Spondilodiscitis due to Mycobacterium tuberculosis in HIV and non-HIV-infected patients: Eleven years experience in a referent Hospital of infectious diseases in Argentina

Background: Tuberculosis (TB) is an emerging health problem despite the advances in the methods of diagnosis and treatment. The resurgence of tuberculous spondilodiscitis (TBSD) or Pott's disease can be expected to be associated with a concomitant increase in the incidence of extra-pulmonary TB. Aim: To describe the clinical features, imaging findings, and laboratory diagnosis in a group of patients with TBSD. Materials and Methods: From January 1 st 2000 to December 31 st 2010, we retrospectively reviewed 22 cases of spinal TB. Only those with positive culture results and/or characteristic clinical and pathological findings were enrolled. Demographic data, comorbilities, clinical manifestations, time up to the definitive diagnosis, outcome and sequelae were considered. Results : During the study period, 22 patients were diagnosed with TBSD; 14 were men and 8 women with a median of age of 34 years at the time of diagnosis. The median duration of symptoms before the TBSD diagnosis was 120 days (range 30 to 360 days). At the time of diagnosis, fever and back pain were the most common clinical symptoms; 7 patients (32%) had fever and 21 (95%) had spinal pain; eleven patients (50%) had constitutional symptoms; 6 (27%) had respiratory symptoms and 3 (13.6%) had neurological manifestations. Magnetic resonance imaging (MRI) was performed in 9 (40%) cases, computed tomography (CT) in 7 patients (32%), and abdominal ultrasound in 6 cases (27%). The lumbar spine was the most commonly involved site (14 patients, 64%); thoracic spine was involved in 2 patients (9%); dorsolumbar spine was compromised in 4 cases (18%). Cervical spine was only involved in one patient (4.5%) and the last patient (4.5%) presents a global spinal involvement (cervical-thoracic and lumbar spine). Conclusion: Insidious clinical course and ambiguous manifestations of TBSD often delay the accuracy of diagnosis. Spinal TB should be included in the differential diagnosis of patients with prolonged back pain and fever.