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Guo LL, Liu HK, Cao JF, Zhang HX, Li B, Li T, Li L. Senility, defecation disorders, sleep disorders, and non-operative spinal infections: A single-center retrospective analysis. World J Orthop 2025; 16:103388. [PMID: 40290607 PMCID: PMC12019144 DOI: 10.5312/wjo.v16.i4.103388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 02/21/2025] [Accepted: 03/21/2025] [Indexed: 04/17/2025] Open
Abstract
BACKGROUND Non-operative spinal infections (NOSI) are caused by tuberculosis, brucella, and other specific bacteria. The etiology of the disease is insidious, the onset is slow and the diagnosis and treatment are difficult. Identifying the factors associated with spinal infection and early intervention can reduce the occurrence of the disease. At present, the research mainly focuses on the accurate diagnosis and treatment of spinal infection, and there are few studies on the prevention of spinal infection. The concept of "preventive treatment of diseases" in traditional Chinese medicine may help identify the causes and reduce the occurrence of NOSI. AIM To determine the association of age, bowel movements, and sleep patterns with NOSI. METHODS Data of 69 NOSI patients and 84 healthy controls in a tertiary hospital from January 2019 to June 2024 were collected. Patients with NOSI had imaging evidence (magnetic resonance imaging) of spinal infections (including infections caused by tuberculosis, brucopathy, and other pathogens) and had no history of spinal surgery in the last 1 year were included in the analysis. Patients with spinal infection due to spinal surgery are excluded in the study. Data including age, sex, place of residence, sleeping status, and bowel movements were collected. SPSS22.0 was used for correlation analysis of all data. RESULTS The mean age of the NOSI group and the control group was 63.55 ± 14.635 years and 59.18 ± 17.111 years, respectively, without statistical difference (P = 0.096). There was also no statistically significant difference in gender between the two groups. In the NOSI group, 45 (65.22%) were over 60 years old, and 44 (63.77%) were rural residents. Compared with the control group, the NOSI group had more patients with sleep disorder and defecation disorder, accounting for 69.57% and 68.12%, respectively, with significant statistical difference (both P < 0.001). Regression analysis showed that defecation and sleep disorders were closely related to NOSI (both P < 0.001). CONCLUSION Most patients with NOSI are older and have sleep disorders and abnormal defecation.
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Affiliation(s)
- Ling-Ling Guo
- Department of Orthopaedics of Integrated Traditional Chinese and Western Medicine, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Hong-Kun Liu
- Department of Orthopaedics of Integrated Traditional Chinese and Western Medicine, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Jin-Feng Cao
- Department of Radiology, Zibo Central Hospital, Zibo 255036, Shandong Province, China
| | - Hai-Xia Zhang
- Telemedicine Consultation Center, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Bo Li
- Department of Orthopaedics of Integrated Traditional Chinese and Western Medicine, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Tong Li
- Department of Traditional Chinese Medicine, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Liang Li
- Department of Traditional Chinese Medicine, Zibo Central Hospital, Zibo 255000, Shandong Province, China
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Jiang G, Tang Y, Xiang S, Wang Q, Zhao D, Du X, Hao J, Hu Z. Sclerotic Bone Adversely Affects Anti-Tuberculosis Drug Distribution in Patients with Spinal Tuberculosis: A Prospective Cross-Sectional Study. J Bone Joint Surg Am 2025; 107:e17. [PMID: 39899645 PMCID: PMC11905907 DOI: 10.2106/jbjs.24.00453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2025]
Abstract
BACKGROUND The effects of sclerotic bone on anti-tuberculosis (anti-TB) drug distribution in the blood and in spinal tuberculosis (STB) lesions were investigated. METHODS Fifty-six patients with STB were prospectively enrolled from January 2020 to March 2023 and were divided into 2 groups: a group with sclerotic bone and a group without sclerotic bone, as identified on preoperative computed tomography (CT) scans. Individuals in the sclerotic bone group were further divided into fragmentary and non-fragmentary sclerotic bone groups. The patients underwent surgery, and blood was collected along with normal vertebral and STB-lesion-containing bone tissue samples. Following treatment, the samples were processed by a pharmacological laboratory in order to detect the concentrations of anti-TB drugs, including pyrazinamide, rifampicin, isoniazid, and ethambutol. RESULTS Twenty-seven East Asian female and 29 East Asian male patients with STB were included in this study. The levels of anti-TB drugs showed a progressive decrease with increased circulatory distance, from blood to normal vertebral tissue to TB lesions, across all patient groups. Drug concentrations in TB lesions in the sclerotic bone group were significantly lower than those in the non-sclerotic bone group, as were concentrations in TB lesions in the non-fragmentary sclerotic bone group relative to those in the fragmentary sclerotic bone group. Drug levels in the blood and in normal vertebral bone tissue did not significantly differ between the sclerotic and non-sclerotic groups, nor between the fragmentary and non-fragmentary groups. Drug levels in the blood were linearly correlated with those in TB lesions in both the non-sclerotic bone group and the fragmentary sclerotic bone group. CONCLUSIONS These results indicate that sclerotic bone negatively affects the dissemination of anti-TB drugs, with non-fragmentary sclerotic bone posing a greater obstacle than fragmentary sclerotic bone. In patients with STB without sclerotic bone or with fragmentary sclerotic bone, anti-TB drug levels in the blood were linearly correlated with drug levels in STB lesions. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Guanyin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yuchen Tang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shanlin Xiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qiufu Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Dezhang Zhao
- College of Pharmacy, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jie Hao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhenming Hu
- Department of Orthopaedic Surgery, The University-Town Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Manske J, Tille E, Schlüßler A, Biewener A, Nowotny J. Tuberculosis of the elbow joint: the complexity of diagnosis and treatment-A case report and review of literature. J Med Case Rep 2025; 19:88. [PMID: 40025616 PMCID: PMC11874434 DOI: 10.1186/s13256-025-05102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/02/2025] [Indexed: 03/04/2025] Open
Abstract
BACKGROUND Tuberculosis is one of the deadliest diseases worldwide, with an estimated incidence of more than 10 million new cases annually. As part of bone and joint tuberculosis (5-6% of all extrapulmonary tuberculosis cases), elbow tuberculosis is a rare manifestation-especially in the Western world-and is associated with nonspecific symptoms such as swelling, redness, and painful limitation of motion. This often leads to initial misdiagnoses, such as septic arthritis or rheumatoid arthritis, resulting in a significant delay in diagnosis and treatment. CASE PRESENTATION A 27-year-old male patient from Bangalore, South India presented with left elbow pain and restricted motion. The clinical and imaging findings led to the suspicion of olecranon bursitis. Intraoperatively, joint tuberculosis was suspected; therefore, multiple tissue samples were taken and a diagnostic routine according to guidelines was initiated. The tuberculosis-specific interferon gamma test was positive and thus confirmed the patient's previous contact with Mycobacterium tuberculosis. Since extrapulmonary tuberculosis is often caused by multidrug-resistant mycobacterial strains, tuberculostatic therapy was started after obtaining the resistogram. Under the initiated therapy, a reduction in synovial inflammation on magnetic resonance imaging and a rehabilitation of the mobility of the elbow were achieved over a period of more than 15 months. CONCLUSION The basis for finding the diagnosis is a detailed, interdisciplinary diagnostic process, especially in patients with persisting unspecific symptoms, since joint tuberculosis is frequently the only site of manifestation. Despite the slow growth of mycobacteria, the microbiological findings, particularly the resistogram, should be awaited since extrapulmonary tuberculosis is often multidrug resistant. As shown in this case, surgical treatment is important for reliable diagnosis, including pathogen identification, but it is not mandatory for successful healing and regaining functionality of the affected joint.
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Affiliation(s)
- J Manske
- University Center for Orthopaedics, Trauma and Plastic Surgery, Shoulder and Elbow Section, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany.
| | - E Tille
- University Center for Orthopaedics, Trauma and Plastic Surgery, Shoulder and Elbow Section, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany
| | - A Schlüßler
- University Center for Orthopaedics, Trauma and Plastic Surgery, Shoulder and Elbow Section, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany
| | - A Biewener
- University Center for Orthopaedics, Trauma and Plastic Surgery, Shoulder and Elbow Section, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany
| | - J Nowotny
- University Center for Orthopaedics, Trauma and Plastic Surgery, Shoulder and Elbow Section, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany
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Xie S, Luo M, Li G, Xiao H. Retrospective evaluation of combined anterior and posterior surgery with autologous tricortical iliac and rib bone grafting for severe kyphotic deformity in thoracic spinal tuberculosis. Neurochirurgie 2025; 71:101635. [PMID: 39800217 DOI: 10.1016/j.neuchi.2025.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 12/22/2024] [Accepted: 12/31/2024] [Indexed: 01/15/2025]
Abstract
BACKGROUND Spinal tuberculosis is a common cause of spinal deformity and neurological dysfunction, with surgical treatment being crucial in severe cases. This study evaluates the efficacy and safety of combined anterior and posterior surgery with autologous tricortical iliac bone and rib grafting for treating spinal tuberculosis. METHODS We included 61 patients with thoracic tuberculosis, who underwent a surgical procedure involving initial posterior correction, followed by anterior debridement and reconstruction with autologous tricortical iliac bone and rib grafts. The surgical outcomes were assessed using preoperative and final follow-up visual analogy scale (VAS) scores, kyphotic Cobb angle, ASIA scores, and radiographic evaluations. Perioperative complications were recorded. RESULTS Preoperative VAS scores were 6.65 ± 1.06, significantly decreasing to 2.63 ± 0.94 at the final follow-up (P < 0.001). The kyphotic Cobb angle improved from 26.28° ± 4.45° preoperatively to 12.05° ± 2.02° at the final follow-up (P < 0.001). Neurological function improved, with ASIA grade E increasing from 56 patients preoperatively to 59 at follow-up, and all patients achieved bony fusion at the final follow-up. The incidence of perioperative complications was 13.11%, primarily including deep vein thrombosis, superficial wound infections, and urinary tract infections, all of which resolved with symptomatic treatment. CONCLUSIONS Combined anterior and posterior surgery with autologous tricortical iliac bone and rib grafting is an effective method for treating spinal tuberculosis, significantly alleviating pain, correcting deformity, improving neurological function, and promoting bony fusion.
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Affiliation(s)
- Shiwei Xie
- Department of Orthopedic Surgery, Panzhihua Central Hospital, Sichuan Province, Panzhihua City, 617067, China
| | - Mingwei Luo
- Department of Orthopedic Surgery, Panzhihua Central Hospital, Sichuan Province, Panzhihua City, 617067, China
| | - Gengwu Li
- Department of Orthopedic Surgery, Panzhihua Central Hospital, Sichuan Province, Panzhihua City, 617067, China.
| | - Heng Xiao
- Department of Orthopedic Surgery, Panzhihua Central Hospital, Sichuan Province, Panzhihua City, 617067, China.
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Misra R, Singh AK, Neyaz Z, Singh VK, Paliwal VK, Mishra P. Role of Gene Xpert MTB/RIF assay for detecting tuberculous spondylitis in specimens obtained by CT-guided aspiration/biopsy and spectrum of imaging findings in spinal tuberculosis. Indian J Tuberc 2025; 72:61-68. [PMID: 39890373 DOI: 10.1016/j.ijtb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2025]
Abstract
OBJECTIVE To evaluate the utility of the GeneXpert MTB/RIF assay for the diagnosis of tuberculous spondylitis in samples obtained by CT-guided aspiration/biopsy. The effect of anti-tubercular treatment, specimen type, and imaging findings on laboratory results was also assessed along with a comparison of imaging findings in tubercular versus non-tubercular cases. METHODS This prospective observational study, planned for CT-guided aspiration/ biopsy, included 70 adults with suspected tuberculous spondylitis. Specimens were sent for microscopy, histopathology, TB culture, and Gene Xpert MTB/RIF assay. The correlation of sampling location, specimen type, anti-tubercular treatment, and imaging findings on microbiology results was documented. RESULTS A definite diagnosis of tuberculous spondylitis was obtained in 50 cases. The assay had a 100 % agreement for smear-positive, culture-positive, specimens while the overall agreement was 41.3 %. Rifampicin resistance was detected in 8 cases. Seventy-one percent of patients were on empiric ATT. Imaging findings such as end plate destruction, paravertebral soft tissue thickening and abscess, disc involvement, sequestrum, and bony fragments were significantly associated with a final diagnosis of spinal tuberculosis. CONCLUSIONS The Gene Xpert MTB/RIF assay performed on specimens obtained by CT-guided aspiration/biopsy is a sensitive and rapid method of establishing a diagnosis of tuberculous spondylitis even in cases on ATT.
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Affiliation(s)
- Richa Misra
- Department of Microbiology, Division Mycobacteriology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Anil Kumar Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Zafar Neyaz
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Vivek Kumar Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Vimal K Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. PIN-226014
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Gan J, Zhang C, Tang D, Du X. Surgical treatment of spinal tuberculosis: an updated review. Eur J Med Res 2024; 29:588. [PMID: 39695719 DOI: 10.1186/s40001-024-02198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 12/04/2024] [Indexed: 12/20/2024] Open
Abstract
Tuberculosis (TB) is a worldwide disease which seriously affects the global public health. Spinal TB is the most common extra-pulmonary TB and may cause vertebral bone destruction, collapse, kyphosis and even paralysis. Anti-TB chemotherapy is considered the cornerstone treatment of spinal TB and surgery is often required for patients with severe kyphosis, impaired neurological function or spinal instability. Debridement of TB lesions, bone grafting and internal fixation are the key procedures of spinal TB surgery. However, the selection of surgical approach, the extent of TB lesion debridement, the choice of bone graft materials, and the method and extent of internal fixation are all remain controversy. The aim of this updated review is to evaluate current literature for advances in management of spinal TB, with particular focus on surgical techniques.
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Affiliation(s)
- Jinjing Gan
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Chuanzhi Zhang
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Dagang Tang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 YouYi Road, Yuanjiagang, Yu Zhong District, Chongqing, 400016, China
- Chongqing Municipal Health Commission Key Laboratory of Musculoskeletal Regeneration and Translational Medicine, Chongqing, 400016, China
- Orthopaedic Research Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Xing Du
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 YouYi Road, Yuanjiagang, Yu Zhong District, Chongqing, 400016, China.
- Chongqing Municipal Health Commission Key Laboratory of Musculoskeletal Regeneration and Translational Medicine, Chongqing, 400016, China.
- Orthopaedic Research Laboratory of Chongqing Medical University, Chongqing, 400016, China.
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Hang L, Haibier A, Kayierhan A, Liu Y, Abudurexiti T. A Comparative Study of Anterior and Posterior Tuberculosis Lesions for the Treatment of Thoracolumbar Tuberculosis disease: A Single Institution Experience in a Major Academic Hospital. Infect Drug Resist 2024; 17:5375-5386. [PMID: 39649429 PMCID: PMC11625419 DOI: 10.2147/idr.s495231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 11/25/2024] [Indexed: 12/10/2024] Open
Abstract
Objective To compare the efficacy of anterior and posterior surgery for thoracolumbar tuberculosis disease. Methods Clinical data of 30 patients with thoracolumbar tuberculosis disease undergoing anterior and posterior surgery from January 2021 to December 2023 were collected for a retrospective study. According to the two surgical procedures, patients were divided into two groups: 1) anterior group (n=15) and 2) posterior group (n=15). We compared the two groups regarding age, gender, body mass index, affected segments, past history (cardiovascular and cerebrovascular diseases, respiratory diseases, endocrine system diseases, metabolic diseases, and tuberculosis history), smoking history, drinking history, operation time, postoperative bleeding, postoperative drainage, postoperative time, postoperative complications (dural tear, lower limb intermuscular vein thrombosis, lower limb deep vein thrombosis, sinus infection, postoperative recurrence rate), and waist VAS score before and after surgery, waist ODI score, and JOA score. Results The intraoperative blood loss was significantly less in the posterior group than in the anterior group, and the difference was significant (P <0.05); the lumbar VAS score was lower in the posterior group than in the anterior group, and the difference between the two groups was significant (P <0.05). The analysis of the remaining data showed no significant difference between the two groups (P> 0.05), indicating that the efficacy of the two procedures was the same. Conclusion In the treatment of thoracolumbar tuberculosis disease, there is no significant difference in the clinical efficacy of anterior surgery and posterior surgery. Intraoperative bleeding in posterior surgery was less than in anterior surgery, but the latter showed a significant improvement in postoperative pain relief. Therefore, spinal surgeons should choose the corresponding surgical treatment according to the actual situation of the patient in order to maximize the efficacy.
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Affiliation(s)
- Lin Hang
- Minimally Invasive Spinal Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
| | - Abuduwupuer Haibier
- Minimally Invasive Spinal Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
| | - Aiben Kayierhan
- Minimally Invasive Spinal Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
| | - Yuntao Liu
- Minimally Invasive Spinal Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
| | - Tuerhongjiang Abudurexiti
- Minimally Invasive Spinal Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China
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Qin X, Qin B, Zhou C, Liu C, Chen T, Zhu J, Huang C, Wu S, He R, Wu S, Feng S, Chen J, Xue J, Wei W, Chen L, He K, Qin Z, Zhou T, Ma J, Zhan X. A Multi Center, Epidemiological Study of Bone Tuberculosis in Southwest China from 2011 to 2023. J Epidemiol Glob Health 2024; 14:1678-1692. [PMID: 39556304 PMCID: PMC11652554 DOI: 10.1007/s44197-024-00325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 11/12/2024] [Indexed: 11/19/2024] Open
Abstract
BACKGROUND Despite continued efforts to manage and control Tuberculosis (TB) in China, it remains a major health concern. Bone tuberculosis (Bone-TB), a common form of extrapulmonary tuberculosis, still adds considerably to the global TB case load. Diagnosing Bone-TB is often difficult as its symptoms can be similar to other bone or joint diseases, which leads to delayed detection and treatment. Currently, comprehensive reports on the epidemiological aspects of Bone-TB in China are scarce. METHODS This retrospective study analyzed demographic and clinical data from 2,191 patients diagnosed with Bone-TB in Southwest China between January 2011 and September 2023.This study fully reveals the characteristics of Bone-TB in Southwest China. RESULTS The overall trend of bone tuberculosis was a slow rise. Among 2191 patients, males, farmers, aged 42-68 years, and people with HIV and diabetes are the priority groups for the prevention and treatment of Bone-TB. The majority of the infected spines (1556/2191) were located in the thoracic vertebra (759/2191) and lumbar vertebra (715/2191). Forty-nine (2.24%) patients had drug-resistant TB (DR-TB). Forty-five (2.05%) died during the treatment. The total and actual hospitalization. Costs amounted to $3,837.10 and $1,914.35 (p < 0.01). Patients with DR-TB incurred the highest costs, amounting to $4,968.37. Cervical TB, with a prevalence of 5 patients (6.10%), exhibited the highest rates of catastrophic expenditures. CONCLUSIONS From 2011 to 2023, the yearly occurrence of Bone-TB in southwestern China exhibited a rising pattern, marked by notable distinctions in terms of gender, age, and regional variations, indicating localized clustering characteristics.
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Affiliation(s)
- Xiaopeng Qin
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Boli Qin
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Chenxing Zhou
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Chong Liu
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Tianyou Chen
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jichong Zhu
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Chengqian Huang
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Shaofeng Wu
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Rongqing He
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Songze Wu
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Sitan Feng
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jiarui Chen
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jiang Xue
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Wendi Wei
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Liyi Chen
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Kechang He
- The Fourth People's Hospital of Nanning, No. 1, Lane 2, Changgang Road, Nanning, 530023, Guangxi, People's Republic of China
| | - Zhendong Qin
- The Fourth People's Hospital of Nanning, No. 1, Lane 2, Changgang Road, Nanning, 530023, Guangxi, People's Republic of China
| | - Tiejun Zhou
- The Fourth People's Hospital of Nanning, No. 1, Lane 2, Changgang Road, Nanning, 530023, Guangxi, People's Republic of China
| | - Jie Ma
- The Fourth People's Hospital of Nanning, No. 1, Lane 2, Changgang Road, Nanning, 530023, Guangxi, People's Republic of China.
| | - Xinli Zhan
- The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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Jeyaraman M, Jeyaraman N, Ram PR, Muthu S, Jain VK, Iyengar KP. Decoding the hidden realm: Molecular pioneering unravelling osteoarticular tuberculosis diagnosis. J Clin Orthop Trauma 2024; 56:102538. [PMID: 39318541 PMCID: PMC11417564 DOI: 10.1016/j.jcot.2024.102538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 08/28/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024] Open
Abstract
Osteoarticular tuberculosis (TB), a form of extrapulmonary tuberculosis, refers to the involvement of Mycobacterium tuberculosis (M.tb) in the bones and joints. While pulmonary tuberculosis is the most common form, osteoarticular TB represents a relatively rare but significant manifestation, accounting for approximately 1-3% of all TB cases. Accurate and timely diagnosis plays a pivotal role in the management of osteoarticular TB. Conventional diagnostic methods for osteoarticular TB, such as acid-fast bacilli smear microscopy and culture, have limitations in terms of sensitivity, specificity, and turnaround time. The purpose of this review is to comprehensively evaluate and synthesize the existing literature on molecular pioneering in osteoarticular TB diagnosis. Molecular techniques, such as nucleic acid amplification tests and gene-based assays, have emerged as promising tools for diagnosing TB. These techniques target specific genetic sequences of M.tb, enabling rapid and sensitive detection of the pathogen. However, the diagnostic accuracy, advantages, and limitations of these molecular techniques in the context of osteoarticular TB diagnosis require further investigation and consolidation of evidence. Furthermore, this review aims to identify areas for future research and development in the field of molecular diagnostics for osteoarticular TB.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600077, Tamil Nadu, India
- Orthopaedic Research Group, Coimbatore, 641045, Tamil Nadu, India
- Virginia Tech India, Chennai, 600095, Tamil Nadu, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600077, Tamil Nadu, India
| | - Pothuri Rishi Ram
- Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, 560029, Karnataka, India
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, 641045, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College and Hospital, Karur, 639004, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, 641021, Tamil Nadu, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk Hospitals, Mersey and West Lancashire Teaching NHS Trust, Southport, PR8 6PN, United Kingdom
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Xu T, Fan W, Chen C, Feng K, Sheng X, Wang H, Yang K, Chen B, Wang X, Wang Y. Transcriptome analysis of the diseased intervertebral disc tissue in patients with spinal tuberculosis. BMC Med Genomics 2024; 17:205. [PMID: 39135040 PMCID: PMC11318271 DOI: 10.1186/s12920-024-01981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE To investigate the differential expression genes (DEGs) in spinal tuberculosis using transcriptomics, with the aim of identifying novel therapeutic targets and prognostic indicators for the clinical management of spinal tuberculosis. METHODS Patients who visited the Department of Orthopedics at the Second Hospital, Lanzhou University from January 2021 to May 2023 were enrolled. Based on the inclusion and exclusion criteria, there were 5 patients in the test group and 5 patients in the control group. Total RNA was extracted and paired-end sequencing was conducted on the sequencing platform. After processing the sequencing data with clean reads and annotating the reference genome, FPKM normalization and differential expression analysis were performed. The DEGs and long non-coding RNAs (LncRNAs) were analyzed for Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment. The cis-regulation of differentially expressed mRNAs (DE mRNAs) by LncRNAs was predicted and analyzed to establish a co-expression network. RESULTS This study identified 2366 DEGs, with 974 genes significantly upregulated and 1392 genes significantly downregulated. The upregulated genes are associated with cytokine-cytokine receptor interactions, tuberculosis, and TNF-α signaling pathways, primarily enriched in biological processes such as immunity and inflammation. The downregulated genes are related to muscle development, contraction, fungal defense response, and collagen metabolism processes. Analysis of LncRNAs from bone tuberculosis RNA-seq data detected a total of 3652 LncRNAs, with 356 significantly upregulated and 184 significantly downregulated. Further analysis identified 311 significantly different LncRNAs that could cis-regulate 777 target genes, enriched in pathways such as muscle contraction, inflammatory response, and immune response, closely related to bone tuberculosis. There are 51 genes enriched in the immune response pathway regulated by cis-acting LncRNAs. LncRNAs that regulate immune response-related genes, such as upregulated RP11-451G4.2, RP11-701P16.5, AC079767.4, AC017002.1, LINC01094, CTA-384D8.35, and AC092484.1, as well as downregulated RP11-2C24.7, may serve as potential prognostic and therapeutic targets. CONCLUSION The DE mRNAs and LncRNAs in spinal tuberculosis are both associated with immune regulatory pathways. These pathways promote or inhibit the tuberculosis infection and development at the mechanistic level and play an important role in the process of tuberculosis transferring to bone tissue.
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Affiliation(s)
- Tian'en Xu
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Wenjuan Fan
- Departments of Cardiovascular Surgery, Gansu Provincial Maternity and Child care Hospital, Gansu Provincial Central Hospital, Lanzhou, Gansu, 730000, PR China
| | - Cong Chen
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Kai Feng
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Xiaoyun Sheng
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Hong Wang
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Kai Yang
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Bao Chen
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Xu Wang
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China
| | - Yapeng Wang
- Department of Orthopaedics, the Second Hospital & Clinical Medical School, Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, Lanzhou City, 730000, Gansu Province, PR China.
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Sekhar Sethy S, Mittal S, Goyal N, Sudhakar PV, Verma V, Jain A, Verma A, Vathulya M, Sarkar B, Kandwal P. Healing Assessment of Spinal Tuberculosis: A Systematic Review. World Neurosurg 2024; 185:141-148. [PMID: 38367856 DOI: 10.1016/j.wneu.2024.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Deciding the healing end point in spinal tuberculosis (STB) remains a controversial topic. The current systematic review aims to address the controversy existing in the literature to find a comprehensive method to assess healing in STB. METHODS A thorough literature search was carried out for studies with the assessment of healing parameters in STB. Data extraction was carried out manually, which included study characteristics and healing criteria evaluated in each study. RESULTS Qualitative analysis of 8 included studies showed that healing parameters were described in 3 domains: clinical, hematologic, and radiologic response of the patient to antitubercular chemotherapy. Each domain included various individual parameters, with clinical and radiologic assessment criteria being used in most of the studies. Improvement in terms of pain, constitutional symptoms, weight gain, neurology; variation in erythrocyte sedimentation rate and C-reactive protein; and changes in radiography, magnetic resonance imaging, and positron emission tomography/computed tomography were found to be promising predictors in the assessment of healing. CONCLUSIONS Radiologic response parameters emerged as the maximally used criteria to assess healing in STB. However, in the absence of any statistical analysis and an observed lag in radiologic response, the cumulative effect of all the parameters in 3 domains (clinical, hematologic, and radiologic) can be used to declare a spinal tubercular lesion nonhealing, healing, or healed.
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Affiliation(s)
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Nikhil Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - P Venkata Sudhakar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vishal Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aakash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aman Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
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Wang C, Lou C, Yang Z, Shi J, Niu N. Plasma metabolomic analysis reveals the metabolic characteristics and potential diagnostic biomarkers of spinal tuberculosis. Heliyon 2024; 10:e27940. [PMID: 38571585 PMCID: PMC10987919 DOI: 10.1016/j.heliyon.2024.e27940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 02/16/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Objectives This study aimed to conduct a non-targeted metabolomic analysis of plasma from patients with spinal tuberculosis (STB) to systematically elucidate the metabolomic alterations associated with STB, and explore potential diagnostic biomarkers for STB. Methods From January 2020 to January 2022, 30 patients with spinal tuberculosis (STBs) clinically diagnosed at the General Hospital of Ningxia Medical University and 30 age- and sex-matched healthy controls (HCs) were selected for this study. Using ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF/MS) based metabolomics, we analyzed the metabolic profiles of 60 plasma samples. Statistical analyses, pathway enrichment, and receiver operating characteristic (ROC) analyses were performed to screen and evaluate potential diagnostic biomarkers. Results Metabolomic profiling revealed distinct alterations between the STBs and HCs cohorts. A total of 1635 differential metabolites were screened, functionally clustered, and annotated. The results showed that the differential metabolites were enriched in sphingolipid metabolism, tuberculosis, cutin, suberine and wax biosynthesis, beta-alanine metabolism, methane metabolism, and other pathways. Through the random forest algorithm, LysoPE (18:1(11Z)/0:0), 8-Demethyl-8-formylriboflavin 5'-phosphate, Glutaminyl-Gamma-glutamate, (2R)-O-Phospho-3-sulfolactate, and LysoPE (P-16:0/0:0) were determined to have high independent diagnostic value. Conclusions STBs exhibited significantly altered metabolite profiles compared with HCs. Here, we provide a global metabolomic profile and identify potential diagnostic biomarkers of STB. Five potential independent diagnostic biomarkers with high diagnostic value were screened. This study provides novel insights into the pathogenesis, diagnosis, and treatment strategies of STB.
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Affiliation(s)
- Chaoran Wang
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Caili Lou
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Zongqiang Yang
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Jiandang Shi
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Ningkui Niu
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
- Research Center for Prevention and Control of Bone and Joint Tuberculosis, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
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Sharma K, Sharma M, Sharma A, Dhillon MS. Diagnosing osteoarticular tuberculosis and detecting rifampicin resistance: A comparative analysis of Truenat MTB Plus vs GeneXpert Ultra. Tuberculosis (Edinb) 2024; 145:102483. [PMID: 38310759 DOI: 10.1016/j.tube.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
SETTING Diagnosing osteoarticular tuberculosis (OATB) and detecting drug resistance is a challenge in an endemic country like India. OBJECTIVE Truenat MTB Plus assay (TruPlus), a chip-based portable machine, was compared with GeneXpert Ultra (GxUltra) for diagnosing drug-resistant OATB. DESIGN 115 synovial fluid and pus specimens [22 culture-positive confirmed, 58 culture-negative clinically-suspected, 35 non-TB controls] processed between 2017 and 2023 were subjected to TruPlus, GxUltra and multiplex-PCR for diagnosing OATB. They were further screened for rifampicin resistance using TruRif chip. The performance was evaluated against composite reference standard, phenotypic drug susceptibility testing and rpoB gene sequencing. RESULTS TruPlus, GxUltra and MPCR detected 77.5 %, 71.25 %, and 83.75 %, cases of OATB, respectively. TruPlus detected five additional cases missed by GxUltra. The performance of TruPlus was comparable to GxUltra (p = 0.074) and to MPCR (p = 0.074), while performance of GxUltra was significantly inferior to MPCR (p = 0.004). The overall agreement with reference standard was substantial for TruPlus and MPCR and moderate for GxUltra. Both TruRif and GxUltra reported 4 cases as rifampicin resistant. CONCLUSION TruPlus along with TruRif offers better sensitivity than GxUltra. Its compact and portable platform allows wider application in peripheral settings, thus making it a pragmatic solution for diagnosing OATB and its drug resistance.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, 174001, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Mandeep Singh Dhillon
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Liu B, Zhao J, Chen Y, Liu Y. Clinical comparison of unilateral biportal endoscopic technique with transforaminal lumbar interbody fusion versus open posterior internal fixation for spinal brucellosis. Asian J Surg 2024; 47:693-694. [PMID: 37827911 DOI: 10.1016/j.asjsur.2023.09.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- Bei Liu
- Department of Orthopedics, Gansu University of Traditional Chinese Medicine, Lanzhou, 731000, China
| | - Jiandong Zhao
- Department of Orthopedics, Gansu University of Traditional Chinese Medicine, Lanzhou, 731000, China
| | - Youying Chen
- Department of Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 731000, China
| | - Yongming Liu
- Department of Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 731000, China.
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Dian S, Ganiem AR, Te Brake LH, van Laarhoven A. Current Insights into Diagnosing and Treating Neurotuberculosis in Adults. CNS Drugs 2023; 37:957-972. [PMID: 37978095 DOI: 10.1007/s40263-023-01047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
Neurotuberculosis has the highest morbidity and mortality risk of all forms of extrapulmonary tuberculosis (TB). Early treatment is paramount, but establishing diagnosis are challenging in all three forms of neurotuberculosis: tuberculous meningitis (TBM), spinal TB and tuberculomas. Despite advancements in diagnostic tools and ongoing research aimed at improving TB treatment regimens, the mortality rate for neurotuberculosis remains high. While antituberculosis drugs were discovered in the 1940s, TB treatment regimens were designed for and studied in pulmonary TB and remained largely unchanged for decades. However, new antibiotic regimens and host-directed therapies are now being studied to combat drug resistance and contribute to ending the TB epidemic. Clinical trials are necessary to assess the effectiveness and safety of these treatments, addressing paradoxical responses in neurotuberculosis cases and ultimately improving patient outcomes. Pharmacokinetic-pharmacodynamic analyses can inform evidence-based dose selection and exposure optimization. This review provides an update on the diagnosis and treatment of neurotuberculosis, encompassing both sensitive and resistant antituberculosis drug approaches, drawing on evidence from the literature published over the past decade.
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Affiliation(s)
- Sofiati Dian
- Department of Neurology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
- Research Centre for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia.
| | - Ahmad Rizal Ganiem
- Department of Neurology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Research Centre for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia
| | - Lindsey Hm Te Brake
- Radboudumc Centre for Infectious Disease (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Arjan van Laarhoven
- Radboudumc Centre for Infectious Disease (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Wu R, Li S, Liu Y, Zhang H, Liu D, Liu Y, Chen W, Wang F. A high proportion of caseous necrosis, abscess, and granulation tissue formation in spinal tuberculosis. Front Microbiol 2023; 14:1230572. [PMID: 37645226 PMCID: PMC10461047 DOI: 10.3389/fmicb.2023.1230572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
The special blood circulation, anatomy, and tissue structure of the spine may lead to significant differences in pathological features and drug resistance between spinal tuberculosis and pulmonary tuberculosis. Here, we collected 168 spinal tuberculosis cases and 207 pulmonary tuberculosis cases, and compared their clinical and pathological features as well as drug resistance. From the anatomical location, the highest incidence was of lumbar tuberculosis, followed by thoracic tuberculosis. PET-CT scans showed increased FDG uptake in the diseased vertebrae, discernible peripheral soft tissue shadow, visible internal capsular shadow, and an abnormal increase in FDG uptake. MRI showed infectious lesions in the diseased vertebral body, formation of paravertebral and bilateral psoas muscle abscess, and edema of surrounding soft tissues. As with control tuberculosis, the typical pathological features of spinal tuberculosis were chronic granulomatous inflammation with caseous necrosis. The incidence of granulomas was not statistically different between the groups. However, the proportions of caseous necrosis, acute inflammation, abscess, exudation, and granulation tissue formation in the spinal tuberculosis group were all significantly increased relative to the control tuberculosis group. Compared to the control tuberculosis group, the incidences of resistance to rifampicin (RFP) + isoniazid (INH) + streptomycin (STR) and INH + ethambutol (EMB) were lower in the spinal tuberculosis group, while the incidences of resistance to RFP + INH + EMB and RFP + EMB were higher. Moreover, we also found some differences in drug-resistance gene mutations. In conclusion, there are noticeable differences between spinal Mycobacterium tuberculosis and pulmonary tuberculosis in pathological characteristics, drug resistance, and drug resistance gene mutations.
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Affiliation(s)
| | | | | | | | | | | | - Wen Chen
- Department of Pathology, The 8th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fenghua Wang
- Department of Pathology, The 8th Medical Center, Chinese PLA General Hospital, Beijing, China
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Mahmoud AA, Abdelhay A, Eltaher B, Mohamed MS. Isolated Tuberculosis of the Cervical Vertebrae. Cureus 2023; 15:e35383. [PMID: 36987467 PMCID: PMC10039971 DOI: 10.7759/cureus.35383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/30/2023] Open
Abstract
Tuberculosis (TB) is a highly infectious disease that primarily affects the lungs, but extrapulmonary affection can occur with lymphatic or hematogenous spread. Skeletal affection commonly involves the spine, but cervical vertebral affection is rare. We report a 23-year-old female patient who presented to the hospital with diffuse limb weakness and neck pain as the only complaints. MRI of the cervical spine revealed a peripherally enhancing lesion arising from the posterior aspects of the cervical vertebrae with compressive myelopathy. She underwent surgical decompression and was noted to have caseous drainage during the procedure. She was started promptly on anti-tuberculous therapy after she had a positive interferon-gamma release assay. Late culture results confirmed isolated cervical TB of the vertebrae as the diagnosis. Prompt awareness and initiation of treatment for vertebral TB are necessary as clinical presentation can mimic other infectious and malignant etiologies.
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Affiliation(s)
- Amir A Mahmoud
- Internal Medicine, Rochester Regional Health, Rochester, USA
| | - Ali Abdelhay
- Internal Medicine, Rochester Regional Health, Rochester, USA
| | - Basant Eltaher
- Hematology and Bone Marrow Transplant, Ain Shams University, Cairo, EGY
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Spekker O, Hunt DR, Király K, Kis L, Madai Á, Szalontai C, Molnár E, Pálfi G. Lumbosacral tuberculosis, a rare manifestation of Pott's disease - How identified human skeletons from the pre-antibiotic era can be used as reference cases to establish a palaeopathological diagnosis of tuberculosis. Tuberculosis (Edinb) 2023; 138:102287. [PMID: 36450192 DOI: 10.1016/j.tube.2022.102287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
The macromorphological examination of identified human osteological collections from the pre-antibiotic era (e.g., Terry Collection) can provide invaluable information about the skeletal manifestations of tuberculosis (TB) in individuals who did not receive pharmaceutical therapy. With analysis of such collections, new diagnostic criteria for TB can be recognised which can be used in palaeopathological interpretation. The aim of our paper is to provide a reference and aid for the identification of TB in past populations by demonstrating and discussing in detail the vertebral alterations indicative of one of its rare skeletal manifestations, lumbosacral TB. These changes were detected in two individuals from the Terry Collection (Terry No. 760 and Terry No. 1093). These two case studies furnish palaeopathologists with a stronger basis for diagnosing lumbosacral TB in skeletons which exhibit similar vertebral lesions from osteoarchaeological series. To illustrate this, an archaeological case from Hungary (KK146) is also presented, displaying vertebral alterations resembling that of the two cases from the Terry Collection. Through the demonstrated case studies, we can derive a better insight into the disease experience of people who lived in the past and suffered from TB.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - David R Hunt
- Northern Virginia District Office of the Chief Medical Examiners, 10850 Pyramid Place, Manassas, VA, 20110, USA.
| | - Kitty Király
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Móra Ferenc Museum, Roosevelt tér 1-3, H-6720, Szeged, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Ágota Madai
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Anthropology, Hungarian National History Museum, Ludovika tér 2-6, H-1083, Budapest, Hungary.
| | - Csaba Szalontai
- National Institute of Archaeology, Hungarian National Museum, Múzeum körút 14-16, H-1088, Budapest, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
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The Distribution Pattern of First-Line Anti-Tuberculosis Drug Concentrations between the Blood and the Vertebral Focus of Spinal Tuberculosis Patients. J Clin Med 2022; 11:jcm11185409. [PMID: 36143056 PMCID: PMC9505838 DOI: 10.3390/jcm11185409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Anti-tuberculosis drug concentrations are critical for the treatment of spinal tuberculosis. The distribution pattern of anti-tuberculosis drugs between the blood and the vertebral focus needs to be further explored. Methods: A total of 31 spinal tuberculosis patients were prospectively included and then divided into a sclerotic group (15 cases) and a non-sclerotic group (16 cases) according to their preoperative CTs. All patients were treated with 2HERZ/6H2R2Z2 chemotherapy for 4 weeks before the operation. During the operation, blood, normal vertebral bone tissue, and vertebral focus tissue were obtained, processed, and sent to the pharmacology laboratory. The concentration values of four anti-tuberculosis drugs in each sample were obtained in a pharmacology laboratory. Results: There was no significant difference in the concentrations of the four anti-tuberculosis drugs in the blood and the normal vertebral bone tissue between the two groups; however, there was a significant difference in the vertebral focus tissue. There existed a linear correlation of four anti-tuberculosis drug concentrations between the blood and the focus in the non-sclerotic bone group. Conclusions: The existence of sclerotic bone hinders the anti-tuberculosis drug distribution. In the absence of sclerotic bone in the vertebral focus, there exists a linear relationship of the four anti-tuberculosis drug concentrations between the blood and the vertebral focus of spinal tuberculosis patients.
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Bonnet I, Haddad E, Guglielmetti L, Bémer P, Bernard L, Bourgoin A, Brault R, Catho G, Caumes E, Escaut L, Fourniols E, Fréchet-Jachym M, Gaudart A, Guillot H, Lafon-Desmurs B, Lanoix JP, Lanotte P, Lemaignen A, Lemaire B, Lemaitre N, Michau C, Morand P, Mougari F, Marigot-Outtandy D, Patrat-Delon S, Perpoint T, Piau C, Pourcher V, Zarrouk V, Zeller V, Veziris N, Jauréguiberry S, Aubry A. Clinical Features and Outcome of Multidrug-Resistant Osteoarticular Tuberculosis: A 12-Year Case Series from France. Microorganisms 2022; 10:1215. [PMID: 35744731 PMCID: PMC9229793 DOI: 10.3390/microorganisms10061215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
The optimal treatment for osteoarticular infection due to multidrug-resistant tuberculosis strains (MDR-OATB) remains unclear. This study aims to evaluate the diagnosis, management and outcome of MDR-OATB in France. We present a case series of MDR-OATB patients reviewed at the French National Reference Center for Mycobacteria between 2007 and 2018. Medical history and clinical, microbiological, treatment and outcome data were collected. Twenty-three MDR-OATB cases were reported, representing 3% of all concurrent MDR-TB cases in France. Overall, 17 were male, and the median age was 32 years. Six patients were previously treated for TB, including four with first-line drugs. The most frequently affected site was the spine (n = 16). Bone and joint surgery were required in 12 patients. Twenty-one patients (91%) successfully completed the treatment with a regimen containing a mean of four drugs (range, 2-6) for a mean duration of 20 months (range, 13-27). Overall, high rates of treatment success were achieved following WHO MDR-TB treatment guidelines and individualized patient management recommendations by the French National TB Consilium. However, the optimal combination of drugs, duration of treatment and role of surgery in the management of MDR-OATB remains to be determined.
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Affiliation(s)
- Isabelle Bonnet
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Elie Haddad
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lorenzo Guglielmetti
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Pascale Bémer
- Department of Bacteriology, University Hospital, CHU Nantes, 44000 Nantes, France;
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Anne Bourgoin
- Service de Virologie et Mycobactériologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Rachel Brault
- Service de Rhumatologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Gaud Catho
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lélia Escaut
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
| | - Eric Fourniols
- Service de Chirurgie Orthopédique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne-Université, 75013 Paris, France;
| | - Mathilde Fréchet-Jachym
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Alice Gaudart
- Service de Bactériologie, Centre Hospitalier Universitaire de Nice, 06000 Nice, France;
| | - Hélène Guillot
- Service de Médecine Interne, Hôpital Robert Ballanger, 93600 Aulnay-sous-Bois, France;
| | - Barthélémy Lafon-Desmurs
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France;
| | - Jean-Philippe Lanoix
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d’Amiens-Picardie, 80054 Amiens, France;
| | - Philippe Lanotte
- Service de Bactériologie, Centre Hospitalier Universitaire de Tours, 37000 Tours, France;
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Bénédicte Lemaire
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Nadine Lemaitre
- Service de Bactériologie, Centre Hospitalier Universitaire d’Amiens-Picardie, 59200 Tourcoing, France;
| | - Christophe Michau
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Saint-Nazaire, 44606 Saint-Nazaire, France;
| | - Philippe Morand
- Service de Bactériologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France;
| | - Faiza Mougari
- Service de Bactériologie, Hôpital Lariboisière, AP-HP, Nord-Université de Paris, 75018 Paris, France;
| | - Dhiba Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Solène Patrat-Delon
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Caroline Piau
- Service de Bactériologie, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Valérie Pourcher
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Nord-Université de Paris, 92110 Clichy, France;
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, 75020 Paris, France;
| | - Nicolas Veziris
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Service de Bactériologie, Hôpitaux Saint-Antoine, Tenon, Trousseau, Rothschild, AP-HP, 75012 Paris, France
| | - Stéphane Jauréguiberry
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Alexandra Aubry
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
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Chen L, Liu C, Ye Z, Chen W, Sun X, Chen J, Li H, Liang T, Huang S, Jiang J, Chen T, Guo H, Yao Y, Liao S, Yu C, Wu S, Fan B, Zhan X. Comparison of Clinical Data Between Patients With Complications and Without Complications After Spinal Tuberculosis Surgery: A Propensity Score Matching Analysis. Front Surg 2022; 9:815303. [PMID: 35425806 PMCID: PMC9002237 DOI: 10.3389/fsurg.2022.815303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study used a propensity score matching (PSM) analysis to explore the risk factors of post-operative complications and compared the differences in clinical data between them following spinal tuberculosis surgery. Methods The clinical data of patients with spinal tuberculosis were collected in our hospital from June 2012 to June 2021, including general information, laboratory results, surgical information, and hospitalization costs. The data were divided into two groups: complication and without complication groups. The baseline data of the two groups were obtained using the PSM analysis. Univariate and multivariate logistic analyses were used to analyze the differences between the two groups. Results A total of 292 patients were included in the PSM analysis: 146 patients with complications and 146 patients without complications. The operation time, incision length, hospital stay, and albumin quantity in the complications group were 162 ± 74.1, 11.2 ± 4.76, 14.7 ± 9.34, and 1.71 ± 2.82, respectively, and those in the without complication group were 138 ± 60.5, 10.2 ± 3.56, 11.7 ± 7.44, and 0.740 ± 2.44, respectively. The laboratory costs, examination costs, guardianship costs, oxygen costs, and total costs in the complications group were higher than those in the without complication group. A significant difference was observed in the albumin quantity by logistic regression analysis (P < 0.05). Conclusion Several costs in the complication group were higher than in the without complication group. The albumin quantity may be an independent factor to predict post-operative complications of spinal tuberculosis by logistic regression analysis.
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Chen L, Gan Z, Huang S, Liang T, Sun X, Yi M, Wu S, Fan B, Chen J, Chen T, Ye Z, Chen W, Li H, Jiang J, Guo H, Yao Y, Liao S, Yu C, Liu C, Zhan X. Blood transfusion risk prediction in spinal tuberculosis surgery: development and assessment of a novel predictive nomogram. BMC Musculoskelet Disord 2022; 23:182. [PMID: 35216570 PMCID: PMC8876452 DOI: 10.1186/s12891-022-05132-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
Objective The present study attempted to predict blood transfusion risk in spinal tuberculosis surgery by using a novel predictive nomogram. Methods The study was conducted on the clinical data of 495 patients (167 patients in the transfusion group and 328 patients in the non-transfusion group) who underwent spinal tuberculosis surgery in our hospital from June 2012 to June 2021. The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analyses were used to screen out statistically significant parameters, which were included to establish a novel predictive nomogram model. The receiver operating characteristic (ROC) curve, calibration curves, C-index, and decision curve analysis (DCA) were used to evaluate the model. Finally, the nomogram was further assessed through internal validation. Results The C-index of the nomogram was 0.787 (95% confidence interval: 74.6%–.82.8%). The C-value calculated by internal validation was 0.763. The area under the curve (AUC) of the predictive nomogram was 0.785, and the DCA was 0.01–0.79. Conclusion A nomogram with high accuracy, clinical validity, and reliability was established to predict blood transfusion risk in spinal tuberculosis surgery. Surgeons must prepare preoperative surgical strategies and ensure adequate availability of blood before surgery.
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Affiliation(s)
- Liyi Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Zhaoping Gan
- Department of Hematology, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Shengsheng Huang
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Tuo Liang
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Xuhua Sun
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Ming Yi
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Shaofeng Wu
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Binguang Fan
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Jiarui Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Tianyou Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Zhen Ye
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Wuhua Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Hao Li
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Jie Jiang
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Hao Guo
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Yuanlin Yao
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Shian Liao
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Chaojie Yu
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Chong Liu
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China.
| | - Xinli Zhan
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China.
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