Pott’s disease

Pott's disease _thoracic

Last Updated August 23rd, 2019

As per statistics, 3% of all tuberculosis cases progress further to affect the musculoskeletal system. However, the spine remains the most affected part in such cases. Co-morbidity of Pott’s disease with HIV is quite common. This is because Pott’s disease progresses rapidly (and is often misdiagnosed) in immunocompromised patients. Though death due to Pott’s disease is rare, spinal complications are severely disabling.
Globally, more than 2 billion people are carriers of the mycobacterium tuberculosis but not all of them develop symptoms. The bacteria usually spread via respiratory droplets. Theoretically speaking, any part of the human body can infected by TB, but it mostly affects the lymph nodes, bones, meninges (brain membranes). If the infection is prevalent in body parts other than the lungs, such as the spine or joints, it is called as extra-pulmonary TB. In such cases, the infection is not contagious.
Globally, 1% of all TB patients show cardiac symptoms. Cardiac tuberculosis is also treated as extra-pulmonary TB. The prevalence of cardiac TB is high in HIV patients. The most common symptom of cardiac TB is pericardial effusion or fluid accumulation in the membrane that surrounds the heart. It may also result in thickening of the cardiac membrane (constrictive pericarditis). Since, this condition often goes undiagnosed in the early stages; mortality rate associated with cardiac TB is quite high. The tell-tale signs of cardiac TB are – short breath, sudden weight loss, chest pain, and swelling of ankles. Several studies also indicate that TB and atherosclerosis-related conditions such as stroke are largely co-related.

Overview of Pott’s disease

Lung diseases and their complications are quite severe. Most of the associated complications are pertaining to respiratory ailments. Hence many are not aware that lung diseases may even give rise to musculoskeletal disorders. Pott’s disease is one such disease where spine disorders arise from certain lung ailments. The complications are very serious since the patient shows symptoms of both pulmonary diseases and joint problems.

What is Pott’s disease?

Pott’s disease is a type of tuberculosis which mainly manifests itself through certain complications in the vertebral bones. Although it is primarily a lung disease, some of the tissues present outside the lungs are also affected. In the advanced stages, the disease even progresses to the spine and affects the intervertebral joints. Mainly considering the different symptoms, Pott’s disease is also known as “tuberculosis spondylitis” or “spinal tuberculosis”. It was named after the British surgeon, Percivall Pott who discovered and explained the symptoms first. The symptoms are mostly restricted to the thoracic portion of the spine and affect mainly the upper lumbar vertebrae and the lower thoracic vertebrae. As the disease progresses, the symptoms are felt in the adjoining areas as well.

What causes Pott’s disease?

Pott’s disease starts with Tuberculosis, which is a lung infection caused by Mycobacterium tuberculosis. A slow and hematogenous spread of tuberculosis to the neighboring sites, particularly the spine, leads to Pott’s disease. The severity increases when the infections spread from the adjacent vertebra into the intervertebral disc space. The disc remains in normal condition when only one vertebra is affected. But when two successive vertebral bones are affected, the disc (which is devoid of blood vessels) stops receiving nutrients through blood and collapses completely. A phenomenon known as caseous necrosis is observed in these cases, wherein the disc tissue dies. This leads to three phenomena-

A dry mass of soft tissue is formed, reducing the chances of associated infections.

The best way to prevent Pott’s disease is to find an effective remedy for TB. Try these top-rated natural products to fight a TB infection.

What are the main warning signs and symptoms?

Potts Disease_coughing Pott’s disease is characterized by both pulmonary and skeletal symptoms. These will be discussed in separate sections.

Pulmonary symptoms

The patient mainly shows some prominent respiratory symptoms which are as follows-

  • A persistent cough (productive or non-productive)
  • Frequent sneezing
  • Difficulty breathing (due to partial obstruction of the respiratory tract)
  • Pain in the chest during breathing, coughing and sneezing
  • Feeling of tightness around the chest
  • High fever and headache
  • Body pain and occasional chills
  • Production of blood-tinged sputum
  • Pain in the diaphragm region radiating to the abdomen
  • Increased heart rate
  • Gastrointestinal disorders
  • Generation of wheezing sound during breathing
  • Loss of appetite
  • Weight loss
  • Dizziness and fatigue
  • Disturbed sleep
  • Disturbed mental state

Joint problems

Along with the pulmonary symptoms, the patient experiences some major joint problems in the spine which are listed below-

  • Stiffness and pain in the joint especially in the morning
  • Pain and stiffness in the neck, back and buttocks
  • Pain and inflammation in the tendons and the ligaments, which is felt mainly in the chest, back of the heel or underneath the foot
  • Inflammation and swelling of the joints and the soft tissues
  • Joint pain during slight movements
  • Temporary immobility (permanent immobility may also occur due to ankylosed or fused joints)
  • Cracking and crunching sounds during normal joint movements
  • Weakness and fatigue of muscles (may lead to muscular dystrophy)
  • Pain radiating to neighbouring regions (lower extremities)
  • Redness around the joint area
  • Extreme tenderness and touch sensitivity of joints
  • Throbbing pain in the joint and muscles after some activity
  • Bone and joint deformities (at an advanced stage)
  • Disturbed sleep due to increased joint pain at night
  • Difficulty maintaining normal body postures
  • Difficulty performing mundane activities such as walking, running, climbing stairs
  • Body aches and fever
  • Extreme fatigue
  • Loss of appetite
  • Visible bulges (due to bone spurs)

How is Pott’s disease diagnosed and treated?

Potts disease_xray For the proper detection of Pott’s disease, a detailed diagnosis of both the respiratory manifestations and the joint ailments is very necessary. For the detection of Tuberculosis, the following diagnostic tests are preferable-

  • Chest X-ray (to examine the condition of the lungs)
  • Sputum cultures (to look for the presence of bacteria)
  • Blood culture
  • Tissue biopsy (to check for the possibilities of cancer)
  • Mantoux Tuberculin skin tests ( results are positive in 84-95% of the patients having Pott’s disease)
  • Nucleic acid amplification test

In addition to the above tests, the doctors also advise the patients to get the following laboratory examinations done in order to detect the extent of the joint problems-

  • Blood tests: The patients generally show an elevated level of C-reactive protein (CRP) and ESR. This is not necessarily related to the degree of inflammation since people having very serious inflammation often have normal or close to normal values of CRP and ESR. An ESR greater than 100 mm/h indicates Pott’s disease. Complete blood count (CBC) is often carried out in order to detect if leukocytosis has occurred or not.
  • Genetic tests: These are required to test for HLA-B27. Above 90% of the patients diagnosed with AS have been tested positive for HLA-B27.
  • BASDAI: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) gives a measure of the inflammatory burden of the existing diseases.
  • Schober’s test: It measures the flexion of the lumbar spine during the preliminary physical examination.

The radiographs of the spine yield the following results-

  • Collapse of the vertebral body
  • Osteoporosis of the vertebral endplates
  • Destruction of the intervertebral discs
  • Fusiform paravertebral shadows (indicates abscess formation)
  • Bone lesions

Pott's disease _thoracicThe first line of treatment for Pott’s disease is the surgical debridement of the entire focus of the tubercular infection. Administration of anti-tubercular medications is done before and after the surgery. This procedure is followed by the surgical reconstruction of the spine.

The treatment protocol is formulated based on the presence or absence of neurological involvement. In case of neurological involvement usually, pharmacotherapy is preferred over surgery. The anti-tubercular medications employed in the pharmacotherapy are Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide.

Is it preventable?

If you have been diagnosed with tuberculosis, it is highly important for you to undergo extensive treatment to completely cure this condition.  When tuberculosis is not treated appropriately or if there is any delay in the treatment, it can result in spreading of the disease to the surrounding tissues.  In some cases, it can affect the spinal cord as well as the vertebral joints.

If you are facing problems with vitamin D, there is a possibility that your musculoskeletal system is not strong enough to withstand the infection and can lead to the breaking of the bone easily.  It is recommended to have adequate vitamin D levels so that calcium is absorbed from the food we eat and provide a healthy musculoskeletal system.

Facts

  • In pott’s disease paralysis might result from the compression of the spine.
  • Spinal tuberculosis accounts for around 2 % of all the tuberculosis cases.
  • According to the World Health Organization (W.H.O), approximately one-third of the world’s population is infected with tuberculosis.

Facts

  • In the year 2016, there were approximately 10.4 million new cases of tuberculosis diagnosed worldwide.
  • The spinal cord works independently. In certain cases, the spinal cord can directly send signals to the muscles without any stimulation from the brain. This is known as the spinal reflex.

Facts

  • An astronaut can grow an inch or two after returning from space as the spinal cord is composed of around 25% of cartilage. Gravity has an impact on height and the cartilage disks expand. We are tallest when we first awaken in the morning as the gravity causes a shrinking effect throughout the day.

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As per statistics, 3% of all tuberculosis cases progress further to affect the musculoskeletal system. However, the spine remains the most affected part in such cases. Co-morbidity of Pott’s disease with HIV is quite common. This is because Pott’s disease progresses rapidly (and is often misdiagnosed) in immunocompromised patients. Though death due to Pott’s disease is rare, spinal complications are severely disabling.
Globally, more than 2 billion people are carriers of the mycobacterium tuberculosis but not all of them develop symptoms. The bacteria usually spread via respiratory droplets. Theoretically speaking, any part of the human body can infected by TB, but it mostly affects the lymph nodes, bones, meninges (brain membranes). If the infection is prevalent in body parts other than the lungs, such as the spine or joints, it is called as extra-pulmonary TB. In such cases, the infection is not contagious.
Globally, 1% of all TB patients show cardiac symptoms. Cardiac tuberculosis is also treated as extra-pulmonary TB. The prevalence of cardiac TB is high in HIV patients. The most common symptom of cardiac TB is pericardial effusion or fluid accumulation in the membrane that surrounds the heart. It may also result in thickening of the cardiac membrane (constrictive pericarditis). Since, this condition often goes undiagnosed in the early stages; mortality rate associated with cardiac TB is quite high. The tell-tale signs of cardiac TB are – short breath, sudden weight loss, chest pain, and swelling of ankles. Several studies also indicate that TB and atherosclerosis-related conditions such as stroke are largely co-related.

 

Dos and Don'ts

Dos
  • Visit your general physician if you observe symptoms like a persistent cough, coughing up blood, weight loss, malaise, night sweats, fever etc.
  • Get screened for a latent TB infection in case you are susceptible to the infection (HIV AIDS patients, health care workers, IV drug users, individuals in contact with TB patients).
  • Get a CT scan or MRI to confirm the diagnosis of spinal tuberculosis.
Don'ts
  • Stop the treatment in between. In case the treatment is stopped mid-way, there are possibilities of developing a drug-resistant strain of TB which is difficult to cure.
  • Self-medicate. Consult a registered general physician and get treated.
  • Miss the regular dose of medications. Follow the treatment protocol religiously.

 

 

 

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CrossFit: Now get the perfectly sculpted body with this explosive gym routine CrossFit is a fitness regimen that makes use of high-intensity exercises in a shorter period to achieve muscle…
colposcopy
Colposcopy Colposcopy is a simple, quick and non- invasive diagnostic tool to look closely inside the vulva, vagina, and…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
lithium test
Lithium test A lithium test is a blood test that is used to diagnose conditions of acute and chronic lithium…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
fitness routine fun
10 fantastic ways to make your fitness routine more fun! Are you too bored to exercise? Do you avoid gym cause it's too monotonous? Looking for fun and…
Spirulina: Battle diabetes and cholesterol with this blue-green algae Spirulina, a species of salt water algae, has now become a billion dollar industry. How you can use…
low carb diet meal
Low carb diet : Go high on fats and low on carbs for a leaner body! Did you know that sugar is the new fat? Going low on carbs and high on fats &…
global warming health
Rising mercury and your health: How Global Warming is damaging your body Don't ignore the rising temperature. Global warming causes more than just heat strokes. It could be a lot…
biotin for hair
Biotin: One-stop-shop for shiny hair and an active body! What is common to bananas, eggs, sweet potatoes, and liver? These are delicious and rich in biotin ;…