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Galloway K.1, Parker R.2
1University of Cape Town, Health and Rehab, Anaesthetics, East London, South Africa, 2University of Cape Town, Health and Rehab, Anaesthetics, Cape Town, South Africa
Background: Tuberculosis is highly prevalent in South Africa, particularly as an opportunistic infection related to HIV. In my work in a district hospital in the Eastern Cape, I encountered many people infected with TB in the spine. Late diagnosis leads to increased disability and risk of death, and monitoring facilitates early identification of resistant strains of the bacilli. The diagnosis of Pulmonary Tuberculosis is made easier by the advent of GeneXpert, however the diagnosis of Spinal Tuberculosis is extremely difficult, especially in the context where CT guided biopsies are not easily available, and mainly done only once there are obvious changes on X-ray, which is late in the course of the disease. This literature review was done to ascertain if there are any other tests that could be requested by the physiotherapist of a person with back pain and at risk of TB spine. The results of these tests could assist the physiotherapist to flag patients at risk of TB spine.
Purpose: To identify assessment tools or tests for the diagnosis of TB spine or to indicate risk of TB spine.
Methods: A literature search was done using Google Scholar and Pubmed using the terms spinal Tuberculosis diagnosis and TB spine diagnosis. Mainly free full text articles were accessed due to the researcher not being affiliated with an academic institution. The articles presenting information on the common findings in presentation, blood test results, Xray findings, and other investigations were identified and explored in depth.
Results: Spinal Tuberculosis is extremely difficult to identify early in the course of the disease. Gold standard diagnosis involves histological confirmation on CT guided biopsy, but even this procedure is difficult to access and is often applied late in the course of the disease. The literature search revealed the use of ESR, CRP, induced sputum with hypertonic saline, exclusion of certain cancers (difficult to do), information about length of time from start of Antiretroviral Therapy (for TB IRIS), and immunological status amongst others. These results, along with the presenting symptoms, can be informative although not definitive. Follow up of high suspicion cases could help with identifying those that fail on their management plan or treatment.
Conclusion(s): More research is needed in the field of Physiotherapy to enable early identification of Spinal Tuberculosis especially in this era of HIV and Antiretroviral Therapy.
Implications: Physiotherapists need to be familiar with Spinal Tuberculosis and its unconventional presentations. Being able to request blood tests and other investigations would help physiotherapists to determine risk of serious spinal pathology related to Spinal Tuberculosis.
Funding acknowledgements: none at present
Topic: Primary health care
Ethics approval: none required for literature search
All authors, affiliations and abstracts have been published as submitted.
