based on high diagnostic suspicion and epidemiological link.

Mal de Pott: uma doença milenar em um novo século / Pott's disease: an ancient disease in a new century

A tuberculose espinhal, também conhecida como Mal de Pott ou Doença de Pott, caracteriza-se como a forma mais frequente de tuberculose extrapulmonar. Apresentamos aqui o caso de uma paciente encaminhada ao Serviço de Neurologia do Hospital de Clínicas de Porto Alegre com um quadro de dois meses de evolução, apresentando sintomas de compressão medular. O diagnóstico de tuberculose espinhal foi realizado por punção guiada por tomografia computadorizada e a paciente foi submetida à drenagem do abscesso. Concomitantemente, foi iniciado o tratamento com RHZ e a paciente evoluiu com melhora dos sintomas neurológicos. Esse caso ilustra que mesmo pacientes com alterações neurológicas importantes devido à tuberculose medular podem apresentar melhora significativa com tratamento.

Spinal tuberculosis, also known as Pott's disease, is the most common form of extra-pulmonary tuberculosis. We report on a patient referred to the Division of Neurology of Hospital de Clínicas de Porto Alegre presenting with spinal cord compression symptoms for two months. The diagnosis of spinal tuberculosis was rapidly done by a computerized tomography guided biopsy. The patient was submitted to abscess surgical draining and complementary RHZ treatment, with recovery of neurological symptoms. This case illustrates that even patients with severe neurological deficits due to spinal tuberculosis may have a good outcome with the appropriate treatment.

Confecção HIV/tuberculose (mal de Pott): um estudo de caso / Coinfection HIV/tuberculosis (Pott´s disease): a case study

O surgimento da aids provocou um aumento nos casos de tuberculose no mundo. Analisamos um caso de coinfecção HIV-tuberculose visando identificar como elas interagem promovendo deterioração na qualidade de vida do paciente. Estudamos o caso de um paciente do sexo masculino cujo diagnóstico de HIV só foi feito após ele apresentar infecções oportunistas que caracterizam a imunodeficiência. O estudo permitiu-nos identificar como o paciente reagiu à aids e ao tratamento prescrito. Também percebemos como a interação entre as duas doenças aumenta a morbimortalidade delas, principalmente se associada a frequentes descontinuações de tratamento, resultando em limitações permanentes.

The advent of aids brought an increase in tuberculosis`s cases in the world. We analyzed a coinfection HIV-Tuberculosis case aiming to identify how theyinteract promoting a deterioration of the patient`s quality of life. We studied a male patient`s case whose diagnose of HIV was only made after he presented opportunistic infections that characterize immunodefi ciency. We were able to identify how he reacted to aids and the treatment prescribed. We also realizehow the interaction between the diseases increased their morbid-mortality principally when associated with frequently treatment discontinuation resultingin permanent limitations.

Perfiles epidemiológico y clínico de la tuberculosis osteoarticular: estudio observacional en el Hospital Universitario San Vicente de Paúl de Medellín, 1994-2004 / Epidemiologic and clinical profiles of bone and joint tuberculosis: observational study at Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 1994-2004

Se llevó a cabo un estudio observacional retrospectivo en el Hospital Universitario San Vicente de Paúl, de Medellín, basado en la revisión de las historias de pacientes con tuberculosis osteoarticular, entre enero de 1994 y diciembre de 2004; con base en los hallazgos se describen las características demográficas, clínicas, de laboratorio y de tratamiento de 47 pacientes que correspondían al 3.2 por ciento del total de casos de tuberculosis hallados en la década estudiada; 35 tuvieron tuberculosis de la columna vertebral y en 12 la enfermedad fue extraespinal; solo en 7 pacientes se halló el antecedente de tuberculosis pulmonar; 23 eran mujeres y 24, hombres, con edades entre 1 y 71 años; 18 eran menores de 12 años; los cultivos para Mycobacterium tuberculosis fueron positivos en 14 pacientes (29.8 por ciento) y las biopsias fueron compatibles con tuberculosis en 26 pacientes (55.3 por ciento); 11 de los 12 pacientes con tuberculosis extraespinal presentaban la tríada radiológica de Phemisther, constituida por ostropenia, osteolisis y disminución del espacio articular.Los síntomas predominantes en los pacientes con tuberculosis espinal fueron: dolor, síntomas neurológicos y deformidad, principalmente cifosis; radiológicamente estos pacientes tenían destrucción de cuerpos vertebrales y disminución del espacio articular, además de osteopenia. La tomografía se hizo en 19 pacientes y mostró compresión medular en 5; la resonancia magnética hecha en 17 pacientes reveló absceso paravertebral en todos ellos y compresión medular en 8.Se discuten los hallazgos a la luz de la información hallada en la literatura médica mundial y en el contexto de la situación de salud de la población colombiana.

An observational, retrospective study was performed at Hospital Universitario San Vicente de Paúl, in Medellín, Colombia, based on the clinical records of patients with bone and joint tuberculosis between January 1994 and December 2004; based on the findings, epidemiological, clinical, laboratory and therapeutic characteristics of 47 patients are described. These patients represented 3.4% of the total of tuberculosis cases found in this hospital during the studied period; 35 had spinal tuberculosis and in 12 the disease affected other bones; a history of pulmonary tuberculosis was found in only 7 patients; 23 were males and 24, females; their ages were between 1 and 71 years; 18 were younger than 12 years; cultures for Mycobacterium tuberculosis were positive in 14 patients (29.8%) and biopsies were consistent with tuberculosis in 26 (55.3%). Eleven of the 12 patients with extraspinal disease had the radiological findings of Phemisther. Predominant symptoms of spinal tuberculosis were: pain, neurological manifestations and deformity, mostly kyphosis. From the radiological point of view, these patients had destruction of vertebral bodies and decrease of articular space in addition to osteopenia. Tomography was performed in 19 patients and revealed medullary compression in 5 of them; magnetic resonance carried out in 17 patients showed medullary compression in 8 and paravertebral abscesses in the 17. Results are discussed on the basis of reports from the world medical literature and in the context of the health situation of the Colombian population