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.

Bone tuberculosis in Roman Period Pannonia (western Hungary)

The purpose of this study was to analyse a skeleton (adult female, 25-30 years) that presented evidence of tuberculous spondylitis. The skeleton, dated from the Roman Period (III-VI centuries), was excavated near the town of Győr, in western Hungary. The skeleton was examined by gross observation supplemented with mycolic acid and proteomic analyses using MALDI-TOF/TOF tandem mass spectrometry. The biomolecular analyses supported the morphological diagnosis.

Espondilitis tuberculosa ("Mal de Pott"): presentación de un caso y revisión bibliográfica / Tuberculous spondylitis (Pott's disease): case report and review of the literature

Tuberculosis of the spine (Pott' disease), is an uncommon evento of extrapulmonary tuberculosis and usually occurs in the absence of extraspinal infection. We report a 24 year-old-man assisted in Córdoba, City (Argentina). Patient arrived at the hospital with mild lumbar pain, thigh's hyperesthesia an patellar hyporreflexia, both in the right side, without general manifestations. X-ray and CT scanning showed severe structural domage of vertebral bodies of the fourth, an fifth lumbar (L4, L5) and first sacral (S1) vertebrae. In addition, paraspinal abscess with extension up to psoas muscle was observed. Mycobacterium tuberculosis was isolated by culture of specimens obtained by aspiration from affected area, fourty days after admission. Patient was treated for nine months with four drugs (Isoniazid, Rifampicine, Pyrazinamide and Ethambutol). Then, the spine was surgically stabilized. During a follw-up of ten years, patient improved progressively. We point out that Pott' disease should be suspected in all cases with vertebral osteomyelitis and negative bacteriological test for common bacteria.

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.

Pott's disease of the spine: findings from Sudan

Spinal tuberculosis is the commonest type of skeletal tuberculosis. It has variable presentations, but commonly presents with backache and weakness of lower limbs. Its prevalence is increasing world wide after the epidemic of HIV. To the best of our knowledge there are no studies addressing the clinical presentation of this disease in Sudan. In this study we included 84 patients with spinal tuberculosis. The study was conducted in two major hospitals in Khartoum in the period from January 2002 to December 2006. Results show males constituted 46 patients [54.8%] and females 38 [45.2%]. Their ages ranged between 16 years and 80 years, the mean age was 44.46 +/- SD 16.99. All patients had pain and or tenderness at the site of the lesion. Paraplegia or paraparesis was reported in 36 patients [42.8%], quadriplegia or quadriparesis in 25 [30%], Sciatica and root weakness in 22 [26.1%] and right brachial monoplegia in one patient. Evidence of active pulmonary tuberculosis was found in 15 patients [17.8%], abdominal tuberculosis in 7 patients [8.3%], lymphatic Tuberculosis in 1 patient [1.2%]. Cervical vertebrae were affected in a total of 26 patients [30.9%], the dorsal in 39 patients [46.4%] and the lumbar in 30 patients [35.7%]. One vertebra was affected in 3 patients [2.57%], 2 adjacent vertebrae in 48 patients [57.14%], 3 vertebrae in 24 patients [28.57%], 4 vertebrae in 4 patients [4.76%], 5 vertebrae in 1 patient [1.19%] and 6 vertebrae in 4 patients [4.76%]. HIV test was negative in all patients. Tuberculin test was positive in 80 patients [95%] and negative in 4 patients [5%]

Gluteal abscess: a manifestation of Pott's spine.

A 3-year-old girl presented with features suggestive of compression of cauda equina. In addition, she had soft, fluctuant gluteal swelling, which on aspiration yielded pus, positive for acid-fast bacilli on staining and culture. She showed significant clinicoradiological improvement following aspiration of pus and antitubercular treatment. Rare manifestations of cold abscess in the spine are discussed.

Correlation of clinical course with magnetic resonance imaging in tuberculous myelopathy.

Sixty cases of spinal tuberculosis with neurological deficit treated with 'middle path regimen' were analysed and therapeutic response was correlated with the magnetic resonance imaging (MRI) observations. Tuberculous lesions were found to be more extensive than seen on plain X-ray in 60% of the cases. MRI showed the involvement of one or both pedicles in nearly 90% of the cases, in addition to the vertebral body lesion as seen in the X-rays. The patients showing predominantly extradural collection of fluid with relatively preserved cord size, and MRI evidence of myelitis/oedema, improved neurologically with treatment. The myelomalacia of cord was found to be a poor prognostic sign for neural recovery. The magnitude of thinning of cord did not always correlate with severity of neural deficit, however, thinning of cord in association with myelomalacia carried a bad prognosis. The complete neural recovery is not expected in patients with syrinx formation proximal or distal to the diseased spine, either with antitubercular drugs or after mechanical decompression. MRI changes in dura-subarachnoid complex suggesting arachnoiditis generally correlated with poor neural recovery. MRI provided a reliable guide to the level and extent of surgical decompression, and prognostication of the outcome of therapeutic measures.

Tuberculosis de la columna cervical. Reporte de un caso y revisión de la literatura / Tuberculosis of the cervical spine. Case report and review of the literature

La tuberculosis (Tb) osteoarticular más frecuente es el Mal de Pott (1 por ciento de todas las Tb), que es la afección de la columna vertebral, en especial a nivel de las regiones lumbar y dorsal. La porción cervical se afecta entre el 3.5 y 7 por ciento de los casos. Se informa el caso de un paciente masculino adulto, con datos de parestesias en miembro superior izquierdo, omalgia y dolor torácico, después de studios de imagen se realiza corporectomía de C5 y C6, se administró tratamiento con antifímicos y tuvo buena evolución. Se revisa la literatura

CT-guided needle aspiration cytology (FNAC) of 112 vertebral lesions.

Aspiration cytology under CT-guidance was utilised as a diagnostic device in 112 lesions of vertebrae from January, 1985 till August, 1992. The age of the patients ranged from 6 years to 82 years. The materials were spread on glass slides, air-dried and stained by May-Grunwald and Giemsa method. In few cases part of the aspirated material was utilised for special stain and cell block preparation. Analysis of results showed metastatic tumours in 61 cases, Tuberculous lesions in 24 cases, Plasmacytoma in 6 cases, Giant cell lesion in 6 cases, Eosinophilic Granuloma in 3 cases, Chordoma in 3 cases, Ewing's sarcoma in 2 cases, Hodgkin's disease in 2 cases, Chondrosarcoma in 1 case and no definite diagnosis was given in 4 cases. These 4 cases on exploration and biopsy proved to be osteoblastoma (2), haemangioma (1) and undifferentiated sarcoma in the other. The giant cell lesions on histopathology proved to be aneuryamal bone cysts in 4 cases while osteoclastoma in 2 cases. The diagnostic accuracy was 96.4%. No complication was encountered in the present study. Early diagnosis by needle aspiration cytology (NAC) prevented unnecessary surgical exploration in majority of the cases and treatment could be started at the earliest.