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Spine TB infection. How long for treatment? Different medication?

Shree Dt 31-8-2012 Respected Doctors I am worried about my father’s health condition and seek your guidance in this matter. My father is diagnosed pott’s spine , Details about this disease and treatment is as follows. Patients History. Name: Sri GopalRao Deshpande. Age 83 years, Male, Resident of Sedam, Gulbarga. BP- Normal, Sugar-Normal, Height- 5’6” My father was operated for Bulbo membraneus stricture c~ cystitis on 20-12-2011 at Raghoji Kidney hospital and research centre at Solapur Maharashtra. This is a well known famous hospital (ISO certified). The doctor’s name is Dr Vijay Raghoji M.S. M.Ch (Uro) DNB (uro). Condition on discharge that is four days after surgery was good. We went home with a cathedra inserted. After 3-4 days, the urine was passing by the side of the cathedra as the cathedra was blocked. On 9th day after operation it was removed. Patient started with little fever and severe backache and become bedridden. At that time our area was under coldwave condition, we couldnot differentiate the problem as this was because of cold, operation at this age or infection. Anyways we went to the hospital on 27-01-2012. At the time of operation, his Hb was 13, but then dropped to 7.7. He then diagnosed for haematuria after culture studies of urine was done. Treatment of antibiotics through intravenous was done blood transfusion was given(AB+) and patient was in hospital for full nine days. His fever was subsided but backache was severe and could not sit. He was given all kidneysafe painkillers but still no relief from the backpain . He was discharged and the next follow up was on 23-2-2012. We put him on waterbed as the chances of getting bedsores was high. On the follow-up of 23-2-2012 he was again admitted, doctors sent him to MRI test (report attached).Prescription was given from a visiting doctor Dr. Mudukanna M.D.(General Medicine). AKT-4 Ultracet Pentab-40 Nervigin P Bevon plus Threptin protein biscuits Smuth (for constipation) By this time my father was very weak weighing only 38 kgs. With the start of AKT-4, he started vomiting, uneasiness was there, coundnot cope up with this. I contacted Dr. S.H. Katti (Former joint director,Health), he is a T.B. specialist and close friend of my father in law Prof Vasant Kushtagi (Elder brother of Dr Pralhad Kushtagi). Dr. Katti has given the treatment for cox From 27-2-2012 to 10-3-2012 AKT4 (Thirteen days) (Solapur) Dr Katti’s treatment From 11-3-2012 to 27-5-2012 Forecox 150 and Omnacortil-5, Both twice a day Tapering dose was started on 28-5-2012 with Monto-3 and Omnacortil-5 Once a day Tablet Omnacortil was discontinued after 15 days of tapering. All the other general health medicines were properly maintained along with Monto – 3. In the month of March, my father was very weak, but recovered and was stable. Pain was there but undercontrol. In April, He used to sit upto half an hour with the help of brace on his waste. He could stand and walk 4-5 steps with the help of walker. Beginning of the new Problem. My father was alright and there was no fresh complaints. Just eight days after starting of tab Monto-3, he started suffering from intense pain in lumber area and pain was spread to buttocks also. Calf muscle of right leg was paining a little. Even small leg movements were painful and difficult. I consulted Dr. Katti. He sought an orthopedic opinion on this and referred to Dr. Ramakant Kulkarni MS (ortho). He examined my father and found that there was no neural deficit. After studying MRI , he expressed doubt of pyogenic abscess in the vertebral body of L5-S1 (Just one doubt).He advised us to put the patient on Amakacin 0.5gm and magnis 1 gm for 10 days intravenous, also referred this to neurosurgeon Dr.Shashank Ramdurg, M.Ch Neurosurgery presently working in Basaveshwar hospital Gulbarga. Dr Shashank carefully examined MRI reports but said this must be TB only. He immediately contacted Dr. Chetan Durgi MD Radiologist for opinion. Radiologist said that in Indian conditions this is 99% TB only.Monto-3 was continued. After 3-4 days of intravenous injection of amakacin and magnis, evening rise of temperature was not there, But on 9th day it relapsed. On communication with doctors , they said this I.V. can be continued for 14 days. Even after completion of 14 days, there was no respite from the problem. We family members decided to take the patient to Ashwini multi superspeciality hospital in Solapur. The nephrologist who treated haematuria Dr. Anand Malu was present and referred this to DR Sachin Baldawa neurosurgeon and Dr Pradeep Singhal MD (Gen Med). They retained the patient for four days from 31-7-12 to 4-8-12. Injections Eldcef and pantocid were given twice a day through i.v. A Repeat MRI was done (Second report attached). Actually infection was increased and abscess in the L5-S1 was slightly increased. There were lengthy discussions among doctors. Discussion with Neurosurgeon: Even after putting the patient on antituberculosis drugs for five months, patient did not responded much. This is the fit case for surgery and grafting of L5- S1. But the patient age is above 80 and the risk ratio is very high as the operation is a real major one. Only conservative therapy can be continued. Discussion with physician: The dosage given for TB i.e; forecox 150 was too less for the patient. The sense of well being was due to omnacortil. TB is curable. In his long experience, he has seen patients like this and adjusted the dosage of medicines. Again AKT-4 regime was started along with L-Cin 750, Ultracet- semi for pain, Grenill for fever and tab ketadol if there is intense pain. I was not satisfied and requested doctors to drain the abscess by C.T. guided aspiration as this is feasible for the patient. In C.T. scan room radiologist Dr Iyer was present for this procedure. He took some C.T cuts on his monitor, analyzed and told me that the abscess is on the other side bone and is hardly one ml(1 ml).There is a dirty tissue around it, It is not possible for the needle to reach from the back. Only two bones of the vertebra are involved, there is no need to drain the abscess as it will heal once the infection subsides. After this they discharged the patient. Next follow-up is on 4th September. This is all the story. At present my father is in Sedam. There is no fever now. He is taking all the medicines regularly. While getting up he feels pain and can sit for only 4-5 minutes. Quality of life is affected. Morale is low. I have few questions. 1. When my father will come out from the burden of this spine TB infection? 2. Whether the path followed by the doctors is correct? 3. What improvements in medicines can be made for fast recovery? 4. Second line of treatment is required or not…(which I heard that they are fairly toxic) From, Smt Radha alias Sapna kushtagi. C/o Dr. (prof).Vasant Kushtagi, MIG 26 Adarshnagar phase-1 Gulbarga 0000 Mobile no 0000 E-mail: YYYY@YYYY Following are the attachments. First MRI Dated 25-2-12 Second MRI
Asked On : Mon, 3 Sep 2012
Answers:  1 Views:  781
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Neurologist, Surgical 's  Response
Dear friend,
If your father has been experiencing any kind of improvement with ATT it is likely that he has been suffering From pots but since he is taking alot of time to recover it is worthwile to do a CT guided Biopsy of the abces or Mass what ever it is , If you could send me images it will be really helpful . Starting any second line without tissue diagnosis is not recomended.
Dr. Vineet Saggar (MCh)
Neuro Surgeon / Spinal Surgeon
Chandigarh, Mohali -
Ivy Hospital Sector 71
Mob. No.:- +91-9855990990
Answered: Sat, 8 Sep 2012
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