Download PDF
Open Access
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(01): 092-100
DOI: 10.1055/s-0042-1756638
Artigo Original
Infectologia

O número relativo de linfócitos é menor quando o agente etiológico da doença de Pott é isolado com sucesso[*]

Article in several languages: português | English

Authors

  • Igor de Barcellos Zanon 

    1   Grupo de Afecções da Coluna Vertebral, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

  • Robert Meves

    2   Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

  • Giselle Burlamaqui Klautau

    1   Grupo de Afecções da Coluna Vertebral, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
    2   Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
Further Information
Also available at
  Permissions and Reprints
Preview

Resumo

Objetivo Descrever as características clínico-epidemiológicas, laboratoriais e radiológicas da espondilodiscite tuberculosa na população brasileira e avaliar se há diferenças entre pacientes em que o agente etiológico da doença de Pott foi isolado ou não.

Métodos Os pacientes diagnosticados com tuberculose (TB) da coluna (doença de Pott) foram acompanhados em um hospital quaternário entre 2009 e 2019 e divididos em 2 grupos: isolamento positivo (IP) do agente etiológico (por baciloscopia, cultura ou teste rápido molecular positivo) e isolamento negativo (IN) do agente etiológico.

Resultados De um total de 26 pacientes com diagnóstico de TB da coluna, 21 (80,7%) eram do sexo masculino, e a média de idade era de 40 ± 22,5 anos. As contagens médias de linfócitos foram maiores no grupo IN (25,35 ± 13,08; p = 0,025) do que no grupo IP (14,18 ± 7,48). Além disso, a relação monócito/linfócito foi menor no grupo IN (0,39 ± 0,22; p = 0,009) do que no grupo IP (0,89 ± 0,65). O número relativo de linfócitos maior ou igual a 16,7 teve sensibilidade de 76,9% e especificidade de 62,5% no grupo IN. A razão monócito/linfócito maior ou igual a 0,58 teve sensibilidade de 84,6% e especificidade de 75,0% no grupo IN.

Conclusão Não observamos diferenças em relação às características clínico-epidemiológicas e radiológicas entre os dois grupos experimentais. No entanto, o grupo IN apresentou maior número de linfócitos e menor razão monócito/linfócito.

Palavras-chave

tuberculose - coluna vertebral - diagnóstico - doença de Pott - espondilodiscite

Suporte Financeiro

Não houve apoio financeiro de fontes públicas, comerciais ou sem fins lucrativos.


* Trabalho desenvolvido no Grupo de Afecções da Coluna Vertebral, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.




Publication History

Received: 26 October 2021

Accepted: 18 July 2022

Article published online:
24 March 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 4 Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone Joint J 2018; 100-B (04) 425-431
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 13 Shi T, Zhang Z, Dai F. et al. Retrospective Study of 967 Patients With Spinal Tuberculosis. Orthopedics 2016; 39 (05) e838-e843
    Search in Google Scholar
  • 14 Lee KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine J 2014; 8 (02) 216-223
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 17 Nayak S, Acharjya B. VDRL test and its interpretation. Indian J Dermatol 2012; 57 (01) 3-8
    Search in Google Scholar
  • 18 Rama Krishna M, Gottam US, Mahendra N. Disseminated tuberculosis with severe immune thrombocytopenia. Respir Med Case Rep 2019; 27: 100812
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 27 Cooper AM. Cell-mediated immune responses in tuberculosis. Annu Rev Immunol 2009; 27: 393-422
    Search in Google Scholar
  • 28 Monina L, Khadera SA. Chemokines in tuberculosis: The good, the bad and the ugly. Semin Immunol 2008; 23 (01) 1-7
    Search in Google Scholar