Paraspinal abscess secondary to tuberculous spondylitis diagnosed by Xpert MTB/RIF assay in rural Tanzania

Hella, Jerry; Hiza, Hellen; Mfinanga, Elirehema; Reither, Klaus

doi:10.1136/bcr-2013-009156

Cited by 3 publications

(2 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The speed of reporting is a major advantage of GeneXpert. 6 , 63 , 64 It should be noted that routine drainage of abscesses is not recommended, as this may result in sinus formation. 20 , 65 , 66 …”

Section: Resultsmentioning

confidence: 99%

Could an increase in vigilance for spinal tuberculosis at primary health care level, enable earlier diagnosis at district level in a tuberculosis endemic country?

Galloway¹,

Parker

2018

Afr. j. prim. health care fam. med.

View full text Add to dashboard Cite

BackgroundExpert clinicians and researchers in the field of spinal tuberculosis (STB) advocate for early identification and diagnosis as a key to reducing disability, severity of disease, expensive surgery and death, especially in tuberculosis (TB) endemic countries like South Africa. South Africa has the highest incidence per capita of tuberculosis in the world, and a conservative estimate of the incidence of STB in South Africa is 8–16:100 000. People living with STB may initially present to primary health care (PHC) centres, where the opportunity exists for early identification. Spinal pain is the most common presentation of STB, but even this symptom may not be present. Occasionally the only symptoms are neurological injury, dysphagia or referred pain. Computerised tomography-guided biopsy remains the diagnostic gold standard for STB.AimA narrative review was undertaken to investigate the evidence available that could assist with the early diagnosis of STB.MethodArticles were searched for and retrieved from three databases and assessed for quality and relevance to primary settings in a TB endemic country.ResultsThe following evidence-based, affordable and available tools could facilitate early diagnosis of STB at PHC and district hospital levels: (1) back pain screening questions, undressed spinal physical examination, HIV and antiretroviral therapy history, (2) erythrocyte sedimentation rate, C-reactive protein, platelets, haemoglobin, white cell count (WCC), sputum for GeneXpert and accurate weight measurement, (3) physiotherapy and/or medical and/or speech therapy assessment, (4) full spinal radiograph, chest radiograph, abdominal ultrasound, urine lipoarabinomannan (LAM) if CD4 < 200 and ultrasound-guided biopsy of superficial abscesses, (5) clear referral guidelines at all levels, (6) a positive response to treatment to confirm the diagnosis.ConclusionThese affordable and simple actions at PHC and district levels could facilitate earlier diagnosis of STB.

show abstract

Section: Resultsmentioning

confidence: 99%

Could an increase in vigilance for spinal tuberculosis at primary health care level, enable earlier diagnosis at district level in a tuberculosis endemic country?

Galloway¹,

Parker

2018

Afr. j. prim. health care fam. med.

View full text Add to dashboard Cite

show abstract

“…Non-automated nucleic acid amplification assays have reported sensitivities of 61 -83% for musculoskeletal TB. [5][6][7][8][9] Only a few studies have investigated GeneXpert MTB/RIF for musculoskeletal disease, including a case report, [10] a small study on 71 spinal samples that we undertook, [11] and another study on 29 spinal tissue samples. [12] GeneXpert MTB/RIF had sensitivities of 72% and 82% in HIV-uninfected and HIV-infected patients, respectively; however, the reference standard in the study [12] was based on clinical and radiological findings only.…”

Section: Researchmentioning

confidence: 99%

Diagnostic accuracy of GeneXpert MTB/RIF in musculoskeletal tuberculosis: High sensitivity in tissue samples of HIV-infected and HIV-uninfected patients

et al. 2017

View full text Add to dashboard Cite

Corresponding author : M Held (michael.held@uct.ac.za) Background. GeneXpert MTB/RIF is useful for the diagnosis of pulmonary TB in adults, but there is limited evidence on its usefulness in extrapulmonary TB. Objectives. To investigate the diagnostic accuracy of GeneXpert MTB/RIF in HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB. Methods. A prospective study of patients with suspected musculoskeletal (bone and joint) TB was undertaken. The diagnostic accuracy of GeneXpert MTB/RIF was compared with the reference standards of culture and histopathology. Results. A total of 206 biopsies from 201 patients (23% HIV-infected) were evaluated. The sensitivity and specificity of GeneXpert MTB/ RIF was 92.3% (84/91) and 99.1% (114/115), respectively. GeneXpert MTB/RIF detected 8.8% more cases than culture (84/91 (92.3%) v. 76/91 (83.5%), respectively; p=0.069). GeneXpert MTB/RIF also detected all 4 multidrug-resistant TB cases and an additional 2 rifampicinresistant cases in culture-negative samples. The sensitivity of GeneXpert MTB/RIF in HIV-infected patients was 96.9% (31/32) v. 89.6% (43/48) in HIV-uninfected patients (p=0.225). Conclusion. GeneXpert MTB/RIF is an accurate test for the detection of TB in tissue samples of HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB. A positive GeneXpert MTB/RIF result should be regarded as microbiological confirmation of TB.

show abstract

Tuberculous spondylitis diagnosed through Xpert MTB/RIF assay in urine: a case report

et al. 2016

View full text Add to dashboard Cite

BackgroundExtrapulmonary tuberculosis (EPTB) is associated with high rates of morbidity and mortality. Diagnosis of EPTB is challenging in resource-limited settings due to difficulties in obtaining samples, as well as the paucibacillarity of the specimens. Skeletal tuberculosis accounts for 10–35 % of EPTB cases, with vertebral osteomyelitis (Pott’s disease) representing 50 % of the cases. We present two cases of suspected Pott’s disease, diagnosed through GeneXpert MTB/RIF assay in urine at a rural Tanzanian hospital.Case PresentationCase IA 49-year old male, HIV-1 positive, on co-formulated tenofovir disoproxil fumarate/lamivudine/efavirenz since 2009 and CD4 counts of 205 cells/μL (13 %). He presented with lower back pain and progressive lower limb weakness for two weeks prior to admission. The physical examination revealed bilateral flaccid paraplegia with reduced reflexes, but otherwise unremarkable findings. A lateral lumbar X-ray showed noticeable reduction of intervertebral space between L4 and L5, and a small calcification in the anterior longitudinal ligament between L4 and L5, being compatible with focal spondylosis deformans but inconclusive with regard to tuberculous spondylitis. An abdominal ultrasound showed normal kidneys, bladder and prostate gland. The urinalysis and complete blood counts (CBC) were normal. M. Tuberculosis was detected through GeneXpert MTB/RIF in centrifuged urine, with no resistance to rifampicin.Case IIA 76-year old female, HIV-1 negative, presented with lower back pain and progressive weakness and numbness of the lower limbs for two months prior to admission. The physical examination revealed paraplegia, but otherwise unremarkable findings. The lumbosacral X-ray findings were compatible with spondylosis deformans of the lumbar spine and possible tuberculous spondylitis in L3-L4. The abdominal and renal ultrasound showed normal kidneys and bladder. The urinalysis and CBC were normal. M. Tuberculosis was detected through GeneXpert MTB/RIF in centrifuged urine, with no resistance to rifampicin.ConclusionWe report two cases of suspected tuberculous spondylitis diagnosed through Xpert MTB/RIF in urine samples from a rural Tanzanian hospital. Urine testing using Xpert MTB/RIF reflects disseminated disease and renal involvement, and may offer a feasible additional diagnostic approach for Pott’s disease in rural Africa.

show abstract

Paraspinal abscess secondary to tuberculous spondylitis diagnosed by Xpert MTB/RIF assay in rural Tanzania

Cited by 3 publications

References 16 publications

Could an increase in vigilance for spinal tuberculosis at primary health care level, enable earlier diagnosis at district level in a tuberculosis endemic country?

Could an increase in vigilance for spinal tuberculosis at primary health care level, enable earlier diagnosis at district level in a tuberculosis endemic country?

Diagnostic accuracy of GeneXpert MTB/RIF in musculoskeletal tuberculosis: High sensitivity in tissue samples of HIV-infected and HIV-uninfected patients

Tuberculous spondylitis diagnosed through Xpert MTB/RIF assay in urine: a case report

Contact Info

Product

Resources

About