Pott's disease

Pott's disease is a rare, but a serious form of tuberculosis that is located in the spinal column. Segments of the spine may actually collapse.

Lumbar Pott's disease

History

Tuberculosis (TB) is a disease that has been around for a long time but recently there has been an increase in the developed nations especially among the immunocompromised.

Cause

The pathogen causing the disease tuberculosis is Mycobacterium tuberculosis species although other species of the genus Mycobacterium can also cause it.

Cervicothoracicspinal TB-scan

Granulomatous inflammatory reaction

The TB infection results in a granulomatous inflammatory reaction.

Risk factors

• Some known risk factors for TB include:
• Prolonged exposure to an infected person
• Overcrowding
• Substance abuse
• Diabetes mellitus
• Silicosis
• Cancer of the head or neck
• Leukemia or Hodgkin’s disease
• Severe kidney disease
• Low body weight
• Certain medical treatments (such as corticosteroid treatment or organ transplants)
• Specialized treatment for rheumatoid arthritis or Crohn’s disease

Pathophysiology

Spinal tuberculosis is usually secondary to hematogenous spread from a primary site of infection such as lungs.

Tuberculosis; spine of boy

Signs and symptoms

Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs (pulmonary TB). TB disease in the lungs may cause symptoms such as:

• a bad cough that lasts 3 weeks or longer
• pain in the chest
• coughing up blood or sputum (phlegm from deep inside the lungs)
• Other symptoms of TB disease are
• weakness or fatigue
• weight loss
• no appetite
• chills
• fever
• sweating at night

Cold abscess

Tuberculosis can lead to what are called cold abscesses that typically lack all the inflammatory signs obvious in abscesses. Areas commonly affected include cervical spine, thoracic spine, and the lumbar spine. they may also form along psoas muscle, Petit's triangle, Scarpa's triangle, or the gluteal region.

Tuberculosis symptoms

Spine deformity

The clinical appearance of kyphotic deformity has been classified based on vertebrae involved as knuckle when only one vertebra was involved, gibbus when two vertebrae are involved and rounded kyphus when more than three vertebrae are involved.

Neurological deficit

A neurological deficit can occur both during active and the healed stage secondary to mechanical traction over the internal gibbus or spinal instability.

Tuberculosis spine mummy

Diagnosis

There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test (TST) and TB blood tests.  A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. It does not tell whether the person has latent TB infection (LTBI) or has progressed to TB disease. Other tests, such as a chest x-ray and a sample of sputum, are needed to see whether the person has TB disease.

If a person is found to be infected with TB bacteria, other tests are needed to see if the person has latent TB infection or TB disease. THe gold standard test is culture of the mycobacterium tuberculosis

Other tests

• Plain radiographs
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Nuclear imaging: 18 F-fluorodeoxyglucose (18F-FDG) labeled positron emission tomography (PET) scan

Laboratory Tests

• Erythrocyte sedimentation rate (ESR)
• Serological tests for IgG and IgM antibody levels against TB antigen
• Acid-fast bacilli (AFB) staining
• TB culture
• Molecular testing and polymerase chain reaction (PCR)
• Gene Xpert MTB/RIF
• Histopathological evaluation

Tests to Detect Latent Tuberculosis

• Mantoux test
• Interferon-gamma release assay
• Whole blood-based enzyme-linked immunosorbent assay (ELISA)

Mycobacterium tuberculosis

Treatment

Treatment decisions should be made in consultation or by the infectious disease specialists. TB disease can be treated by taking several drugs for 6 to 9 months.  There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are:

• isoniazid (INH)
• rifampin (RIF)
• ethambutol (EMB)
• pyrazinamide (PZA)

MDR TB

Multi-drug resistant TB, or MDR-TB, is defined as TB infection resistant to INH and rifampicin

Complications

TB of the spine with destruction of vertebrae can lead to changes in curvature of the spine

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