Challenges and controversies in the treatment of spinal tuberculosis

Pandita, Aakriti; Madhuripan, Nikhil; Pandita, Saptak; Hurtado, Rocio

doi:10.1016/j.jctube.2020.100151

Cited by 35 publications

(42 citation statements)

References 94 publications

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“…Spinal TB can be more aggressive and involve more vertebrae in children than in adults; therefore, following vertebral destruction and collapse, they are at particular risk of rapid and severe deformity progression [ 17 , 18 , 67 , 69 , 70 ]. Moreover, in pediatric spinal TB cases, progression of the deformity even after healing of the disease is not uncommon due to the growing nature of the vertebral column in childhood [ 31 , 57 , 65 , 67 , 71 ].…”

Section: Discussionmentioning

confidence: 99%

An unusual case of childhood osteoarticular tuberculosis from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (Győr-Moson-Sopron county, Hungary)

et al. 2021

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Ancient human remains exhibiting bony changes consistent with osteoarticular tuberculosis (OATB) indicate that the disease has afflicted mankind for millennia. Nonetheless, not many pediatric OATB cases have been published in the paleopathological literature–from Hungary, only three cases have been described up to now. In our paper, we demonstrate a child (S0603) from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (northwestern Hungary), who represents a unique case of OATB regarding both the pattern and severity of the observed bony changes. During the macromorphological and radiological investigations, the most serious alterations were discovered in the upper thoracic spine–the development of osteolytic lesions led to severe bone loss and consequent collapse and fusion of several adjacent vertebrae. The pathological process terminated in a sharp, rigid angular kyphosis. Disruption of the normal spine curvature resulted in consequent deformation of the whole thoracic wall–it became “rugby-ball-shaped”. The overall nature and pattern of the detected alterations, as well as their resemblance to those of described in previously published archaeological and modern cases from the pre-antibiotic era indicate that they are most consistent with OATB. Based on the severity and extent of the lesions, as well as on the evidence of secondary healing, S0603 suffered from TB for a long time prior to death. Besides body deformation, OATB resulted in consequent disability in daily activities, which would have required regular and significant care from others to survive. It implies that in the Árpádian Age community of Győrszentiván-Révhegyi tag, there was a willingness to care for people in need. Detailed archaeological case studies can give us a unique insight into the natural history and different presentations of OATB. Furthermore, they can provide paleopathologists with a stronger basis for diagnosing TB and consequently, with a more sensitive means of assessing TB frequency in past populations.

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Section: Discussionmentioning

confidence: 99%

An unusual case of childhood osteoarticular tuberculosis from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (Győr-Moson-Sopron county, Hungary)

et al. 2021

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“…In general, spinal tuberculosis is distinct from bacterial osteomyelitis, and the pathogenesis is thought to involve paravertebral venous spread as opposed to arterial hematogenous seeding of bone [9]. Treatment is challenging due to the need for bone penetration with antimicrobials coupled by the paucibacillary nature of spinal tuberculosis, as opposed to the multibacillary form in highly oxygenated lung parenchyma [9]. Furthermore, most high-quality studies have traditionally focused on pulmonary tuberculosis [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment is challenging due to the need for bone penetration with antimicrobials coupled by the paucibacillary nature of spinal tuberculosis, as opposed to the multibacillary form in highly oxygenated lung parenchyma [9]. Furthermore, most high-quality studies have traditionally focused on pulmonary tuberculosis [9,10]. For spinal tuberculosis, Infectious Diseases Society of America (IDSA) guidelines recommend 6-9 months of therapy for drug-susceptible MTB, with experts recommending 12-month courses for patients with spinal hardware [10].…”

Section: Discussionmentioning

confidence: 99%

Pott Disease: A Tale of Two Cases

Radcliffe

Grant

2021

Pathogens

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Tuberculosis is considered one of the great masqueraders alongside syphilis and vasculitis. Pott disease is recognized as a classic manifestation of tuberculosis, yet it stands as a rare infectious syndrome in regions with low tuberculosis disease burden. To illustrate the challenges of diagnosing Pott disease in these settings, we report two cases and offer a brief overview of management recommendations for vertebral osteomyelitis caused by Mycobacterium tuberculosis. Case one concerns an 81-year-old man with a remote history of incarceration who presented with altered mental status and new pleural effusions. Case two is a 49-year-old man with well-controlled HIV who was transferred to our institution after being found to have extensive destruction of L3–L5 vertebrae and bilateral iliopsoas abscesses on outpatient imaging. These stand as illustrative examples of low and high suspicion for tuberculosis, respectively, and both cases required complex diagnostic and management decisions.

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“…The treatment is comparatively complex than pulmonary TB and requires combination therapy for longer duration around a year or two as destroying dormant population is quite challenging. Inadequate killing of MTB can cause relapse with variation in treatment response (5,6) The conventional therapy regimens have been successful to some extent in bringing about, if not complete but at least partial eradication of TB. The drawbacks associated with currently available treatment mainly include long period of treatment, toxicity, increased frequency of dosing (7).…”

Section: Introductionmentioning

confidence: 99%

Design, development and characterization of carrier mediated drug delivery system for effective management of Osteoarticular Tuberculosis

Prabhu¹,

Fernandes²,

Chaubey³

et al. 2021

Preprint

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Tuberculosis (TB) is a potentially fatal contagious disease and is a second leading infectious cause of death in world. Bone and joint TB (BJTB)/ Osteoarticular TB is a secondary form of TB occurring most commonly due to hematogenous seeding of mycobacterium (MTB) from the primary site of infection. The prevalence of the disease is around 30 million globally and approximately 30% or 10 million cases exist in India. Osteoarticular tuberculosis, is found in about 10–20% of all diagnosed tuberculosis, is the most common extrapulmonary tuberculosis. Osteoarticular TB is treated using standard regimen of 1 st and 2 nd line Anti- Tubercular drugs (ATDs) for extensive period of 8 - 20 months. These drugs are commonly administered in high doses by oral route or by intravenous route, because of their compromised bioavailability. The common drawbacks associated with conventional therapy are poor patient compliance due to long treatment period, frequent and high dosing and toxicity. Additionally failure by the patients to follow therapeutic regimen properly has given rise to development of resistance against these ATDs. This aspect marks for the need of formulations to eliminate these drawbacks. MTB is an intracellular pathogen of mononuclear phagocyte. This attribute makes nanotherapeutics an ideal approach for MTB treatment as macrophages capture nano forms. Polymeric nanoparticles are removed from the body by opsonization and phagocytosis, this forms an ideal strategy to target macrophage containing mycobacteria. To further improve targetability, the nanoparticles are conjugated with ligand, which serves as an easy substrate for the receptors present on the macrophage surface. The purpose of present work was to develop intra articular injectable in-situ gelling system containing polymeric nanoparticles, which would have promising advantages over conventional method of treatment. The rationale behind formulating nanoparticle incorporated in situ gel based system was to ensure localization of the formulation in intra articular cavity along with sustained release and conjugation of nanoparticles with mannose as ligand to improve uptake by macrophages. Rifampicin standard ATD was formulated into Chitosan nanoparticles. Chitosan with 85% degree of deacetylation (DDA) and Sodium tripolyphosphate (TPP) as the crosslinking agent was used for preparing nanoparticles. The percent entrapment was found to be about 71%. The prepared nanoparticles were conjugated with mannose. Conjugation of ligand was ascertained by performing Fourier transformed Infrared spectroscopy. The particle size was found to be in the range of 130 -140 nm and zeta potential of 38.5 mV. Additionally we performed scanning electron microscopy to characterize the surface morphology of ligand-conjugated nanoparticles. The conjugated Chitosan nanoparticles were incorporated into in situ gelling system comprising of Poloxamer 407 and HPMC K4M. The gelling system was evaluated for viscosity, gelling characteristics and syringeability. The drug release from conjugated nanoparticles incorporated in in situ gel was found to be about 70.3% at the end of 40 hours in simulated synovial fluid following zero order release kinetics. Based on the initial encouraging results obtained, the nanoparticles are being envisaged for ex-vivo cellular uptake study using TB infected macrophages

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Challenges and controversies in the treatment of spinal tuberculosis

Cited by 35 publications

References 94 publications

An unusual case of childhood osteoarticular tuberculosis from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (Győr-Moson-Sopron county, Hungary)

An unusual case of childhood osteoarticular tuberculosis from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (Győr-Moson-Sopron county, Hungary)

Pott Disease: A Tale of Two Cases

Design, development and characterization of carrier mediated drug delivery system for effective management of Osteoarticular Tuberculosis

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