Acute Paraplegia in a Toddler: A Diagnostic Journey Compounding the Challenge in Management: A Case Report

Spinal tuberculosis is not common in the paediatric age group. Initial clinical features are often vague and non specific until the disease progresses to later stages. We highlight the diagnostic difficulties and management challenges of a complicated extradural tuberculoma with neurological deficits in a very young girl.

Tuberculosis of the Spine: A new Understanding of an Old Disease

STUDY DESIGN: A review of related literatures of diagnosis and treatment of spinal tuberculosis. OBJECTIVES: The aim of the study was to discuss treatment strategies by understanding of emerging problems related to spinal tuberculosis. SUMMARY OF LITERATURE REVIEW: Owing to modern diagnostic modalities, development of prevention and chemotherapy, the incidences of tuberculosis infection including spinal tuberculosishave been decreasing. Moreover, these medical these improvements of medical and surgical treatments the improvement of surgical techniques for spinal tuberculosis reduced the incidence of kyphosis or neurologic complications such as Pott's paralysis. MATERIALS AND METHODS: Review of related literatures. RESULTS: Recently,the occurrence of multi-drug resistant strain, an increasing number of opportunistic infections and an atypical presentation in spinal tuberculosis are emerging as new challenges. CONCLUSIONS: An appropriate diagnosis and surgical interventions are our obligation as clinicians dealing with this unique infectious disease to minimize the complications for the treatment of spinal tuberculosis.

Evaluation of an enzyme-linked immunospot assay for the immunodiagnosis of atypical spinal tuberculosis (atypical clinical presentation/atypical radiographic presentation) in China

BACKGROUND: Atypical spinal tuberculosis (TB) usually presents in a slowly indolent manner with nonspecific clinical presentations making the diagnosis a great challenge for physicians. New technologies for the detection of atypical spinal TB are urgently needed. The aim of this study was to assess the diagnostic value of an enzyme-linked immunospot (ELISPOT) assay in clinically suspected cases of atypical spinal TB in China. METHODS: From March 2011 to September 2012, a total of 65 patients with suspected atypical spinal TB were enrolled. In addition to conventional tests for TB, we used ELISPOT assays to measure the IFN-I response to ESAT-γ and CFP-10 in T-cells in samples of peripheral blood mononuclear cells. Patients with suspected atypical spinal TB were classified by diagnostic category. Data on clinical characteristics of the patients and conventional laboratory results were collected. RESULTS: Out of 65 patients, 4 were excluded from the study. 18 (29.5%) subjects had cultureconfirmed TB, 11 (18.0%) subjects had probable TB, and the remaining 32 (52.5%) subjects did not have TB. Generally, the features of atypical spinal TB include the following aspects: (1) worm-eaten destruction of vertebral endplate; (2) destruction of centricity of the vertebral body or concentric collapse of vertebral body; (3) tuberculous abscess with no identifiable osseous lesion; (4) contiguous or skipped vertebral body destruction. 26 patients with atypical spinal TB had available biopsy or surgical specimens for histopathologic examination and 23 (88.5%) specimens had pathologic features consistent with TB infection. The sensitivities of the PPD skin test and ELISPOT assay for atypical spinal TB were 58.6% and 82.8%, and their specificities were 59.4% and 81.3%, respectively. Malnutrition and age were associated with ELISPOT positivity in atypical spinal TB patients. CONCLUSIONS: The ELISPOT assay is a useful adjunct to current tests for diagnosis of atypical spinal TB.