What are the Symptoms of Tuberculosis of the Bone?
Pain
Tuberculosis can affect any bone, but most commonly it attacks the spine and weight-bearing joints. According to the Merck Manuals Online Medical Library, hands, wrists and elbows often are affected, especially if the patient previously injured them. The type of pain depends on the exact location of the tuberculosis. Spinal tuberculosis, also called Pott’s disease, usually affects the thoracic part of the spine, causing constant back pain as the virus degrades the discs cushioning the vertebrae. Tuberculosis in the joints causes an aching pain and stiffness. Tuberculous osteomyelitis, or bone infection, causes constant pain in the bone itself and can cause complications in nearby tissues, such as carpal tunnel syndrome if the wrist is affected.
Decreased movement in the joints/Arthritis
Tuberculosis of the joints, called articular TB, progressively destroys the joints at the hips or knees. Doctors refer to the condition as “mono-arthritis” because only one joint is affected. The affected joint swells and becomes painful. Movement stiffens, and range of motion is limited. In severe and chronic cases, abscesses develop in the affected joints.
Paralysis
Spinal tuberculosis, if left untreated, can spread from one vertebra to the next, weakening the bones and destroying the cushioning discs between them. In severe cases, the spine can collapse and pinch the spinal cord, causing paralysis of the lower body.
Spinal Hump
If spinal TB progresses to destruction of the vertebrae and discs, the bones of the spine jut forward. A doctor might be able to feel the displacement as the bones of the spine form a hump called a gibbus.
Generalized Symptoms
Patients with TB in their bones might or might not exhibit generalized signs of tuberculosis such as fever, fatigue, night sweats and unexplained weight loss. Patients with spinal TB typically experience generalized symptoms, while those with articular TB generally do not. Although about half of all patients with bone TB also have infected lungs, the disease usually is not active there. This means that most patients with bone TB do not suffer from coughing and probably do not suspect that they have tuberculosis. Patients with bone TB are generally not contagious because the disease spreads through coughed up active virus particles.
What are the places which are most affected by Tuberculosis?
Although tuberculosis, or TB, primarily affects the lungs, it can spread through the blood stream to other sites, a circumstance called extrapulmonary or disseminated tuberculosis. The ends of long bones and the vertebrae are commons sites of extrapulmonary tuberculosis, accounting for up to 35 percent of all cases.The spine is the most common site followed by the hip joint which constitutes approximately 15% of all cases.The most common form of articular tuberculosis is spondylitis followed by arthritis of weight bearing joints (especially knee and hip).
Pott disease
Pott disease or Pott’s disease is a form of tuberculosis that is seen in the vertebrae, a kind of tuberculous arthritis of the intervertebral joints. The disease is named after Percivall Pott (1714–1788), a British surgeon. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. The formal name for the disease is tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine.
Pott’s disease results from haematogenous spread of tuberculosis from other sites, often the lungs. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc space. If only one vertebra is affected, the disc is normal,but if two are involved, the disc, which is avascular, cannot receive nutrients and collapses. In a process called caseous necrosis the disc tissue dies leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare.
Diagnosis
Blood tests
– CBC: leukocytosis
– Elevated erythrocyte sedimentation rate: >100 mm/h
Tuberculin skin test
– Tuberculin skin test (purified protein derivative [PPD]) results are positive in 84–95% of patients with Pott disease who are not infected with HIV.
Radiographs of the spine
– Radiographic changes associated with Pott disease present relatively late. The following are radiographic changes characteristic of spinal tuberculosis on plain radiography:
Lytic destruction of anterior portion of vertebral body
Increased anterior wedging
Collapse of vertebral body
Reactive sclerosis on a progressive lytic process
Enlarged psoas shadow with or without calcification
– Additional radiographic findings may include the following:
Vertebral end plates are osteoporotic.
Intervertebral disks may be shrunk or destroyed.
Vertebral bodies show variable degrees of destruction.
Fusiform paravertebral shadows suggest abscess formation.
Bone lesions may occur at more than one level.
Bone scan
CT of the spine
Bone biopsy
MRI
Prevention
Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Patients who have a positive PPD test (but not active tuberculosis) may decrease their risk by properly taking medicines to prevent tuberculosis.To effectively treat tuberculosis, it is crucial that patients take their medications exactly as prescribed.
Management
Non-operative – antituberculous drugs
Analgesics
Immobilization of the spine region using different types of braces and collars
Surgery may be necessary, especially to drain spinal abscesses or debride bony lesions fully or to stabilize the spine. A 2007 review found just two randomized clinical trials with at least one year-follow up found which compared chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine. As such there is no high grade evidence but the results of this study indicates that surgery should not be recommended routinely and clinicians have to selectively judge and decide on which patients to operate.
Thoracic spinal fusion with or without instrumentation as a last resort
Physical therapy for pain-relieving modalities, postural education and teaching a home exercise program for strength and flexibility
Prognosis
Vertebral collapse resulting in kyphosis
Spinal cord compression
Sinus formation
Paraplegia (so called Pott’s paraplegia)
What is the cause of Spinal Tuberculosis?
The characteristic clinical features of spinal tuberculosis include local pain, local tenderness, stiffness and spasm of the muscles, a cold abscess, gibbus, and a prominent spinal deformity. The cold abscess slowly develops when tuberculous infection extends to adjacent ligaments and soft tissues.
How does TB spread to the Spine?
When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain. TB disease in the lungs or throat can be infectious. This means that the bacteria can be spread to other people
What is tuberculosis of the hip?