TB of the spine is important.The disastrous consequence for the patient of a missed diagnosis of thoracic or cervical spinal TB is paralysis. TB starts in an intervertebral disc and spreads along the anterior and longitudinal ligaments, before involving the adjacent vertebral bodies. Where TB is common, plain X-ray of the spine is usually diagnostic.The typical appearance is erosion of the anterior edges of the superior and inferior borders of adjacent vertebral bodies. The disc space is narrowed. The sites most commonly involved are the lower thoracic, lumbar and lumbosacral areas.
The main differential diagnoses are malignancy and pyogenic spinal infections. Malignant deposits in the spine tend to erode the pedicles and spinal bodies, leaving the disc intact. Pyogenic infection tends to be more acute than TB, with more severe pain.
Ileocaecal TB may present with constitutional features, chronic diarrhoea, subacute obstruction, or a right iliac fossa mass. Diagnosis rests on barium examination of the small and large bowel, or on colonoscopy, if available. The differential diagnosis includes ileocaecal Crohn disease, carcinoma of the caecum, appendix abscess, lymphoma, amoeboma and tubo-ovarian abscess.
Miliary TB may involve the liver. Hepatic TB can cause diagnostic confusion. Solitary or multiple TB abscess formation can mimic amoebic liver abscess. Nodular hepatic TB can mimic hepatoma. In these situations, ultrasound examination is useful. Liver biopsy, available in some hospitals, is diagnostic.
] SUGGESTIONS FOR FURTHER READING [
Crofton J, Horne N, Miller F. Clinical tuberculosis. second edition. London, MacMillan Press Limited, 1999.
Donald PR, Fourie PB, Grange JM. Tuberculosis in childhood. Pretoria, JL van Schaik, 1999.
Harries AD, Maher D, Nunn PAn approach to the problems of diagnosing and treating adult smear-negative pulmonary tuberculosis in high HIV prevalence settings in sub-Saharan Africa. Bulletin of the World Health Organization, 1998, 76, (6): 651-662.
Maher D, Harries AD. Tuberculous pericardial effusion: a prospective clinical study in a low-resource setting - Blantyre, Malawi. International Journal of Tuberculosis lung Disease, 1997, 1 (4): 358-364.
Miller FJW Tuberculosis in children. New Delhi, Churchill-Livingstone, 1986.
Toman's tuberculosis case detection, treatment and monitoring: questions and answers. Edited by T Frieden, second edition. World Health Organization, Geneva, 2004. ISBN 92 4 154603 4. (WHO/HTM/TB/2004.334).
Was this article helpful?