Pott’s disease

Pott's disease _thoracic

Last Updated December 20th, 2021

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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Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
50 common health conditions
What are the top 50 deadly and widespread diseases? A complete list of the top 50 most common and deadly diseases that plague humanity. Which disease is…
xylitol gum
Xylitol : Is this the right sugar substitute for you? Discovered during World War 2 owing to sugar shortage, xylitol has become a common name in pharamaceutical industry.…
Shilajit: A miracle Himalayan herb for an active and happy life The Himalayas contain more wonders than you thought. Shilajit is a miracle herb that is widely used in…
GM Diet: The fastest way to lose weight or yet another hoax diet? General Motors started this trend of extreme dieting for 7 straight days to ensure its employees were able…
What to eat, what not to eat in the South Beach Diet? The South Beach Diet is one among the most popular weight loss programs that have been the talk…
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
BoneMarrow-Biopsy
Bone Marrow Biopsy Bone marrow biopsy is a diagnostic procedure where a small amount of bone marrow is extracted from hip…
ureteroscopy
Ureteroscopy Ureteroscopy is the diagnostic procedure which is used for the detection of the kidney stones in addition to…
quinoa salad
Quinoa : A prodigious superfood you need to include in your diet today! Quinoa - what is so special about this native South American grain that has taken the world by…
oral hygiene tips
6 shocking consequences of bad oral hygiene (and how to avoid them) Did you know bad breath is not just turning off, but also harms your body in ways you…
The complete “what to eat” guide for gluten intolerance Does eating breads and pastas often makes you nauseous? Gluten intolerance is a common reason why you might…
LFT-test
Liver Function Test – LFT LFT or Liver Function Test is a blood test used to determine the levels of hepatic enzymes which…
Glucose-6-Phosphate Dehydrogenase (G6PD) test Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that is found in every cell of the body and it plays…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
carbamazepine
Carbamazepine / Tegretol test The carbamazepine is a drug that is used to treat epilepsy and the carbamazepine test is performed to…
cardioliin antibody iga
Cardiolipin Antibody (ACL) – IgA test Cardiolipins are phospholipids that are constituents of the platelets and the cell membranes. The IgA test detects the…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
nature health benefits
Green Healing: The amazing health benefits of being in nature You have no idea what sitting in a closed room does to your body and mind.Can a stroll…
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…
glutamine workout
Glutamine: Why is this the right choice for muscle-gain supplement? Glutamine can help you gain muscles and build higher immunity. Read more to find out how you can…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
Plexus Slim: Is this pink slimming drink the ultimate one-stop fat burner? How effective is Plexus Slim in helping people lose weight? What are its ingredients? Can it be safely…