Spondylitis TB Presentasi 2
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Transcript of Spondylitis TB Presentasi 2
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Spondylitis TB
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INTRODUCTION
• Evidence of spinal TB dates back to Egyptiantimes and has been docmented in !"""#yea$#oldmmmies%
• In &''() *e$cival *ott pblished the +$st mode$ndesc$iption of spinal defo$mity and pa$aplegia
$eslting f$om spinal TB%
• ,cco$ding to -.O/0""12) abot one thi$d of the3o$ld4s poplation is infected by 5ycobacte$im
TB) and ( million individals develop TB each
yea$%
Tuberculosis of the spine
in an Egyptianmumm
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Cont4d
• Spinal tbe$closis /often called *ott6s disease2 isby de+nition) an advanced disease) $e7i$ingmeticlos assessment and agg$essive systemicthe$apy%
• It is sally seconda$y to lng o$ abdominalinvolvement and may also be the +$stmanifestation of tbe$closis%
• Skeletal involvement of Tb has been $epo$ted to
occ$ in app$o8imately &"9 of all patents 3ithe8t$a#plmona$y tbe$closis)
#and half of these patients develop infection 3ithinthe spinal colmn%
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What Is Spinal Tuberculosis?
• Tuberculosis of the spine, also known as tuberculous spondylitis or Pott'sDisease, is a is an infection of the spine by the 5ycobacte$imtbe$closis bacte$im (TB).
• It sally infects anothe$ a$ea of the body +$st befo$e moving into
the spine%
• Spinal tbe$closis is $a$e in indst$iali:ed cont$ies bt stillcommon in developing nations%
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TB 5anifestations
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E8t$aplmona$y TB
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Symptoms
• Some of the most common symptoms of Pott's Disease are – Back pain
– !e"er
– #i$ht sweats
– %nore&ia
•
This leads to a si$nificant, unhealthy wei$htloss.
• The back pain is sometimes so painful patients will de"elop a mass in thespine which can cause – Tin$lin$
– #umbness
– eakness in the le$s – The deterioration and back pain will cause the sufferer to sit and walk in a ri$id, upri$ht
manner.
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Causes
• Pott's Disease, like other forms of TB, is caused by a mycobacterium whichis spread by way of blood or breathin$ droplets from an infected person into your lun$s where the bacteria will thri"e and $row if not killed by yourimmune system.
• nce in your blood stream, tuberculosis can infect a number of or$ans, each with their own set of symptoms and complications.
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*athogenesis
• In child$en) the main $ote of infection of spinaltbe$closis is th$ogh hematogenos sp$eadf$om a p$ima$y site of infection) 3hich is oftennkno3n%
• , concomitant active plmona$y disease isp$esent in ;!"9 of the cases%
• The mycobacte$im is deposited via the enda$te$ioles in the ve$teb$al body ad
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• -hile the infection is developing) the co$te8 is dis$pted and theinfection may sp$ead p and do3n)
# st$ipping the ante$io$ and poste$io$ longitdinal ligaments andthe pe$iostem f$om the f$ont and sides of the ve$teb$al bodies%
• This $eslts in loss of the pe$iosteal blood spply and dist$action
of the ante$olate$al s$face of the ve$teb$ae%
• Tisse nec$osis and b$eakdo3n of in=ammato$y cells $esltin a pa$aspinal abscess%
• *$og$essive nec$osis of bone leads to a kyphotic defo$mityand >ibbs fo$mation
• The infection then sp$eads to the ad
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Pott’s Disease
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Diagnosis
• Tbe$closis cases the disks in the spine to die and b$eak do3n)3hich often leads to the na$$o3ing of the ve$teb$a and theevental collapse of the spine%
• Radiog$aphs and CT scans of the spine a$e sometimes able to
sho3 tbe$closis of the spine) if p$esent) a bone biopsy 3ill bedone fo$ con+$mation%
• , test is often pe$fo$med to check a patient6s Enth$ocyteSedimentation Rate? a high ESR is a sign of *ott6s Disease%
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*hysical e8amination of thespine
• @ocalised tende$ness and pa$ave$teb$al msclespasms)
• Ayphotic defo$mity)
•
Cold abscess s3elling sins t$act• Ce$vical spine TB is a less common p$esentation)
#cha$acte$i:ed by neck pain stiness 3ithdysphagia st$ido$ mo$e common in lo3e$ce$vical spine involvement%
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S*IN,@ TUBERCU@OSIS
DI,>NOSIS
LAB STUDIES
5anto8 Tbe$clin skin test / p$i+ed p$oteinde$ivative F**DG2
ESR may be ma$kedly elevated /neithe$ speci+cno$ $eliable2%
E@IS, H fo$ antibody to mycobacte$ial antigen#1 )sensitivity of 1" J"9%
*CR H sensitivity of K"9 only%
#The ampli+ed M tuberculosis di$ect test is anisothe$mal t$ansc$iption#mediated ampli+cationthat ta$gets RN,%
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Cont4d
Microbiology stuies to con!rm iagnosis "
Miehl#Neelsen stainingH
#a 7ick and ine8pensive method%
Obtain bone tisse o$ abscess samples tostain fo$ acid#fast bacilli /,B2) isolateo$ganisms fo$ clt$e d$g ssceptibility%
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Cont4d
#ADI$L$%I&AL DIA%'$SIS
&% *@,IN R,DIO>R,*.
0% CT SC,N
% 5RI S*INEK% BONE SC,N
•. TB bacilli a$e $a$ely fond in CS) the$efo$e
imaging plays pivotal $ole in sggesting thediagnosis%
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SP$'D(LITIS TB& ) PA#A *E#TEB#AL ABS&ESS
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PLAI' #ADI$%#AP+
5o$e than !"9 of bone has to be dest$oyedbefo$e a lesion can be seen on P#$ay%
This p$ocess takes app$o8imately si8 months%
The classic P#$ay t$iad in spinal tbe$closis is
#p$ima$y ve$teb$al lesion)
#disc space na$$o3ing and
#pa$ave$teb$al abscess% Skip lesions as involvement of non contigos
ve$teb$ae /' &" 9 cases2%
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DIERENTI,@ DI,>NOSIS
• The die$ential diagnosis of the tbe$clos spineincldesH
&%S*IN,@ INECTIONS# pyogenic) b$cella fngal%
0%NEURO*,T.IC spine
%NEO*@,STIC commonly lymphoma metastasis
K%DE>ENER,TIQE
• No pathognomonic imaging signs allo3
tbe$closis to be $eadily distingished f$omothe$ conditions%
• Biopsy is de+nitive%
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CO5*@IC,TIONS O S*IN,@ TUBERCU@OSIS
• Ne$ological complications pa$aplegia and spinaldefo$mity a$e the most d$eaded complications oftbe$closis of spine%
• Ne$ological complications develop in the active
o$ healed stage of the disease%
• The se7elae of these t3o complications aectthe 7ality and span of life%
Cold abscess
Sinses
Seconda$y infection
atality
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• K#d$g $egimen
• Isonia:id and Rifampin /(#&0 bln2
• ,dd% +$st 0 months /+$st#line d$gs2)py$a:inamide) ethambtol) andst$eptomycin%
• The se of second#line d$gs isindicated in cases of d$g $esistanceci $o=oksasin
5EDIC,@ C,RE
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•
TRE,T5ENT&%chemote$apy conse$vative
0%chemote$apy ope$ation
5EDIC,@ C,RE
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◦ Ne$ologic de+cit /acte ne$ologic dete$io$ation)
pa$apa$esis) pa$aplegia2
◦ Spinal defo$mity 3ith instability o$ pain
◦ No $esponse to medical the$apy /contining
p$og$ession of kyphosis o$ instability2
◦ @a$ge pa$aspinal abscess
◦ Nondiagnostic pe$ctaneos needle biopsy sample
INDIA,SI O*ER,SI
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• ,nte$io$ $adical focal deb$idementand poste$io$ stabili:ation 3ithinst$mentation%0K) &"
• Involves the ce$vical spine) thefollo3ing facto$s IC,@ C,RE
http://www.emedicine.com/Med/topic1902.htmhttp://www.emedicine.com/Med/topic1902.htmhttp://www.emedicine.com/Med/topic1902.htmhttp://www.emedicine.com/Med/topic1902.htm
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BR,CE *OST O*ER,SI
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@apo$an Aass
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T.,NA OU