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Bir Olgu Nedeniyle Tüberküloz Spondilodiskit

Yıl 2012, Cilt: 69 Sayı: 4, 229 - 234, 01.12.2012

Öz

Akciğer dışı tüberküloz ADTB gelişmiş ve gelişmekte olan ülkelerde, akciğer tüberkülozu TB gibi önemli bir sağlık sorunudur. ADTB primer enfeksiyondan yıllar sonra ortaya çıkabileceği gibi hızla ilerleyerek akut bir tablo ile de kendini gösterebilir. TB tanısı genellikle aside dirençli basil ARB boyama, radyografi bulguları gibi geleneksel yöntemler ve kültür ile konulmaktadır. Mevcut tanı yöntemleri örnekteki düşük mikobakteri seviyeleri veya zaman alıcı prosedürler nedeniyle yetersiz kalmaktadır. Bu yazıda TB PCR polimeraz zincir reaksiyonu ile tanı konmuş bir ADTB vakası sunulmaktadır. Radyolojik ve patolojik bulgular TB için kuşkulandırıcı olsa da ARB incelemesinde ve TB kültüründe pozitiflik saptanmamıştır. 34 yaşında kadın hasta, 3-4 yıldır var olan ve son 10 günde artış gösteren bel ağrısı yakınması ile başvurmuştur. Hasta beyin cerrahisi kliniğine spondilodiskit öntanısı ile yatırılmıştır. Öyküsünde ateş ve gece terlemesi olmadığı ancak iştahsızlık ve son birkaç ayda kilo kaybı olduğu öğrenilmiştir. Direkt akciğer grafisi ve toraks bilgisayarlı tomografisi BT normal olarak saptanmıştır. Çekilen kontrastlı lomber magnetik rezonans MR grafisinde L2-3 seviyesinde, psoas kasında yoğun kontrast tutulumu, lomber BT’de L2-3 vertebra korpus ve posterior elemanlarda kemik destrüksiyonu tesbit edilmiştir. Hastaya tanı ve tedavi amacı ile planlanan cerrahi operasyon esnasında abse drenajı yapılmıştır. Örneğin mikroskobik incelemesinde ARB negatif olarak saptanmıştır.LJ Lowenstein- Jensen besiyerinde gerçekleştirilen TB kültüründe de üreme gözlenmemiştir. Patolojik incelemede kronik inflamasyon, fibrozis ve granülomatöz reaksiyon gözlenmiştir. Aynı örnekten Real-Time PCR yöntemi ile çalışılan TB PCR sonucu ise pozitif olarak bulunmuştur. Son yıllarda ADTB’de tanısal dezavantajlar moleküler testlerin kullanımı ile azalmıştır. Bu da ADTB’de erken tanı konarak, erken tedaviye başlanmasına ve dolaylı olarak da morbidite ve mortalite oranlarında azalmaya yol açacaktır. Sonuç olarak ADTB tanısında konvansiyonel mikrobiyolojik yöntemlerin yetersiz kaldığı durumlarda moleküler testlerin kullanılabileceği düşünülmektedir.

Kaynakça

  • 1. World Health Organization: Global tuberculosis control: Surveillance, Planning, Financing. Geneva, WHO Report, 2008.
  • 2. Sreeramareddy CT, Panduru KV, Vermal SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal-a hospital based retrospective study. BMC Infect Dis, 2008; 8: 8.
  • 3. Cailhol J, Decludt B, Che D. Sociodemographic factors that contribute to the development of extrapulmonary tuberculosis were identified. J Clin Epidemiol, 2005; 58: 1066-71.
  • 4. Bozkurt H, Turkkanı MH, Musaombasıoglu S, Gullu U, Baykal F, Hasanoglu HC, Ozkara S. The National tuberculosis report’s 2009. Ankara, Turkish Republic. Ministry of Health, 2009.
  • 5. Demiralay R. Some epidemiological features of extrapulmonary tuberculosis registered in the tuberculous struggle dispensaries in Isparta. Tuberkuloz Toraks, 2003; 51: 33-9.
  • 6. Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am, 2001; 39: 329-42.
  • 7. Cormican L, Hammal R, Messenger J, Milburn HJ. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J, 2006; 82: 46-51.
  • 8. Soini H, Musser JM. Molecular diagnosis of Mycobacteria. Clin Chem, 2001; 47: 809-14.
  • 9. American Thoracic Society and the Centers for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000; 161: 1376-95.
  • 10. Hale YM, Pfyffer GE, Salfinger M. Laboratory diagnosis of mycobacterial infections: New tools and lessons learned. Clin Infect Dis, 2001; 33: 834-46.
  • 11. Sarmiento OL, Weigle KA, Alexander J, Weber DJ, Miller WC. Assessment by meta-analysis of PCR for diagnosis of smear-negative pulmonary tuberculosis. J Clin Microbiol, 2003; 41: 3233-40.
  • 12. Turgut M. Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev, 2001; 24: 8-13.
  • 13. Gouliamos AD, Kehagias DT, Lahanis S, Athanassopoulou AA, Moulopoulou ES, Kalovidouris AA, Trakadas SJ, Vlahos LS. MR imaging of tuberculous vertebral osteomyelitis: pictorial review. Eur Radiol, 2001; 11: 575-79.
  • 14. Amin I, Idrees M, Awan Z, Shahid M, Afzal S, Hussain A. PCR could be a method of choice for identification of both pulmonary and extrapulmonary Tuberculosis. BMC Research Notes, 2011; 4: 332.
  • 15. Cheng VCC, Yam WC, Hung IFN, Woo PCY, Lau SKP, Tang BSF, Yuen KY. Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. J Clin Pathol, 2004; 57: 281–85.
  • 16. Moore DF, Guzman JA, Mikhail LT. Reduction in turnaround time for laboratory diagnosis of pulmonary tuberculosis by routine use of a nucleic acid amplification test. Cent Diagnostic Microbiol Infect Dis, 2005; 52: 247–54.
  • 17. Pandey V, Chawla K, Acharya K, Rao S, Rao S. The role of polymerase chain reaction in the management of osteoarticular tuberculosis. International Orthopaedics (SICOT), 2009; 33: 801–5.

A Case Of Tuberculous Spondylodiscitis

Yıl 2012, Cilt: 69 Sayı: 4, 229 - 234, 01.12.2012

Öz

Extrapulmonary tuberculosis EPTB is an important health problem like pulmonary TB in both developing and developed countries. EPTB may occur years after the primary infection or it may manifest itself as a rapidly progressive disease. TB is generally diagnosed by traditional methods, such as expectorate smear microscopy, chest radiography findings and expectorate culture. Current diagnostic procedures remain inadequate due to low mycobacteria levels in sample and/or time consuming procedures. We presented a case of EPTB who was diagnosed with TB polymerase chain reaction PCR . Although the radiological and pathological findings were suspicious for TB, searching for acido-resistant bacilli ARB and TB culture did not reveal a positivity. A 34 year old woman patient presented with 3-4 years history of waist pain which increased in the last 10 days. The patient was admitted to neurosurgery clinic with a prediagnosis of spondilodyscitis. The past history revealed that she had no fever and night sweeting but she had decreased appettite and weight loss in the last few months. X-ray chest graphy and computed tomography of the thorax were normal. While lomber magnetic resonance MR with contrast revealed dense contrast involvement in psoas muscle, lomber CT revealed bone destruction in corpus and posterior element of vertebra at L2-3 level. Abscess in the bacterial and tuberculous cultures of sample, ARB was also negative. Pathologic examiantion revealed chronic inflammation, fibrosis and granulomatous reaction. TB PCR result of the same sample has been found positive by Real-Time PCR. In recent years, diganostic disadvantages are decreased with the usage of molecular tests. This will provide early diagnosis, treatment and decreased morbidity and mortality in EPTB. We suggest that molecular tests should be used in the situations where conventional microbiologic methods failed. drainage was performed during surgery which was done for diagnosis and treatment. While no bacteria was grown.

Kaynakça

  • 1. World Health Organization: Global tuberculosis control: Surveillance, Planning, Financing. Geneva, WHO Report, 2008.
  • 2. Sreeramareddy CT, Panduru KV, Vermal SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal-a hospital based retrospective study. BMC Infect Dis, 2008; 8: 8.
  • 3. Cailhol J, Decludt B, Che D. Sociodemographic factors that contribute to the development of extrapulmonary tuberculosis were identified. J Clin Epidemiol, 2005; 58: 1066-71.
  • 4. Bozkurt H, Turkkanı MH, Musaombasıoglu S, Gullu U, Baykal F, Hasanoglu HC, Ozkara S. The National tuberculosis report’s 2009. Ankara, Turkish Republic. Ministry of Health, 2009.
  • 5. Demiralay R. Some epidemiological features of extrapulmonary tuberculosis registered in the tuberculous struggle dispensaries in Isparta. Tuberkuloz Toraks, 2003; 51: 33-9.
  • 6. Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am, 2001; 39: 329-42.
  • 7. Cormican L, Hammal R, Messenger J, Milburn HJ. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J, 2006; 82: 46-51.
  • 8. Soini H, Musser JM. Molecular diagnosis of Mycobacteria. Clin Chem, 2001; 47: 809-14.
  • 9. American Thoracic Society and the Centers for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000; 161: 1376-95.
  • 10. Hale YM, Pfyffer GE, Salfinger M. Laboratory diagnosis of mycobacterial infections: New tools and lessons learned. Clin Infect Dis, 2001; 33: 834-46.
  • 11. Sarmiento OL, Weigle KA, Alexander J, Weber DJ, Miller WC. Assessment by meta-analysis of PCR for diagnosis of smear-negative pulmonary tuberculosis. J Clin Microbiol, 2003; 41: 3233-40.
  • 12. Turgut M. Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev, 2001; 24: 8-13.
  • 13. Gouliamos AD, Kehagias DT, Lahanis S, Athanassopoulou AA, Moulopoulou ES, Kalovidouris AA, Trakadas SJ, Vlahos LS. MR imaging of tuberculous vertebral osteomyelitis: pictorial review. Eur Radiol, 2001; 11: 575-79.
  • 14. Amin I, Idrees M, Awan Z, Shahid M, Afzal S, Hussain A. PCR could be a method of choice for identification of both pulmonary and extrapulmonary Tuberculosis. BMC Research Notes, 2011; 4: 332.
  • 15. Cheng VCC, Yam WC, Hung IFN, Woo PCY, Lau SKP, Tang BSF, Yuen KY. Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. J Clin Pathol, 2004; 57: 281–85.
  • 16. Moore DF, Guzman JA, Mikhail LT. Reduction in turnaround time for laboratory diagnosis of pulmonary tuberculosis by routine use of a nucleic acid amplification test. Cent Diagnostic Microbiol Infect Dis, 2005; 52: 247–54.
  • 17. Pandey V, Chawla K, Acharya K, Rao S, Rao S. The role of polymerase chain reaction in the management of osteoarticular tuberculosis. International Orthopaedics (SICOT), 2009; 33: 801–5.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Olgu Sunumu
Yazarlar

Reyhan Yiş Bu kişi benim

Hadiye Demirbakan Bu kişi benim

Nuran Akmirza İnci Bu kişi benim

Erdal Yayla Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 69 Sayı: 4

Kaynak Göster

APA Yiş, R., Demirbakan, H., İnci, N. A., Yayla, E. (2012). Bir Olgu Nedeniyle Tüberküloz Spondilodiskit. Türk Hijyen Ve Deneysel Biyoloji Dergisi, 69(4), 229-234.
AMA Yiş R, Demirbakan H, İnci NA, Yayla E. Bir Olgu Nedeniyle Tüberküloz Spondilodiskit. Turk Hij Den Biyol Derg. Aralık 2012;69(4):229-234.
Chicago Yiş, Reyhan, Hadiye Demirbakan, Nuran Akmirza İnci, ve Erdal Yayla. “Bir Olgu Nedeniyle Tüberküloz Spondilodiskit”. Türk Hijyen Ve Deneysel Biyoloji Dergisi 69, sy. 4 (Aralık 2012): 229-34.
EndNote Yiş R, Demirbakan H, İnci NA, Yayla E (01 Aralık 2012) Bir Olgu Nedeniyle Tüberküloz Spondilodiskit. Türk Hijyen ve Deneysel Biyoloji Dergisi 69 4 229–234.
IEEE R. Yiş, H. Demirbakan, N. A. İnci, ve E. Yayla, “Bir Olgu Nedeniyle Tüberküloz Spondilodiskit”, Turk Hij Den Biyol Derg, c. 69, sy. 4, ss. 229–234, 2012.
ISNAD Yiş, Reyhan vd. “Bir Olgu Nedeniyle Tüberküloz Spondilodiskit”. Türk Hijyen ve Deneysel Biyoloji Dergisi 69/4 (Aralık 2012), 229-234.
JAMA Yiş R, Demirbakan H, İnci NA, Yayla E. Bir Olgu Nedeniyle Tüberküloz Spondilodiskit. Turk Hij Den Biyol Derg. 2012;69:229–234.
MLA Yiş, Reyhan vd. “Bir Olgu Nedeniyle Tüberküloz Spondilodiskit”. Türk Hijyen Ve Deneysel Biyoloji Dergisi, c. 69, sy. 4, 2012, ss. 229-34.
Vancouver Yiş R, Demirbakan H, İnci NA, Yayla E. Bir Olgu Nedeniyle Tüberküloz Spondilodiskit. Turk Hij Den Biyol Derg. 2012;69(4):229-34.