Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis

Jain, Anil K.; Jena, Santosh Kumar; Singh, Mastan; Dhammi, Ish Kumar; Ramachadran, VG; Dev, Geeta

doi:10.4103/0019-5413.40253

Cited by 59 publications

(59 citation statements)

References 12 publications

(19 reference statements)

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“…The diagnosis of Pott's disease is principally based on classical clinical manifestations of spinal infection supplemented by modern imaging like CT and MRI 1415. The CT and MRI in particular can detect the subtle changes in the spine, from initial changes in the intensity pattern of the vertebrae to the extreme changes like deformity of the spine including soft tissue shadow, granulation tissue and pus etc 16. However, the various pathologies including neoplastic and other inflammatory conditions simulate with Pott's diseases on imaging.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of diagnostic battery in Pott’s disease: A prospective study

Kumar

Srivastva

et al. 2014

IJOO

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Background:The diagnosis of Pott's disease is mostly based on clinicoradiological observations substantiated by the bacterial culture, staining and histopathology. Since, no single technique is enough to conclude Pott's disease in diagnosis, the present study was undertaken to correlate the clinicoradiological, microbiological, histopathological and molecular method to evaluate the effectiveness in diagnosis of Pott's disease.Materials and Methods:62 clinicoradiologically suspected cases of Pott's disease were included in this study. The specimens for diagnostic work up were collected either during surgery or by computed tomography guided fine needle aspiration. All these specimens were tested for tuberculosis (TB) through Ziehl-Neelsen (ZN) microscopy, BACTEC culture, histopathology and polymerase chain reaction (PCR). The final diagnosis was established by the results of performed tests and clinicoradiological improvement of cases at the end of 6 months on anti tubercular treatment.Results:Out of 62 cases, 7 were excluded from this study as these were turned out to be neoplastic lesions on histopathology. Amongst remaining 55 cases, the TB was diagnosed in 39 (71%) on histopathology, 37 (67.5%) on PCR, 27 (49%) on BACTEC culture and 20 (36.3%) on ZN microscopy. Ultimately 45 cases were tested as positive and 10 were detected as negative for TB in combination of ZN microscopy, BACTEC culture and histopathology. PCR was positive in 37 of 45 cases and 10/55 cases remained negative. On clinical analysis of these 10 cases, it was noted that these were cases of relapse/poor compliance. The combination of PCR and histopathology was also shown positive for TB in 45 cases. Hence, the PCR showed a fair positive agreement (Κc = 0.63) against the combined results of all performed traditional methods.Conclusions:The combination of PCR and histopathology is a rapid and efficient tool for diagnosis of Pott's disease.

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Section: Discussionmentioning

confidence: 99%

The efficacy of diagnostic battery in Pott’s disease: A prospective study

Kumar

Srivastva

et al. 2014

IJOO

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“…The chances of the culture showing growth and demonstrating culture positivity are very low. Spinal TB is a deep-seated lesion where the tissue cannot be procured repeatedly; hence, it is difficult to suspect and diagnose drug resistance 1415. So, our suspicion has to be clinical and radiological, which is not reliable.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis spine: Therapeutically refractory disease

et al. 2012

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Background:India ranks second amongst the high-burden multi drug resistant tuberculosis (MDR-TB) countries, with an estimated incidence of 2.3% MDR-TB cases amongst the new cases and 17.2% amongst the previously treated cases. The diagnosis and treatment protocol for MDR-TB of the spine are not clearly established. We report outcome of a series of 15 cases of TB spine who were suspected to be therapeutically refractory cases (MDR-TB) on the basis of clinicoradiological failures of initial treatment.Materials and Methods:Fifteen cases of TB spine from C2 to L5 spine were suspected to be the cases of MDR-TB (therapeutically refractory cases) on the basis of failures of adequate clinicoradiological healing response at 5 months or more on antitubercular treatment (ATT). None of the patient was immunocompromised. Thirteen out of 15 patients had tissue samples sent for histopathology, culture and sensitivity, smear, BACTEC, and polymerase chain reaction (PCR). All patients were put on second line ATT and followed up fortnightly with regular liver and kidney function tests, erythrocyte sedimentation rate (ESR), and plain X-ray. Healing was documented as subjective improvement of symptoms, reduction in ESR, and observations on contrast enhanced magnetic resonance imaging (MRI) such as resolution of marrow edema, fatty replacement of bone marrow and resolution of abscesses. Ambiguous MRI observations in a few patients were resolved on positron emission tomography (PET) scan. Patients were monitored continuously for 2 years after stopping ATT.Results:We could demonstrate a positive culture in three cases. Two of them had multi drug resistance. We could achieve healing status in 13 out of 14 patients after starting second line drugs, one patient is still on treatment while other patient with no drug resistance is responding well on ATT.Conclusions:The suspicion of therapeutically refractory case is of paramount importance. Once suspected, surgery to procure tissue for diagnosis and culture is to be undertaken. The demonstration of drug resistance on culture may not be achieved in all TB spine cases and empiric drug regimen for MDR-TB is to be started. We have achieved the healed status with immunomodulation and second line ATT. The length of treatment needs to be monitored with MRI and PET scan.

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“…However, there are limitations to the above tests. Serological tests such as ESR, immunoglobulin (Ig) M, and IgG have no diagnostic value 38. ESR is always high in all inflammatory conditions and has been quoted to be 48–84.5 mm/h for TB 3.…”

Section: Discussionmentioning

confidence: 99%

“…PCR does have some limitations such as difficulty in differentiating between living and dead organisms and easy contamination as small amount of contaminating DNA may become amplified. In general, the sensitivity and specificity of PCR have been reported to be 78.6–100% and 71.4–87.1%, respectively 38. Biopsy is the gold standard as it could provide a tissue diagnosis of granulomatous inflammation and caseous necrosis.…”

Section: Discussionmentioning

confidence: 99%

Unusual presentations of osteoarticular tuberculosis in two paediatric patients

Lam

Shek

2012

BMJ Case Reports

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Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae.

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Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis

Cited by 59 publications

References 12 publications

The efficacy of diagnostic battery in Pott’s disease: A prospective study

The efficacy of diagnostic battery in Pott’s disease: A prospective study

Tuberculosis spine: Therapeutically refractory disease

Unusual presentations of osteoarticular tuberculosis in two paediatric patients

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