Utility of clinicoradiological, microbiological, histopathological, and molecular methods in the diagnosis of spinal tuberculosis.
Culture
Diagnosis
Gene Xpert
Pott’s spine
Spinal tuberculosis
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
15
12
2022
accepted:
22
03
2023
revised:
21
02
2023
medline:
22
11
2023
pubmed:
4
4
2023
entrez:
3
4
2023
Statut:
ppublish
Résumé
The diagnosis of STB is mainly based on clinicoradiological observations substantiated by bacterial culture, staining, Gene Xpert, and histopathology. The purpose of the study was to correlate these methods to evaluate the effectiveness in the diagnosis of STB. A total of 178 clinicoradiologically suspected cases of STB were included in the study. The specimens for diagnostic workup were collected either during surgery or by CT-guided biopsy. All these specimens were tested for tuberculosis through ZN staining, solid culture, histopathology, and PCR. The sensitivity, specificity, PPV, and NPV of each test were calculated using histopathology as a gold standard. Out of the 178 cases, a total of 15 cases were excluded from this study. Among the remaining 163 cases, TB was diagnosed in 143 [87.73%] on histopathology, 130 [79.75%] on Gene Xpert, 40 [24.53%] on culture, and 23 [14.11%] on ZN stain. The sensitivity, specificity, PPV, and NPV of Gene Xpert were 86.71, 70, 95.38, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of AFB culture were 27.97, 100, 100, and 16.26%, respectively. The sensitivity, specificity, PPV, and NPV of AFB stain were 16.08, 100, 100, and 14.29%, respectively. Gene Xpert showed a moderate agreement [Ƙc = 0.4432] with histopathology. No single diagnostic modality can ascertain the diagnosis, and it is desirable to have a combination of diagnostic batteries for better results. A combination of Gene Xpert and histopathology aids in early and reliable diagnosis of STB.
Identifiants
pubmed: 37005928
doi: 10.1007/s00586-023-07683-8
pii: 10.1007/s00586-023-07683-8
doi:
Substances chimiques
Rifampin
VJT6J7R4TR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4229-4237Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92:905–913. https://doi.org/10.1302/0301-620X.92B7.24668
doi: 10.1302/0301-620X.92B7.24668
Global tuberculosis report (2022) World ReliefWeb. https://reliefweb.int/report/world/global-tuberculosis-report-2022 . Accessed 19 Feb 2023
Mittal S, Yadav G, Ahuja K et al (2021) Predicting neurological deficit in patients with spinal tuberculosis -a single-center retrospective case-control study. SICOT-J 7:7. https://doi.org/10.1051/sicotj/2021002
doi: 10.1051/sicotj/2021002
Rajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM (2018) Spinal tuberculosis: current concepts. Glob Spine J 8:96S-108S. https://doi.org/10.1177/2192568218769053
doi: 10.1177/2192568218769053
Tuli SM (2016) Tuberculosis of the Skeletal System. JP Medical Ltd, Victoria
Ahuja K, Ifthekar S, Mittal S et al (2021) Defining mechanical instability in tuberculosis of the spine: a systematic review. EFORT Open Rev 6:202–210. https://doi.org/10.1302/2058-5241.6.200113
doi: 10.1302/2058-5241.6.200113
Garg RK, Somvanshi DS (2011) Spinal tuberculosis: a review. J Spinal Cord Med 34:440–454. https://doi.org/10.1179/2045772311Y.0000000023
doi: 10.1179/2045772311Y.0000000023
Steingart KR, Schiller I, Horne DJ et al (2014) Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009593.pub3
doi: 10.1002/14651858.CD009593.pub3
Chawla K, Gupta S, Mukhopadhyay C et al (2009) PCR for M. tuberculosis in tissue samples. J Infect Dev Ctries 3:83–87. https://doi.org/10.3855/jidc.53
doi: 10.3855/jidc.53
Parsons LM, Somoskövi Á, Gutierrez C et al (2011) Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities. Clin Microbiol Rev 24:314–350. https://doi.org/10.1128/CMR.00059-10
doi: 10.1128/CMR.00059-10
Paramasivan CN, Lee E, Kao K et al (2010) Experience establishing tuberculosis laboratory capacity in a developing country setting. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis 14:59–64
Ssengooba W, Gelderbloem SJ, Mboowa G et al (2015) Feasibility of establishing a biosafety level 3 tuberculosis culture laboratory of acceptable quality standards in a resource-limited setting: an experience from Uganda. Health Res Policy Syst 13:4. https://doi.org/10.1186/1478-4505-13-4
doi: 10.1186/1478-4505-13-4
Kumar R, Srivastva A, Nag V et al (2014) The efficacy of diagnostic battery in Pott′s disease: a prospective study. Indian J Orthop 48:60. https://doi.org/10.4103/0019-5413.125503
doi: 10.4103/0019-5413.125503
Solanki AM, Basu S, Biswas A et al (2019) Sensitivity and specificity of Gene Xpert in the diagnosis of spinal tuberculosis: a prospective controlled clinical study. Glob Spine J. https://doi.org/10.1177/2192568219858310
doi: 10.1177/2192568219858310
Purohit M, Mustafa T (2015) Laboratory diagnosis of extra-pulmonary tuberculosis (EPTB) in resource-constrained setting: state of the art, challenges and the need. J Clin Diagn Res JCDR 9:EB01–EB06. https://doi.org/10.7860/JCDR/2015/12422.5792
doi: 10.7860/JCDR/2015/12422.5792
Jain AK, Jena SK, Singh M et al (2008) Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis. Indian J Orthop 42:173–177. https://doi.org/10.4103/0019-5413.40253
doi: 10.4103/0019-5413.40253
Yu Y, Kong Y, Ye J, Wang A (2020) Performance of conventional histopathology and GeneXpert MTB/RIF in the diagnosis of spinal tuberculosis from bone specimens: a prospective clinical study. Clin Biochem 85:33–37. https://doi.org/10.1016/j.clinbiochem.2020.08.010
doi: 10.1016/j.clinbiochem.2020.08.010
Guha M, Lal H, Boruah T et al (2021) Clinico-radio-histopathological correlation by c-arm image-guided biopsy in spinal tuberculosis. Indian J Orthop 55:1028–1036. https://doi.org/10.1007/s43465-021-00361-1
doi: 10.1007/s43465-021-00361-1
Arockiaraj J, Michael JS, Amritanand R et al (2017) The role of Xpert MTB/RIF assay in the diagnosis of tubercular spondylodiscitis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 26:3162–3169. https://doi.org/10.1007/s00586-017-5076-9
doi: 10.1007/s00586-017-5076-9
Held M, Laubscher M, Zar HJ, Dunn RN (2014) GeneXpert polymerase chain reaction for spinal tuberculosis: an accurate and rapid diagnostic test. Bone Jt J 96-B:1366–1369. https://doi.org/10.1302/0301-620X.96B10.34048
doi: 10.1302/0301-620X.96B10.34048
Gu Y, Wang G, Dong W et al (2015) Xpert MTB/RIF and genotype MTBDRplus assays for the rapid diagnosis of bone and joint tuberculosis. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 36:27–30. https://doi.org/10.1016/j.ijid.2015.05.014
doi: 10.1016/j.ijid.2015.05.014
Kandala M (2017) Clinico radiological correlation with histopathological and molecular diagnosis in spinal tuberculosis. MedPulse Int J Orthop 4:5
Karthek V, Bhilare P, Hadgaonkar S et al (2021) Gene Xpert/MTB RIF assay for spinal tuberculosis- sensitivity, specificity and clinical utility. J Clin Orthop Trauma 16:233–238. https://doi.org/10.1016/j.jcot.2021.02.006
doi: 10.1016/j.jcot.2021.02.006
Lakhanpal VP, Tuli SM, Singh H, Sen PC (1974) The value of histology, culture and guinea pig inoculation examination in osteo-articular tuberculosis. Acta Orthop Scand 45:36–42. https://doi.org/10.3109/17453677408989119
doi: 10.3109/17453677408989119
Negi SS, Gupta S, Khare S, Lal S (2005) Comparison of various microbiological tests including polymerase chain reaction for the diagnosis of osteoarticular tuberculosis. Indian J Med Microbiol 23:245–248
doi: 10.1016/S0255-0857(21)02529-9
Hillemann D, Rüsch-Gerdes S, Boehme C, Richter E (2011) Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB/RIF system. J Clin Microbiol 49:1202–1205. https://doi.org/10.1128/JCM.02268-10
doi: 10.1128/JCM.02268-10
Rasit A, Ibrahim S, Wong C (2011) The role of polymerase chain reaction (pcr) in diagnosis of spine tuberculosis after pre-operative anti-tuberculosis treatment. Malays Orthop J 5:5
doi: 10.5704/MOJ.1103.002
Cousins DV, Wilton SD, Francis BR, Gow BL (1992) Use of polymerase chain reaction for rapid diagnosis of tuberculosis. J Clin Microbiol 30:255–258. https://doi.org/10.1128/jcm.30.1.255-258.1992
doi: 10.1128/jcm.30.1.255-258.1992
Salian NV, Rish JA, Eisenach KD et al (1998) Polymerase chain reaction to detect Mycobacterium tuberculosis in histologic specimens. Am J Respir Crit Care Med 158:1150–1155. https://doi.org/10.1164/ajrccm.158.4.9802034
doi: 10.1164/ajrccm.158.4.9802034
Wen H, Li P, Ma H, Lv G (2017) Diagnostic accuracy of Xpert MTB/RIF assay for musculoskeletal tuberculosis: a meta-analysis. Infect Drug Resist 10:299–305. https://doi.org/10.2147/IDR.S145843
doi: 10.2147/IDR.S145843
Shah SR, Shenai S, Desai DC et al (2010) Comparison of Mycobacterium tuberculosis culture using liquid culture medium and Lowenstein Jensen medium in abdominal tuberculosis. Indian J Gastroenterol Off J Indian Soc Gastroenterol 29:237–239. https://doi.org/10.1007/s12664-010-0075-3
doi: 10.1007/s12664-010-0075-3