Yes, there is something call spinal tuberculosis. The Mycobacterium tuberculosis is responsible for more morbidity than any other microbial pathogen till date…we should beware of the tuberculosis factor in life which is so pernicious around the world with India topping the list.

By Pankajbala R Patel

MOST of think TB or tuberculosis is tuberculosis and perhaps like leprosy, one of the oldest diseases known to humankind which has been seen ancient societies with evidence emerging from the ancient mummies of Egypt. This one is more interesting and complex than many other infectious diseases for people fear it as a social stigma. It becomes a social issue when the common perception is that TB is infectious and one should keep all patients at a distance and stop keeping them company in any way.
There are many myths around TB and its treatment. There are several versions of TB good, bad and ugly and the one which makes us shudder the most perhaps is the most prevalent pulmonary tuberculosis, infectious enough to warrant the patient’s isolation with all necessary precautions in place until the disease is cured.
TB is no longer an incurable disease and cures in months with the right regiment of chemotherapy drugs and a diet changeover, both of which very finely honed now in the Natiional TB Elimination Program (NTEP) which seeks to eradicate TB forever in India and around the world too there are similar programs monitored by the World Health Organisation (WHO).
Still, the thinking is that more than five decades have passed since the availability of anti-tubercular medicines but we are still far away from eradicating TB which presents in various avatar. There are primarily seven types of TB and these range from pulmonary TB (a fever dominated TB); pleural TB; skeletal TB; brain TB; bladder and kidney TB; gastro intestinal tract TB and a dire form called Military TB. Its presentation as spinal TB is classified to be a severe form of extrapulmonary affection as categorised by WHO. Such musculoskeletal infection is seen rarely and affects only 4% of patients, 50% of which involve the spine.

SPINE TB
SKELETAL or skeleton or spine TB generally gets neglected as just long standing back pain – back pain is something one should never neglect. Also be conscious of your posture and do yoga regularly for it is the best limbering physiotherapy of them all and we may practice it right into our silver and golden years
The report is that despite the availability of anti-tubercular medicines yet someone every 15 seconds dies of TB and a person is infected with Mycobacterium tuberculosis infection every second. With advent of HIV and multi-drug resistant TB this “kingsize evil” has re-emerged as a public health problem and is currently one of the top 10 causes of death worldwide.
Worldwide TB is the 13the leading cause of death and the second leading infection killer after Covid-19 (above HIV and AIDS). In 2021, an estimated 10.6 million people fell ill with TB worldwide. Six million men and 3.4 million women and 1.2 million children. TB is prevalent in most countries and age groups although the US is now free from TB. Interestingly, TB is considered to have a genetic component too.

SENIOR CITIZENS, BEWARE
IN the case of spinal or spine TB it is usually to be found in children in poor and badly governed countries where sanitation is practically non-existent. It is rare in adults but in tragic circumstances it manifests in senior citizens who end up in a combination or a co-morbidities situation of degeneration of the spine vulnerable to several infection issues.
We just never know from where and how we pick up the TB bacteria which enters the body and proceeds to feed of various body parts including the spine, especially if there are other aggravations like a rectum prolapse, failed surgeries and history of spinal pain manifesting with back pain which is generally never checked out for TB early enough to save the patient much grief later on.
As it is old age degeneration of the body’s vitality from the inside out is a challenge and never a happy story for many seniors who forget or are gradually unable to take care of themselves except very cursorily in the early and adult years of their life, when staying alive means working practically around the clock in ruthlessly demanding jobs and professions.

MOST DANGEROUS
THE most dangerous form of TB is considered Military TB, a form of TB that spreads in body affecting one or several organs. This type affects lungs, bone marrow, including spinal cord, brains, heart. If not treated it is fatal. TB is also an important risk factor for cancer. It is really a sorry situation if a patient ignores the symptoms of TB for any length of time and late detections are common for a gamut of reasons social and idiotic. There is a first line of treatment and also a second line of treatment.

TB MEDICATION STANDARDIZED
MOSTLY, treatment for is now standardized and revolves around medicines called rifampin, isoniazid pyrazinamide and ethambutal, also streptomycin. Of these the first two rifampin and isoniazid are antibiotics. The three stages of TB are exposure, latent and activated; diagnosis of the disease early is very difficult with practically all the tests prescribed turning out negative until the disease has spread across the body. Diagnostic tests include Mantoux test, chest X-RAYS, blood test, ultrasound scan, urine test of abdomen, CT scan of brain and some more – including the “nucleic acid amplification tests (NAATs) which interestingly is also the test for detection of Covid19.
There is also something called AFB2C. These tests are reportedly based on gene-typing. If NAATs and AFB smears are both positive one may presume TB and begin treatment for TB while awaiting culture result which is presumably some kind of confirming gold test or something like that.
In conclusion, there is more to the disease of tuberculosis that one may think and imagine and the symptoms are so wide-ranging and so similar to other diseases like say in some cases of Guillian-Barre, septicemia heading for septic shock, even cancer. It is yet to be conclusively proved that the Covid19 pandemic and subsequent vaccine program were gene targeted vaccines to bring out latent forms of disease in the human body; for this mortality statistics have to be meticulously studied post-pandemic and this would be very difficult to do for some obvious reasons of the political as well as healthcare reasons. Some dedicated researchers should take look into this to tell us what the truth is which is always so bitter and ironic. For truly, humankind cannot bear to too much reality in the realm of healthcare or so to speak.
NOTE: It is widely acknowledged that diet plays a crucial role in recovery from all TB manifestations. Include oranges, pomegranates, pineapple, papaya, guava, especially berries which are powerful antioxidant-rich fruit easing inflammation reactions in the body.
Needless to say we are talking fresh organically cultivated fruit here and not canned or processed fruit. Other foods which boost immunity, usually low in the elderly, are mushrooms, nuts and seeds such as sunflower/chia/ pumpkin/sesame/flax seeds.
Garlic is perceived in food-is-medicine naturopathy circles as a natural antibiotic. This is to say elderly patients of TB may be down in their immunity, but this hateful disease IS curable in our enlightened times given the sunlight, salt and time!