The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated^[*]

Abstract

Objective To describe the clinico-epidemiological, laboratory, and radiological characteristics of tuberculous spondylodiscitis in the Brazilian population, and to assess whether there are differences between patients in whom the etiological agent in Pott disease was isolated or not.

Methods Patients diagnosed with tuberculosis (TB) of the spine (Pott disease) underwent follow-up between 2009 and 2019 at a quaternary hospital and were divided into 2 groups: successful isolation (SI) of the etiological agent (through bacilloscopy, culture, or positive molecular rapid test) and unsuccessful isolation (UI) of the etiological agent.

Results From a total of 26 patients diagnosed with TB of the spine, 21 (80.7%) were male, with a mean age of 40 ± 22.5 years. The average lymphocyte counts were higher in the UI group (25.35 ± 13.08; p = 0.025) compared to the SI group (14.18 ± 7.48). Moreover, the monocyte/lymphocyte ratio was lower in the UI group (0.39 ± 0.22; p = 0.009) than in the SI group (0.89 ± 0.65). Relative lymphocyte counts higher than or equal to 16.7 had a sensitivity of 76.9% and specificity of 62.5% in the UI group. Values higher than or equal to 0.58 for the monocyte/lymphocyte ratio showed a sensitivity of 84.6% and specificity of 75.0% in the UI group.

Conclusion No differences were observed regarding the clinico-epidemiological and radiological characteristics of the two experimental groups. However, the UI group had higher lymphocyte counts and a lower monocyte/lymphocyte ratio.

Keywords

tuberculosis - spine - diagnosis - Pott disease - spondylodiscitis

Financial Support

There was no financial support from public, commercial, or non-profit sources.

^* Work developed at the Spinal Disorders Team, Departament of Orthopedics and Traumatology, Santa Casa de Misericórida de São Paulo, São Paulo, SP, Brazil.

Publikationsverlauf

Eingereicht: 26. Oktober 2021

Angenommen: 18. Juli 2022

Artikel online veröffentlicht:
24. März 2023

• Referências

• 1 Qian J, Rijiepu A, Zhu B, Tian D, Chen L, Jing J. Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis. Int Orthop 2016; 40 (10) 2081-2088
• 2 Wang G, Dong W, Lan T. et al. Diagnostic accuracy evaluation of the conventional and molecular tests for Spinal Tuberculosis in a cohort, head-to-head study. Emerg Microbes Infect 2018; 7 (01) 109
• 3 Dean A, Zyck S, Toshkezi G, Galgano M, Marawar S. Challenges in the Diagnosis and Management of Spinal Tuberculosis: Case Series. Cureus 2019; 11 (01) e3855
• 4 Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone Joint J 2018; 100-B [phone]
• 5 Chen CH, Chen YM, Lee CW, Chang YJ, Cheng CY, Hung JK. Early diagnosis of spinal tuberculosis. J Formos Med Assoc 2016; 115 (10) 825-836
• 6 BRASIL Ministério da Saúde. Manual de recomendações para o controle da Tuberculose no Brasil. 2019 ;(61). Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil.pdf
• 7 Kilborn T, Janse van Rensburg P, Candy S. Pediatric and adult spinal tuberculosis: imaging and pathophysiology. Neuroimaging Clin N Am 2015; 25 (02) 209-231
• 8 Uppal SS, Tewari SC, Verma S, Dhot PS. Comparison of CD4 and CD8 lymphocyte counts in HIV-negative pulmonary TB patients with those in normal blood donors and the effect of antitubercular treatment: hospital-based flow cytometric study. Cytometry B Clin Cytom 2004; 61 (01) 20-26
• 9 Jones BE, Oo MM, Taikwel EK. et al. CD4 cell counts in human immunodeficiency virus-negative patients with tuberculosis. Clin Infect Dis 1997; 24 (05) 988-991
• 10 Couto BB, Umeta RSG, Caffaro MFS, Meves R, Landim E, Avanzi O. Análise radiológica comparativa entre espondilodiscite tuberculosa e inespecífica. Coluna/Columna 2010; 9 (04) 394-400
• 11 Rivas-Garcia A, Sarria-Estrada S, Torrents-Odin C, Casas-Gomila L, Franquet E. Imaging findings of Pott's disease. Eur Spine J 2013; 22 (Suppl. 04) 567-578
• 12 Kanna RM, Babu N, Kannan M, Shetty AP, Rajasekaran S. Diagnostic accuracy of whole spine magnetic resonance imaging in spinal tuberculosis validated through tissue studies. Eur Spine J 2019; 28 (12) 3003-3010
• 13 Shi T, Zhang Z, Dai F. et al. Retrospective Study of 967 Patients With Spinal Tuberculosis. Orthopedics 2016; 39 (05) e838-e843
• 14 Lee KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine J 2014; 8 (02) 216-223
• 15 Durovni B, Saraceni V, van den Hof S. et al. Impact of replacing smear microscopy with Xpert MTB/RIF for diagnosing tuberculosis in Brazil: a stepped-wedge cluster-randomized trial. PLoS Med 2014; 11 (12) e1001766
• 16 Batirel A, Erdem H, Sengoz G. et al. The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. Clin Microbiol Infect 2015; 21 (11) 1008.e9-1008.e18
• 17 Nayak S, Acharjya B. VDRL test and its interpretation. Indian J Dermatol 2012; 57 (01) 3-8
• 18 Rama Krishna M, Gottam US, Mahendra N. Disseminated tuberculosis with severe immune thrombocytopenia. Respir Med Case Rep 2019; 27: 100812
• 19 O'Shea MK, Tanner R, Müller J. et al. Immunological correlates of mycobacterial growth inhibition describe a spectrum of tuberculosis infection. Sci Rep 2018; 8 (01) 14480
• 20 Bashir AB, Abufatima AS, Mohamedani AA. Impact of pulmonary tuberculosis on total and differential peripheral blood leukocytes count. Int J Trop Med 2014; 9 (03) 33-37
• 21 Liana P, Brestilova B, Yakub Rahadiyanto K. The ratio of monocytes to lymphocytes accuracy as tuberculosis predictor. J Phys Conf Ser 2019; 1246: 012024
• 22 Djordjevic D, Rondovic G, Surbatovic M. et al. Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia?. Mediators Inflamm 2018; 2018: 3758068
• 23 Wang J, Yin Y, Wang X. et al. Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis. Braz J Infect Dis 2015; 19 (02) 125-131
• 24 La Manna MP, Orlando V, Dieli F. et al. Quantitative and qualitative profiles of circulating monocytes may help identifying tuberculosis infection and disease stages. PLoS One 2017; 12 (02) e0171358
• 25 Roy Chowdhury R, Vallania F, Yang Q. et al. A multi-cohort study of the immune factors associated with M. tuberculosis infection outcomes. Nature 2018; 560 (7720): 644-648
• 26 Jasenosky LD, Scriba TJ, Hanekom WA, Goldfeld AE. T cells and adaptive immunity to Mycobacterium tuberculosis in humans. Immunol Rev 2015; 264 (01) 74-87
• 27 Cooper AM. Cell-mediated immune responses in tuberculosis. Annu Rev Immunol 2009; 27: 393-422
• 28 Monina L, Khadera SA. Chemokines in tuberculosis: The good, the bad and the ugly. Semin Immunol 2008; 23 (01) 1-7