PURPOSE: Spinal tuberculosis (TB) is a well recognised presentation of TB with a high morbidity and mortality if left untreated. In 2009 spinal TB represented 4.1% of the 8217 newly diagnosed TB cases in the UK. In 2004 there was one new case of spinal TB in our district general hospital; in 2010 this number had risen to ten. Our aim was to determine the local incidence of spinal TB in the catchment area of a South East London district general hospital.
METHODS: A retrospective case note review was conducted of all patients who were diagnosed with spinal TB in Queen Elizabeth hospital (Woolwich, London) between 2004 and 2010.
RESULTS: 31 patients were diagnosed with spinal TB in this timeframe. 25 had case notes available for review. The median age at diagnosis was 39 (range 17 to 78). 48% of patients were from Africa, 36% were from Asia, 4% were from Europe and 12% did not have the country of origin documented. The median length of stay in the UK prior to onset of symptoms was 4 years and the mean length of stay was 8.7 years. (range <1 to 37 years). The incidence of spinal TB compared to TB from any site in our hospital is shown below: Spinal TB TB all sites Proportion 2004 1 100 1.0% 2005 4 103 3.9% 2006 4 105 3.8% 2007 3 110 2.7% 2008 2 137 1.5% 2009 3 114 2.6% 2010 10 121 8.3%
CONCLUSIONS: Our data is suggestive of a disproportionate rise in the numbers of patients diagnosed with spinal TB in 2010 in the local area compared to previous years. This occurs against a backdrop of relatively stable overall TB incidence. This suggests either that the diagnosis of spinal TB has improved due to factors such as increased awareness or better assessment of patients with back pain, or that there is a true increase in the incidence of this condition in the local population.
CLINICAL IMPLICATIONS: These results underline the importance of maintaining a high index of suspicion of spinal TB in patients presenting with back pain, especially in those from high-incidence countries.
DISCLOSURE: The following authors have nothing to disclose: Peter Sommerville, Richard Hopkins, Elena Karampini, Deepak Rao, Bassey Asuquo, Thomas Stokes
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