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Management of Spinal Tuberculosis in Young Children
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
S. Rajasekaran, Sri Vijay Anand, Ajoy Prasad Shetty, Rishi Mugesh Kanna
The statement, ‘Children are not miniature adults’, is true in spinal tuberculosis (TB) also. Spinal TB in children differs from that of adults in many ways. Children generally have a paucibacillary disease but have a higher propensity to progress from infection to disease because of their low immunity [1]. The incidence of extrapulmonary tuberculosis is higher in children (20%–25%) as compared to adults [2]. In children, a central type of lesion is more common than a paradiscal lesion, resulting in early and profound vertebral collapse. Spinal tuberculosis in children progresses faster and involves more segments, usually >3 due to its cartilaginous nature [3, 4]. The rapid destruction of immature cartilaginous vertebrae by the disease and ligamentous laxity in children frequently results in kyphotic deformity and buckling. While most deformities of spine worsen with growth, TB kyphosis tends to remain the same, progress, or correct spontaneously [5–7].
Microbiological Diagnosis of Tuberculosis
Published in Nancy Khardori, Bench to Bedside, 2018
Hitender Gautam, Urvashi B. Singh
Other areas that require attention and improvement are diagnosis of pediatric and extrapulmonary tuberculosis. Pediatric tuberculosis is more difficult to diagnose due to the lower yield of AFB smear and culture as is the case with extrapulmonary tuberculosis. Also there is a need for tests to follow and monitor response to treatment of tuberculosis. Management of HIV disease where both host and viral markers are available for monitoring response to drug therapy serves as an optimal example.
Respiratory infections
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
Extrapulmonary tuberculosis is secondary to hematogenous or lymphatic spread of pulmonary lesions and virtually any organ can become infected. Extrapulmonary sites of interest include the gastrointestinal tract (swallowed secretions), the pericardium where tuberculosis can cause a constrictive pericarditis, the pleural space (pleural tuberculosis), and the bones including the spine (Pott's disease).
Nontubercular Mycobacteria Associated Uveitis in HIV Positive Patients
Published in Ocular Immunology and Inflammation, 2022
Kusum Sharma, Nitin Menia, Priya Bajgai, Megha Sharma, Aman Sharma, Deeksha Katoch, Ramandeep Singh
PCR is a fast, sensitive, and specific method of detection of tuberculosis as well as NTM. These methods are useful for diagnosis in extrapulmonary tuberculosis where samples (purulent secretions or fluids) have low bacterial load. Studies have shown the utility of PCR in diagnosis of intraocular tuberculosis.16,17 However, the literature regarding the use of PCR studies in diagnosis of uveitis due to NTM is sparse.1,12,17 In the present series, the diagnosis was confirmed in all patients based on molecular PCR studies in which M. avium was detected in 3 cases and M. fortuitum was detected in one case (Figure 3). Out of these four PCR positive cases, culture was positive later on in two cases and it was confirmed as M. avium isolate and M. fortuitum isolate on sequencing carried out from DNA extracted from culture. A study from South India by Lalitha et al.16 showed varied manifestations of NTM infections. They reported culture proven cases of corneal infections, endophthalmitis, and suture abscesses due to NTM infections.16 They reported poor visual outcomes in anterior as well as posterior segment involvement in their patients similar to the current study.
Adjacent segment degeneration and spinal cord compression in rigid angular kyphosis of spinal tuberculosis and its intraoperative management strategy
Published in The Journal of Spinal Cord Medicine, 2021
Xinghuo Wu, Guang Xiong, Wenbin Hua, Kun Wang, Shuai Li, Yunkun Zhang, Cao Yang
Tuberculosis (TB) is a common infectious disease, and the most common form of extrapulmonary tuberculosis is spinal tuberculosis. Tuberculous spondylitis is the main cause of severe angular kyphosis in the developing countries.1 Tuberculosis of the spine may develop late-stage neurologic deficit due to chronic spinal cord compression from the progressive severe angular deformity.2 Posttuberculosis kyphotic deformity usually occurs at the region of thoracolumbar junction, followed by middle and lower thoracic spine. Thoracolumbar tuberculosis shows a significantly higher risk for severe deformity than lumbar or lumbosacral lesions.3 Posttuberculosis kyphotic deformity usually can result in spinal biomechanical changes and spinal cord compression. Subsequent back pain, neurological symptoms, and functional disability are common in patients with a progressive kyphotic deformity in spinal tuberculosis.4,5 In this situation, nonoperative treatment is not adequate, and surgical treatment may be required.
Clinical profiling and management outcome of atypical skull base osteomyelitis
Published in British Journal of Neurosurgery, 2020
Urvashi Singh, Shruti Venkitachalam, Rayappa Chinnusamy
Patients were followed up until resolution of disease. The point of resolution of disease was based on complete improvement of symptoms and/or no residual foci of disease on follow-up MRI of skull base. Duration of follow-up ranged from 2 weeks to 1 year. Patients were reviewed every 2 weeks, and earlier if sudden progression of symptoms was noted. The average duration of follow-up was around 12 weeks. Antibiotic therapy was altered based on response. One patient diagnosed with Ciprofloxacin resistant Pseudomonas aeruginosa required a follow-up of 1 year for complete resolution; he showed poor response to intravenous antibiotic and oral anti-fungal therapy at the end of 6 months follow-up. In view of clinical deterioration, patient was started on anti-tubercular Directly Observed Treatment - Short Course (DOTS) therapy as per Revised National Tuberculosis Control Program (RNTCP) protocol for category I (extra-pulmonary tuberculosis) for a duration of 6 months. At the end of 12th month follow-up, patient showed marked clinical improvement with resolution of disease on follow-up MRI of skull base. One out of the 10 patients had residual disease related neurological deficit at the time of last follow up.