Spinal tuberculosis in HIV positive and negative patients: immunological response and clinical outcome

Govender, S.; Annamalai, Ken; Kumar, Kush; Govender, Ugene

doi:10.1007/s002640000125

Cited by 26 publications

(11 citation statements)

References 13 publications

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“…Spinal tuberculosis in HIV-infected patients can also be satisfactorily treated with good clinical outcome irrespective of HIV status and treatment with antiretroviral therapy. 102,103 However, there are several important differences between patients with and without HIV infection. These differences include the potential for drug interactions, especially between the rifamycins and antiretroviral agents, paradoxical reactions that may be interpreted as clinical worsening, and the potential for the development of acquired resistance to rifamycins when treated with highly intermittent therapy.…”

Section: Treatment Of Spinal Tuberculosis In Hiv Infectionmentioning

confidence: 99%

Spinal tuberculosis: A review

Garg

Somvanshi

2011

The Journal of Spinal Cord Medicine

636

660

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Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.

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Section: Treatment Of Spinal Tuberculosis In Hiv Infectionmentioning

confidence: 99%

Spinal tuberculosis: A review

Garg

Somvanshi

2011

The Journal of Spinal Cord Medicine

636

660

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“…2,18 Histopathology studies of pulmonary and pleural TB have been performed 18 but exploratory investigations of the spine are rare. 19,20 None of these studies, however, fully explores the role of specific cell types, such as macrophages, as drivers and/or sites of divergent HIV evolution.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Dominant HIV Quasispecies Suggests Independent Viral Evolution Within Spinal Granulomas Coinfected with Mycobacterium tuberculosis and HIV-1 Subtype C

Danaviah

Oliveira

Gordon³

et al. 2016

AIDS Research and Human Retroviruses

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Extrapulmonary tuberculosis (TB) is a significant public health challenge in South Africa and worldwide, largely fuelled by the HIV epidemic. In spinal TB, Mycobacteria infect the spinal column without dissemination to the spinal cord. The immune microenvironment, target cell characteristics, and other evolutionary forces within granulomas during HIV/TB coinfection are poorly characterized. We investigated whether spinal TB granulomas represent a sequestered anatomical site where independent HIV evolution occurs, and assessed the role of macrophages as a target cell for both HIV and mycobacteria. RNA was extracted from plasma and granulomatous tissue from six antiretroviral-naive HIV-1/spinal TB-coinfected patients, RT-PCR amplified, and the C2-V5 env segment was cloned and sequenced. Analysis of genetic diversity, phylogeny and coalescence patterns was performed on clonal sequences. To investigate their role in HIV sequestration, macrophages and the HIV-1 p24 protein were immune localized and ultrastructural features were studied. Intercompartment diversity measurements and phylogenetic reconstruction revealed anatomically distinct monophyletic HIV-1 clusters in four of six patients. Genotypic CCR5-tropic variants were predominant (98.9%) with conservation of putative N-linked glycosylation sites in both compartments. CD68+ reactivity was associated with higher tissue viral load (r = 1.0; p < 0.01) but not greater intrapatient diversity (r = 0.60; p > 0.05). Ultrastructural imaging revealed the presence of bacterial and virus-like particles within membrane-bound intracellular compartments of macrophages. Spinal tuberculosis granulomas may form anatomically discreet sites of divergent viral evolution. Macrophages in these granulomas harbored both pathogens, suggesting that they may facilitate the process of viral sequestration within this compartment.

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“…108 What published data there are suggest that the clinical manifestations of OATB and response to treatment are similar in HIV-positive and HIVnegative individuals even in the absence of anti-retroviral therapy. 77,109 Late mortality may, however, be high 110 and patients with a severely decreased CD4 count may more likely develop spinal tuberculosis. 108 Several papers document the almost legendary longevity of M tuberculosis within sequestered bone lesions.…”

Section: Chemotherapy Of Osteo-articular Tb In Childrenmentioning

confidence: 99%

The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children

2011

Journal of Infection

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Spinal tuberculosis in HIV positive and negative patients: immunological response and clinical outcome

Cited by 26 publications

References 13 publications

Spinal tuberculosis: A review

Spinal tuberculosis: A review

Analysis of Dominant HIV Quasispecies Suggests Independent Viral Evolution Within Spinal Granulomas Coinfected with Mycobacterium tuberculosis and HIV-1 Subtype C

The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children

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