The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated

Zanon, Igor de Barcellos; Meves, Robert; Klautau, Giselle Burlamaqui

doi:10.1055/s-0042-1756638

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Sumário

Original Article • Rev. bras. ortop. 58 (1) • Jan-Feb 2023 • https://doi.org/10.1055/s-0042-1756638 copy

The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated^* * Work developed at the Spinal Disorders Team, Departament of Orthopedics and Traumatology, Santa Casa de Misericórida de São Paulo, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To describe the clinico-epidemiological, laboratory, and radiological characteristics of tuberculous spondylodiscitis in the Brazilian population, and to assess whether there are differences between patients in whom the etiological agent in Pott disease was isolated or not.

Methods

Patients diagnosed with tuberculosis (TB) of the spine (Pott disease) underwent follow-up between 2009 and 2019 at a quaternary hospital and were divided into 2 groups: successful isolation (SI) of the etiological agent (through bacilloscopy, culture, or positive molecular rapid test) and unsuccessful isolation (UI) of the etiological agent.

Results

From a total of 26 patients diagnosed with TB of the spine, 21 (80.7%) were male, with a mean age of 40 ± 22.5 years. The average lymphocyte counts were higher in the UI group (25.35 ± 13.08; p= 0.025) compared to the SI group (14.18 ± 7.48). Moreover, the monocyte/lymphocyte ratio was lower in the UI group (0.39 ± 0.22; p= 0.009) than in the SI group (0.89 ± 0.65). Relative lymphocyte counts higher than or equal to 16.7 had a sensitivity of 76.9% and specificity of 62.5% in the UI group. Values higher than or equal to 0.58 for the monocyte/lymphocyte ratio showed a sensitivity of 84.6% and specificity of 75.0% in the UI group.

Conclusion

No differences were observed regarding the clinico-epidemiological and radiological characteristics of the two experimental groups. However, the UI group had higher lymphocyte counts and a lower monocyte/lymphocyte ratio.

Keywords
tuberculosis; spine; diagnosis; Pott disease; spondylodiscitis

	N	SI	%	UI	%	p-value
N	26	9	34.6	17	65.4
Age (mean and standard deviation in years)	40 ± 22.5	42	−	40	−	0.578**
Gender	26	9	34.6	17	65.4	1.000*
Male	21	8	38.1	13	61.9
Female	5	1	20.0	4	80.0
Diabetes mellitus	4	1	25.0	3	75.0	1.000*
Chronic kidney disease	1	0	0.0	1	100.0	1.000*
Neoplasia	2	0	0.0	2	100.0	1.000*
Duration of the corticotherapy (months)	1	0	0.0	1	100.0	1.000*
Type of Household	26	9	34.6	17	65.4	0.216**
Urban	12	2	16.7	10	83.3
Rural	14	6	42,9	8	57.1
Treatment	26	9	34.62	17	65.38	0.078*
Non-surgical	17	4	44.44	13	76.47
Surgical	9	5	55.56	4	23.53
Time until cure (months)	14.2	11.25		14.24		0.613**
Location						1.000*
Thoracic	13	5	38.5	8	61.5
Lumbar	13	4	30.8	9	69.2
Levels						0.316***
1	21	7	33.3	14	66.7
2	2	1	50.0	1	50.0
3	2	−	−	2	100.0
4	1	1	−	−	−
Multiple-level disease	3	1	33.3	2	66.7	1.000*
Complications	10	5	50	5	50	0.16***
Death	1	0	0	1	100
Neurological deficit	8	4	50	4	50
Chronic pain	1	1	100	0	0
Postoperative infection	0	0	0	0	0
None	16	4	25	12	75

	n	%
Isolation of the etiologic agent	9	34.62
Pathology	6	23.08
Therapeutic testing	11	42.31

	N	SD/%	SI	SD/%	UI	SD/%	p-value
Hemoglobin (g/dL)	12.1	2.1	12.1	2.71	12.15	1.61	0.678**
Leukocytes (mil/μL)	8.1	2.3	7.45	2.47	8.6	2.08	0.148**
Lymphocytes (%)	21.1	12.4	14.18	7.48	25.35	13.08	0.025**
Monocytes (%)	8.5	2.4	9.65	3.04	7.86	1.79	0.110**
Monocyte/Lymphocyte Ratio	0.6	0.5	0.89	0.65	0.39	0.22	0.009**
CRP (mg/dL)	7.0	6.7	7.25	3.18	6.83	8.51	0.195**
ESR (mm)	83.3	27.0	97.5	18.81	77.6	28.48	0.179**
LDH (mg/dL)	550.8	437.5	775.3	735.77	438.5	210.6	0.606**
Creatinine (mg/dL)	0.8	0.8	0.6	0.23	0.95	0.98	0.683**
Total proteins (g/dL)	6.8	0.6	7.23	0.68	6.5	0.47	0.131**
Albumin (g/dL)	3.2	0.5	2.9	0.53	3.37	0.51	0.157**
Positive reactive tuberculin skin test	4	15.38	3	33.33	1	5.88	1.000*
Bacilloscopy	5	19.23	5	55.56	0	0.00	0.001*
Pathology	11	42.31	5	55.56	6	35.29	0.637*
Culture	5	19.23	5	55.56	0	0.00	0.001*
Rapid molecular test	7	26.92	7	77.78	0	0.00	0.0001*

	n	Mean	p-value**
Positive anatomopathological examination	11
Positive sputum-smear	5	12.54	0.004
Negative sputum-smear	6	33.18	0.004

	Sensitivity (%)	Specificity (%)	PPV (%)	NVP (%)	Accuracy (%)
Involvement of more than 2 vertebrae in adjacent levels	50.0	66.7	57.1	66.7	58.8
Presence of collection within a vertebra or in adjacent paravertebral tissues	100.0	10.0	47.1	10.0	50.0
Subligamentous spread	100.0	20.0	42.9	20.0	50.0
Destruction of the vertebral body with a decrease in the height of more than 50%	85.7	30.0	46.2	30.0	52.9
Involvement of non-contiguous levels in different regions of the spine	0.0	90.0	0.0	90.0	52.9
Alteration of the disk morphology with CSF-like isosignal, hypointense on T1, and hyperintense on T2	71.4	30.0	41.7	30.0	47.1
Irregularity of the end plates' margins of the vertebral bodies in T2- and STIR-weighted sequences	100.0	0.0	41.2	0.0	41.2
Invasion of the epidural space by bone or granulation tissue	71.4	50.0	50.0	50.0	58.8

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Igor de Barcellos Zanon, MD, MSc, Rua Doutor Cesário Motta Júnior 112, Vila Buarque, São Paulo, SP, Brazil (e-mail: igorzanon@gmail.com).

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The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated* * Work developed at the Spinal Disorders Team, Departament of Orthopedics and Traumatology, Santa Casa de Misericórida de São Paulo, São Paulo, SP, Brazil.

Abstract

Objective

Methods

Results

Conclusion

The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated^* * Work developed at the Spinal Disorders Team, Departament of Orthopedics and Traumatology, Santa Casa de Misericórida de São Paulo, São Paulo, SP, Brazil.