Pott disease

The primary site of infection in the case of TB is either of pulmonary focus or includes lymph nodes as well as abdominal viscera. Pott’s disease occurs when one contracts TB and it spreads outside the lungs. This spread occurs either through arteries or veins. Spinal TB is initially apparent in the anterior inferior portion of the vertebral body. Later on, it spreads into the central part of the body or disc.

Spinal TB is painless in the early stages. It is also possible that sometimes the disease is dormant in the lungs and spread itself further, without the patient knowing they have any form of tuberculosis at all. In fact, a fraction as big as 65-90% of the population that has Pott’s Disease is asymptomatic.
Needless to say, it is very difficult to diagnose spinal TB until it is at a much-advanced stage. Even then, the following should be looked out for:

• Abscess
• Pain in the back (Read more: Back pain causes)
• Swelling
• Muscle spasms
• Night sweats
• Weight loss
• Fever 
• Neurological deficits
• Spinal Deformity and reduced motion of the spine 
• Fatigue
• Localised tenderness

It can be difficult to diagnose Pott’s disease in its earlier stages. In most cases, it is only once the disease has progressed considerably that a diagnosis can be made. However, there are some tests that doctors suggest as tools for diagnosis, like:

• Skin test (The Mantoux Test) - To determine if an individual is infected with the TB bacteria, a purified protein derivative (PPD) skin test can be recommended. This test is not completely accurate as some people do not respond to it and it does not indicate the presence of active TB disease.
• Blood test - Following the skin test results, a blood test may be opted for. Two TB blood tests that are approved in the United States are Quantiferon and T-Spot. Though the blood test results are either positive, negative or indeterminate, it has the same limitations as the skin test. 
• Chest X-ray - A chest x-ray detects small spots in the lungs and is recommended if an individual’s skin test or blood test results are positive. 
• Tests on sputum or mucus to check for TB bacteria.
• CT scan of the chest
• Bronchoscopy 
• Lung Biopsies

Since Pott's disease cannot be treated with a short course of antibiotics, a combination of medications for six to nine months is required to be continued by the patient. To prevent recurring infection, it is essential for the patient to complete the full treatment course. Common medication combinations for active TB infections are:

• Ethambutol (Myambutol)
• Rifampin (Rifadin, Rimactane)
• Pyrazinamide 
• Isoniazid
• Rifapentine (Priftin) 
• Anti-Tuberculosis Chemotherapy 

Patients taking medication for pott’s disease should monitor liver-injury symptoms since the combination of medicines mentioned can affect the liver. These symptoms include - 

• Loss of appetite 
• Jaundice 
• Abdominal pain 
• Dark urine 
• Fever which lasts longer than 3 days
• Unexplained nausea or vomiting

Though Pott’s disease can be complicated by pre-existing health conditions and insufficient access to medical attention, treatments can prove to be successful. It is important for medication to be taken as prescribed. It is difficult to treat Pott's disease if the patient suffers from diseases that weaken the immune system, like HIV. However, with early diagnosis and treatment including a full course of antibiotics, patients may be cured of Pott’s.