Abstract
Background: Some patients with clinically suspected STB are given empirical ATT under specialist supervision, without histological or microbiological confirmation of disease, due to lack of resources.
Aim: To assess the outcome following empirical ATT in a cohort with a clinical diagnosis of STB.
Methodology: We followed up 33 patients diagnosed with STB based on history, negative blood culture, spinal CT and/or MR imaging and supported by tuberculin test and inflammatory markers. None had microbiological or histological confirmation. All were given standard category I ATT, with prolonged regimen for neurologically complicated disease.
Results: CT/MRI showed end plate destruction/sclerosis and/or evidence of discitis in 28 patients, with paraspinal and psoas abscesses in some. In the remaining five, imaging findings were atypical. One patient died and another with body and pedicle destruction was found to have metastatic spinal disease. 22 completed ATT, while 9 are still on treatment, completing minimum of six months. All 31 patients followed up, including 4 with atypical imaging features, had symptomatic improvement with ESR normalizing in 90% and weight gain in 77%. Serial spinal X-rays did not show worsening in any. None had ATT related major adverse effects. Six with neurological deficits had completed 12 months ATT, where the recovery was full in 4 and partial in 2.
Conclusion: Imaging based diagnosis of STB and empirical ATT with close supervision appears to be safe and effective, in a setting with high degree of clinical suspicion, low drug resistance and limited resources.
- © 2011 ERS