Scribd
Upload
3 views20 pages

TB Lecture -7

The document provides an overview of extrapulmonary tuberculosis, specifically focusing on skeletal tuberculosis and spinal tuberculosis. It outlines clinical features, investigation methods, complications, and treatment options for spinal TB, emphasizing the importance of early diagnosis and management. The lecture aims to equip students with knowledge about the pathogenesis, symptoms, and radiologic findings associated with spinal TB.

Uploaded by

mohammad278789
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
3 views20 pages

TB Lecture -7

The document provides an overview of extrapulmonary tuberculosis, specifically focusing on skeletal tuberculosis and spinal tuberculosis. It outlines clinical features, investigation methods, complications, and treatment options for spinal TB, emphasizing the importance of early diagnosis and management. The lecture aims to equip students with knowledge about the pathogenesis, symptoms, and radiologic findings associated with spinal TB.

Uploaded by

mohammad278789
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 20

Extrapulmonaey

Tuberculosis
By Assist. Prof. Dr. Najeebullah Rahimy
MD, DTM&H, DEM, MCTM

1
Outlines

• Skeletal Tuberculosis
• Overview
• Spinal Tuberculosis
• Clinical features
• Investigation
• Complications
• Treatment

2
Objectives

• At the end of this lecture, students will be able to;


• Describe clinical features of spinal TB
• Explain pathogenesis of spinal TB
• Write down radiologic findings suggestive for the diagnosis of spinal TB
• List main complications of spinal TB

3
Skeletal
Tuberculosis

4
Overview

• In bone and joint disease, pathogenesis is related to


• Reactivation of hematogenous foci
• Spread from adjacent paravertebral lymph nodes
• Weight-bearing joints are commonly affected
• The spine (40% )
• The hips (13%)
• The knees (10%)
• Spinal tuberculosis (Pott’s disease or tuberculous spondylitis)
often involves two or more adjacent vertebral bodies

5
SPINAL TUBERCULOSIS

• The upper thoracic spine is the most common site in


children
• The lower thoracic and upper lumbar vertebrae are usually
affected in adults.
• From the anterior superior or inferior angle of the vertebral
body, the lesion slowly reaches the adjacent body, later
affecting the intervertebral disk.
• With advanced disease, collapse of vertebral bodies results
in kyphosis (gibbus).

6
Cont. …
• A paravertebral “cold” abscess may
form
• In the upper spine, this abscess may track
to and penetrate the chest wall,
presenting as a soft tissue mass
• In the lower spine, it may reach the
inguinal ligaments or present as a psoas
abscess.

7
Clinical Feature of Spinal TB

• Presentation depends on:


• Stage of disease
• Site
• Presence of complications such as
• Neurologic deficits
• Abscesses
• Sinus tracts
• Average duration of symptoms at the time of diagnosis is 3 – 4 months.
• Back pain is the earliest and most common symptom.
• Constitutional symptoms
• Neurologic symptoms (50 % of cases).

8
Cont. …

• Physical examination of the spine :


 Localised tenderness

 Paravertebral muscle spasm

 Kyphotic deformity

 Cold abscess / swelling / sinus tract

 Cervical spine TB is a less common presentation, characterized by pain & stiffness with
dysphagia / stridor more common in lower cervical spine involvement

9
INVESTIGATION

LAB STUDIES
• Mantoux / Tuberculin skin test
• ESR may be markedly elevated (neither specific nor reliable).
• ELISA: for antibody to mycobacterial antigen-6, sensitivity of 60 to 80%.
• Microbiology studies to confirm diagnosis
• Ziehl-Neelsen staining:
• Quick
• Inexpensive
• Bone tissue or abscess samples
• Culture

10
Cont. …
• RADIOLOGICAL DIAGNOSIS
• Plain Radiograph
• CT Scan
• MRI Spine

11
Cont. …

• More than 50% of bone has to be destroyed.

• May take approximately six months

• The classic roentgen triad in spinal tuberculosis is;


• Primary vertebral lesion
• Disc space narrowing
• Paravertebral abscess

12
13
14
15
Complication of spinal tuberculosis
• Paraplegia
• Cold abscess
• Spinal deformity
• Sinuses
• Secondary infection
• Amyloid disease
• Fatality

16
Treatment

• Etiologic
• Surgical
• Supporting

17
Reference

1. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC,
Friedman LN, et al. American Thoracic Society. Am J Respir Crit Care
Med. 2003;167(4):603-62.
2. Mert A, Bilir M, Tabak F, Ozaras R, Ozturk R, Senturk H, et al. Miliary
tuberculosis: clinical manifestations, diagnosis and outcome in 38
adults. Respirology. Sep 2001;6(3):217-24.
3. Sharma SK, Mohan A, Sharma A, Mitra DK. Miliary tuberculosis: new
insights into an old disease. Lancet Infect Dis. Jul 2005;5(7):415-30.
4. Dennis L. Kasper, Anthony S. Fauci. Extrapulmonary Tuberculosis.
Harrison’s Principles of Internal Medicine, 17th Edition.

18
Cont. …

5. Daniel WF, Timothyr S, David WH. Mycobacterium tuberculosis.


Mandell, Douglas, and Bennett's Principles and Practice of Infectious
Diseases. 7th ed 2010. p.3135.
6. Grange MJ, Zumla AI. Tuberculosis. Manson's Tropical Diseases. 22nd
ed 2010. p.1073-983.
7. Knechel NA. Tuberculosis: Pathophysiology, Clinical Features, and
Diagnosis. Crit Care Nurse 2009; 29:34-43.
8. Nancy A. Knechel. Tuberculosis: Pathophysiology, Clinical Features,
and Diagnosis. Crit Care Nurse 2009; 29:34-43.

19
Thanks for the attention

20

You might also like