Tuberculous spondylitis diagnosed through Xpert MTB/RIF assay in urine: a case report

BMC Infectious Diseases

Case Report

Manuel Battegay¹  George Sikalengo²  Diana Faini²  Kim Mwamelo²  Emilio Letang³  Klaus Reither⁴  Levan Jugheli⁴  Christoph Hatz⁴  Adria Ramirez⁵ 

[1] Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University Basel, Basel, Switzerland;University Basel, Basel, Switzerland;Ifakara Health Institute, Ifakara, Tanzania;Ifakara Health Institute, Ifakara, Tanzania;University Basel, Basel, Switzerland;Swiss Tropical and Public Health Institute, Basel, Switzerland;ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain;University Basel, Basel, Switzerland;Swiss Tropical and Public Health Institute, Basel, Switzerland;University Hospital son Espases, Palma de Mallorca, Spain;

关键词: Tuberculosis;    Vertebral spondylitis;    Xpert MTB/RIF;    Pott’s disease;    Urine;    Case report;   

DOI  :  10.1186/s12879-016-1844-0

 received in 2015-10-12, accepted in 2016-09-17,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundExtrapulmonary tuberculosis (EPTB) is associated with high rates of morbidity and mortality. Diagnosis of EPTB is challenging in resource-limited settings due to difficulties in obtaining samples, as well as the paucibacillarity of the specimens. Skeletal tuberculosis accounts for 10–35 % of EPTB cases, with vertebral osteomyelitis (Pott’s disease) representing 50 % of the cases. We present two cases of suspected Pott’s disease, diagnosed through GeneXpert MTB/RIF assay in urine at a rural Tanzanian hospital.Case PresentationCase IA 49-year old male, HIV-1 positive, on co-formulated tenofovir disoproxil fumarate/lamivudine/efavirenz since 2009 and CD4 counts of 205 cells/μL (13 %). He presented with lower back pain and progressive lower limb weakness for two weeks prior to admission. The physical examination revealed bilateral flaccid paraplegia with reduced reflexes, but otherwise unremarkable findings. A lateral lumbar X-ray showed noticeable reduction of intervertebral space between L4 and L5, and a small calcification in the anterior longitudinal ligament between L4 and L5, being compatible with focal spondylosis deformans but inconclusive with regard to tuberculous spondylitis. An abdominal ultrasound showed normal kidneys, bladder and prostate gland. The urinalysis and complete blood counts (CBC) were normal. M. Tuberculosis was detected through GeneXpert MTB/RIF in centrifuged urine, with no resistance to rifampicin.Case IIA 76-year old female, HIV-1 negative, presented with lower back pain and progressive weakness and numbness of the lower limbs for two months prior to admission. The physical examination revealed paraplegia, but otherwise unremarkable findings. The lumbosacral X-ray findings were compatible with spondylosis deformans of the lumbar spine and possible tuberculous spondylitis in L3-L4. The abdominal and renal ultrasound showed normal kidneys and bladder. The urinalysis and CBC were normal. M. Tuberculosis was detected through GeneXpert MTB/RIF in centrifuged urine, with no resistance to rifampicin.ConclusionWe report two cases of suspected tuberculous spondylitis diagnosed through Xpert MTB/RIF in urine samples from a rural Tanzanian hospital. Urine testing using Xpert MTB/RIF reflects disseminated disease and renal involvement, and may offer a feasible additional diagnostic approach for Pott’s disease in rural Africa.

【 授权许可】

CC BY   
© The Author(s). 2016