Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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REVIEW ARTICLE
Year : 2016  |  Volume : 11  |  Issue : 4  |  Page : 233-236

Multi-drug resistant tuberculous spondylitis: A review of the literature


Department of Medicine, University of Texas Health Northeast; Department of Medicine/Infectious Diseases, University of Texas Health Science Center; Heartland National TB Center, San Antonio, TX, USA

Correspondence Address:
Quratulain Fatima Kizilbash
Texas Center for Infectious Disease, 2303 SE Military Drive, San Antonio, TX 78223
USA
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DOI: 10.4103/1817-1737.191867

PMID: 27803747

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While tuberculous vertebral osteomyelitis is an ancient scourge, multi-drug resistant-tuberculosis (MDR-TB) is a modern major public health concern. The objective of this study was to review and summarize the data available on MDR-TB spondylitis. An extensive search of the PubMed database was conducted for articles in English relevant to MDR-TB spondylitis by December 2015. Tuberculous spondylitis accounts for 0.5–1% of all TB cases, and it is estimated that there are probably 5000 MDR-TB spondylitis cases each year worldwide. The diagnosis of MDR-TB spondylitis requires a high index of suspicion based on epidemiologic, clinical, and radiologic features. Cultures and susceptibility testing remain the gold standard for the diagnosis of MDR-TB, but this can take several weeks to obtain. Medical treatment is the mainstay of therapy, and ideally, it should be based on drug susceptibility testing. If empiric treatment is necessary, it should be based on drug exposure history, contact history, epidemiology, and local drug resistance data, if available. The total duration of treatment should not be <18–24 months. Clinical, radiographic, and if possible, bacteriologic improvement should be used to assess the treatment success. Surgery should be reserved for neurologic deterioration, significant kyphosis, spinal instability, severe pain, and failure of medical management.


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