title: Spinal tuberculosis in non-HIV-infected patients: 10 year experience of a medical center in central Taiwan.
abstract: OBJECTIVE
  Tuberculosis (TB) is an endemic disease in Taiwan and it usually affects the lung. Spinal TB accounts for 1-3% of all TB infections. The purpose of this study was to investigate the clinical manifestations, management, outcomes and drug susceptibility of Mycobacterium tuberculosis in non-HIV-infected patients with spinal TB.
  
  
  METHODS
  From January 1998 to December 2007, we retrospectively reviewed the medical charts of adult patients with a diagnosis of spinal TB. Only those with positive culture results and/or characteristic pathologic findings were enrolled. Demographic data, clinical manifestations and susceptibility to anti-TB drugs were reviewed and analyzed.
  
  
  RESULTS
  During the study period, 38 patients (23 men, 15 women) with spinal TB were identified and the mean age was 68 years. The median duration of symptoms was 60 days (range, 3-720 days). Amongst the 38 patients, back pain (100%) was the most common clinical symptom, followed by weakness (53%) and numbness (26%). The lumbar spine (15 patients, 39%) was the most commonly involved site, followed by the thoracic spine (14 patients, 37%). Concomitant pulmonary TB was found in 12 patients (32%). Three patients (8%) had concurrent bacterial or fungal infections. Almost all of the patients (35 patients, 92%) were successfully treated with surgery and anti-TB medications. The erythrocyte sedimentation rate was followed up in 16 patients before and after therapy and a significant decline was observed after treatment (p = 0.004). No mortality was related to spinal TB.
  
  
  CONCLUSIONS
  Insidious clinical course and ambiguous manifestations of spinal TB often delay and hinder the accuracy of diagnosis of spinal TB. In addition to pyogenic osteomyelitis, spinal TB should be included in the differential diagnosis especially in elderly patients with chronic back pain accompanied by elevated erythrocyte sedimentation rate, and those living in the TB endemic area.
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ching-Yun
authors.initials: CY
authors.lastname: Weng
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Chi
authors.forename: Pai-Jun
authors.initials: PJ
authors.lastname: Shih
authors.forename: Cheng-Mao
authors.initials: CM
authors.lastname: Ho
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Lin
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Chou
authors.forename: Jen-Hsien
authors.initials: JH
authors.lastname: Wang
authors.forename: Mao-Wang
authors.initials: MW
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D014399:Tuberculosis, Spinal / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery
chemical_list: D000995:Antitubercular Agents