Draft:Tuberculous myelitis
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| Tuberculous myelitis | |
|---|---|
| Other names | Tuberculous transverse myelitis |
| Specialty | Neurology, Infectious disease |
| Symptoms | Back pain, Muscle weakness, Paralysis, sensory loss, Bowel dysfunction, Bladder dysfunction |
| Complications | Permanent neurological deficits, paralysis |
| Usual onset | Acute or sub-acute |
| Causes | Mycobacterium tuberculosis infection of the spinal cord |
| Diagnostic method | MRI, CSF analysis, microbiological tests |
| Differential diagnosis | Other causes of Transverse myelitis, Multiple sclerosis, spinal cord infarction |
| Treatment | Anti-tuberculosis therapy, Corticosteroid, supportive care |
| Prognosis | Variable; partial to full recovery possible, some cases with permanent deficits |
Tuberculous myelitis is a form of Transverse myelitis caused by infection of the spinal cord by Mycobacterium tuberculosis. It is a rare but serious neurological complication of tuberculosis (TB), characterised by inflammation and damage to the spinal cord leading to neurological deficits.[1][2][3] Tuberculous myelitis may occur as a direct infection of the spinal cord or as a complication of Tuberculous meningitis or spinal tuberculosis (Pott disease).[2][4] The condition presents with symptoms such as Back pain, Muscle weakness, Paralysis, sensory loss, and bladder or bowel dysfunction.[5][1] Diagnosis is based on clinical presentation, MRI, and laboratory evidence of tuberculosis infection.[1][6][3] Treatment involves standard anti-tuberculosis drug regimens (such as Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) combined with corticosteroids to reduce inflammation.[7][1] Prognosis varies depending on the severity and timeliness of treatment, with some patients recovering fully while others may suffer lasting neurological impairments.[1][6][3]
Signs and symptoms
[edit]Tuberculous myelitis typically presents with symptoms of spinal cord dysfunction that develop over hours to weeks. Common clinical features include:
- Back pain localised to the back or radiating along nerve roots
- Muscle weakness or Paralysis affecting the limbs below the lesion level
- sensory loss such as numbness, tingling or paraesthesia
- Bladder dysfunction and bowel dysfunction, including urinary retention or incontinence and constipation
- Possible Fever and constitutional symptoms related to active tuberculosis infection[5][1][3][8]
The neurological deficits usually correspond to the spinal cord segments involved and may be unilateral or bilateral.[1][2][9]
Causes
[edit]Tuberculous myelitis results from infection of the spinal cord by M. tuberculosis. The infection can reach the cord via haematogenous spread from a primary pulmonary or extrapulmonary focus or by direct extension from adjacent vertebral tuberculosis (Pott disease). It can also complicate Tuberculous meningitis.[2][1][4]
The pathogenesis involves an inflammatory response to the mycobacterial infection leading to oedema, Demyelination, and Necrosis of the spinal cord. This inflammation disrupts neural transmission and causes neurological deficits.[6][3]
Other infectious and non-infectious causes of Transverse myelitis include viral infections (e.g. herpesviruses, HIV, Enterovirus), bacterial infections (e.g. Lyme disease, Syphilis), autoimmune disorders (such as Multiple sclerosis), and idiopathic causes.[5][10][11]
Pathophysiology
[edit]Inflammation in tuberculous myelitis is characterised by infiltration of inflammatory cells, spinal cord oedema, and Demyelination, visible on MRI as hyperintense T2-weighted signals with cord enlargement.[1][3] Post-contrast MRI may show marginal enhancement of the affected segments.[9][6]
The immune response to M. tuberculosis within the cord leads to tissue damage and neurological impairment. The extent of damage depends on the severity of infection and host immune factors.[6][11]
Diagnosis
[edit]Diagnosis involves a combination of clinical evaluation, imaging findings and laboratory tests:
- Magnetic resonance imaging (MRI): Shows cord lesions with T2 hyperintensity, oedema and, occasionally, contrast enhancement. Lesions may be multifocal, most often in the cervicothoracic region.[1][9]
- CSF analysis: May reveal lymphocytic pleocytosis, elevated protein and low glucose, findings consistent with TB meningitis or spinal infection.[1][3]
- Microbiological tests: Acid-fast bacilli staining, culture and nucleic acid amplification tests (e.g. PCR, metagenomic NGS) on CSF or tissue confirm M. tuberculosis infection.[6][4]
- Chest imaging: Chest X-ray or CT scan may identify pulmonary tuberculosis as the source.[1][2]
The differential diagnosis includes other causes of Transverse myelitis such as Multiple sclerosis, viral myelitis, neurosyphilis and spinal cord infarction.[5][10][11]
Treatment
[edit]Management follows standard WHO-recommended anti-tuberculosis therapy, typically comprising Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol during an intensive phase followed by continuation phase therapy.[7][1][3]
Adjunctive corticosteroids are frequently used to reduce cord inflammation and oedema, potentially improving neurological outcomes.[1][3][11]
Supportive care includes physiotherapy to address motor deficits and measures to manage bladder and bowel dysfunction.[5][8]
Prognosis
[edit]Outcome is variable. Early diagnosis and prompt treatment improve prognosis: studies report that about 60 % of patients recover fully, 20 % have mild deficits and 20 % sustain severe permanent impairments.[1][3] Delayed therapy or extensive cord involvement is associated with worse outcomes.[6][4]
Epidemiology
[edit]Tuberculous myelitis is rare but more commonly encountered in regions with a high prevalence of tuberculosis. It can affect any age group but is more frequent among immunocompromised individuals or those with disseminated TB.[1][2][11]
See also
[edit]References
[edit]- ^ a b c d e f g h i j k l m n o p Gupta, R (16 March 2022). "Myelitis: A common complication of tuberculous meningitis". Frontiers in Neurology. 13 (5): 626–648. doi:10.1002/ca.23880. PMC 8965833. PMID 35396731.
- ^ a b c d e f Jain, R. S. (2011). "Tuberculous myelitis: Clinical profile and outcome". Annals of Indian Academy of Neurology. 14 (1): 35–39. doi:10.1371/journal.pone.0018416. PMC 3081097. PMID 21541019.
- ^ a b c d e f g h i j Ravishankar, S (2017). "Tuberculous myelitis: A rare cause of acute transverse myelitis". Journal of Neurosciences in Rural Practice. 8 (1): 164–166. doi:10.4103/0976-3147.193555. PMC 5322754. PMID 28250567.
- ^ a b c d Omar, N (2023). "Tuberculous myelitis: A case series and review". Journal of Infection in Developing Countries. 17 (2): 267–273. doi:10.1111/rda.14339. PMID 36881512. Retrieved 3 June 2025.
- ^ a b c d e "Transverse myelitis – Symptoms & causes". Mayo Clinic. 19 January 2022. Retrieved 3 June 2025.
- ^ a b c d e f g Zhang, Y (2022). "Tuberculous myelitis: A prospective follow-up study". Journal of Neurology. 43 (9): 5615–5624. doi:10.1007/s10072-022-06221-6. PMC 9225802. PMID 35739331.
- ^ a b "Tuberculosis". World Health Organization. 10 October 2023. Retrieved 3 June 2025.
- ^ a b Kumar, V (2015). "Acute transverse myelitis: Clinical profile, etiology and predictors of outcome". Annals of Indian Academy of Neurology. 18 (4): 409–413. doi:10.4103/0972-2327.165468 (inactive 1 July 2025). PMC 4677229. PMID 26677476.
{{cite journal}}: CS1 maint: DOI inactive as of July 2025 (link) - ^ a b c Zhou, Y (6 November 2021). "Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report". World Journal of Clinical Cases. 9 (31): 9645–9653. doi:10.12998/wjcc.v9.i31.9645. PMC 8610911. PMID 34867653.
- ^ a b "Transverse Myelitis (TM): Causes, Symptoms & Treatment". Cleveland Clinic. 19 March 2025. Retrieved 3 June 2025.
- ^ a b c d e Beh, S. C. (February 2013). "Transverse myelitis". Neurologic Clinics. 31 (1): 79–138. doi:10.1016/j.ncl.2012.09.008. PMC 7132741. PMID 23186897.
External links
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