Child and adult spinal tuberculosis at tertiary hospitals in the Western Cape, South Africa: 4-year burden and trend

Abstract

The aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year (P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6–4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.

Loss to follow-up among patients diagnosed with spinal tuberculosis at a tertiary hospital in Western Cape Province, South Africa: A retrospective cohort study

“…[3][4][5][6] Progression of the disease is associated with significant morbidity, with previous reports suggesting spinal deformity in 16 -77% of cases and neurological deficits due to compression of the spinal cord in 33 -73%. [4][5][6][7] Early diagnosis and adequate TB treatment are key factors in optimising outcomes. [5] Western Cape Province, South Africa (SA), has one of the highest burdens of TB worldwide, with 681 notified cases per 100 000 population and an HIV co-infection rate of 38.5% in 2015.…”

“…[8] In this setting, spinal TB is comparatively common, with at least 393 cases seen at tertiary hospitals in the province between 2012 and 2015 and an estimated incidence of 1.22 -2.57 cases per 100 000 over this period. [7] Drug-resistant spinal TB was established in 9% of cases. [7] While health policy specifically addressing spinal TB is currently lacking, established practice in the province has been to refer patients with suspected spinal TB to specialist orthopaedic services for diagnosis, including an in-theatre spine biopsy.…”

“…[7] Drug-resistant spinal TB was established in 9% of cases. [7] While health policy specifically addressing spinal TB is currently lacking, established practice in the province has been to refer patients with suspected spinal TB to specialist orthopaedic services for diagnosis, including an in-theatre spine biopsy. [3,7] TB treatment is typically initiated in hospital and then continued at a local primary healthcare clinic upon discharge.…”

“…[7] While health policy specifically addressing spinal TB is currently lacking, established practice in the province has been to refer patients with suspected spinal TB to specialist orthopaedic services for diagnosis, including an in-theatre spine biopsy. [3,7] TB treatment is typically initiated in hospital and then continued at a local primary healthcare clinic upon discharge. Patients are treated with a combination preparation of rifampicin, isoniazid, ethambutol and pyrazinamide throughout the course of treatment, although this approach is informed by clinical experience rather than controlled trials.…”

“…These patients formed part of a larger, finite population of 319 adults diagnosed with spinal TB at tertiary hospitals in the Western Cape over the 4-year period, with further details of case identification and diagnosis described elsewhere. [7] This lengthy study period and systematic inclusion of patients was necessary, given the comparatively low incidence of spinal TB. [7] The follow-up period was 2 years from diagnosis to allow for 9 -18 months of treatment plus the standard post-treatment assessment.…”