TB of the spine: Silent killer that confines thousands to paralysis

At only 27, Francis Ngure was living his dream in 2007. He had a well-paying job, was recently married and a proud father of a two-year-old boy.

He was an accountant of a leading Mombasa-based transport company that operates in East and Central Africa. Mr Ngure earned enough to support a middle-income lifestyle.

“I was in a stable job with a good salary and it never occurred to me that I would grapple with a financial crisis,” he said in an interview.

That was before tragedy struck in August 2007.

Mr Ngure’s right leg fell numb while he was driving back home from work one evening, incapacitating him for a few minutes.

“My leg was on the accelerator and I was behind a truck. I tried to move it over to the brakes but it simply could not move and had to drive off the road and literally lift it off from the accelerator after a few minutes, however it became lively again, so I headed home,” he recalls.

He did not pay much attention to that incident until it happened again a few days later. This time he was attending a friend’s wedding committee meeting and as they were leaving his left foot went numb so he faltered and immediately his right foot also became numb. Mr Ngure was carried home by his friends.

“By the time I got home, I had lost function even in my arms and I knew at that moment that there was something terribly wrong with my body. I recall telling my wife that because it was so late she would have to drive me to the hospital early the following day. Shockingly, I woke up with my whole body functioning well and went to work,” he says.

That was the start of his deteriorating health. By December of that year, he was bedridden having completely lost function in all his limbs and completely reliant on his family to do basic things like feeding, taking a bath and relieving himself.

All this time, Mr Ngure had been seeking medical attention. The first doctor he went to as he began losing function of his legs told him that he had arthritis and put him on medication for management.

Two months later, things were still going downhill and he sought a second opinion from a different doctor. This time he was diagnosed as having gout and given medicine but he got worse by the day.

For close to a year he was in and out of hospitals trying to find out what was ailing him and getting a cure.

Physical examination

“I remember one doctor who after a physical examination told me point blank that I would never walk again. I became depressed and wondered whether this was the life that God wanted me to lead,” he said.

By end of 2008, Mr Ngure was bankrupt and had the property he had to his name. He was forced to move in with his parents to get the support system he needed to adapt to his new life.

The move also allowed his wife who was traumatised by the whole experience to concentrate on raising their son.

It was at this time that his body slowly started turning black, the soles of his feet cracked and he gained a considerable amount of weight as a result of being bedridden.

He lost touch with most of his former colleagues and friends and soon started harbouring thoughts of death.

Upon his father’s recommendation, he visited another specialist — Dr Samson Bebora — though he doubted that this visit would be any different from previous ones.

“I still remember the doctor asked me how I felt and I was tired of repeating the symptoms over and over; so, I took a pen and wrote it down.Immediately after reading through what I had written down, he asked me the last time I had passed stool and I recall thinking to myself that perhaps he knew what he was doing,” Mr Ngure said.

Dr Bebora sent him for a series of tests that included basic blood work, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT scans) among other procedures.

The results reaffirmed the doctor’s initial suspicions and diagnosed Mr Ngure with spinal tuberculosis also known as Pott’s disease. It is what caused the paralysis.

He was immediately booked into surgery to remove sections of the spine that had been infected and put on medication.

“The doctor told me that it would take three years to get back on my feet. Though I had lost all hope, his words of encouragement sprung on me and I kept telling myself that I had to be patient through it all.”

He began his physiotherapy sessions a few weeks after the surgery while in hospital. After close to a month of therapy, his legs did not seem to show any progress and his care-givers were sceptical that the situation would improve.

After being discharged, Dr Bebora referred him to a different physiotherapist who previously helped two other spinal TB victims get back on their feet.

“Even after five months of therapy, I had no function in my limbs which was disappointing but I kept drawing inspiration from my four-year old son who was growing up so fast and who kept asking why I always sat on the wheelchair instead of walking. I wanted to walk again and be an active part of his life,” he recalled

With intensive therapy sessions both in hospital and at home, he slowly moved from the wheelchair that he had been using for three years to using a walker for the better part of 2010. In 2011, he started using a crutch to support his left leg.

It was in the same year that he embarked on restoring his financial independence, venturing into shipping supplies with the help of friends though he had no experience.

“It was a lot of hard work going into something blindly not knowing what to expect. At the back of my mind, I knew had to provide for my son.”

He started with a small office after raising the Sh1 million seed money and had to familiarise himself with ships and how they work.

In the last one year, his business has grown and he has moved to a bigger office within Mombasa’s Central Business District and even employed five people.

“I have contracts with the Kenya Navy and the Kenya Ports Authority where I supply ship spare parts and, sometimes, food stuff. It has not been an easy journey bidding for these tenders but I am glad with the progress the business has made; so far, I am able to provide not just for my family my employees,” he adds, smiling.

Mr Ngure admits that there is little information with the public about spinal TB that often leads to late diagnosis and reduces the chances of a patient fully recovering from paralysis.

“I know only two other people in Mombasa who have suffered a similar fate; a woman who has fully recovered and is currently working with a parastatal and a man who was undergoing treatment but who unfortunately succumbed a few months ago. That is why I want to raise as much awareness about the disease as possible,” he explained

Though he still walks with a limp, he has since replaced the crutch with a cane and hopes that with more therapy he will get back to walking normally.

Dr Jeremiah Chakaya, a leading TB expert and director of the Kenya Association for the Prevention of Tuberculosis and Lung Disease (KAPTLD), cases of spinal TB in the country are rare.

“I have been dealing with TB for close to 15 years now and sometimes I can go for between one and three months before I get such a patient,” he said.

Dr Chakaya said that most of the time, symptoms like swelling of joints and in more extreme cases paralysis are not attributed to TB by many people, adding that because of its rareness, some doctors would initially diagnose it as either arthritis or gout.

A patient suffering from spinal TB is also likely to suffer from extreme back pain and incidents of angulations of the spine in the form of a gibbus along with other common symptoms of TB like fever and loss of weight.

The TB expert says that an Xray helps to identify the disease which causes the collapse of the vertebrae and in some cases a rim of pus is seen around the collapsed vertebrae.

“Treatment for TB of the spine is similar to that of the pulmonary TB that most people are familiar with and the patient may take medication for between nine months and a year. If there has been damage to the spinal cord causing paralysis, the patient will require going for therapy sessions,” added Dr Chakaya.

Though there is a lot of awareness creation on tuberculosis currently in the country, many misconceptions still exist.

Dr Chakaya says that the perception among the public is that the disease is restricted to affecting the lung yet there are several other ways in which the infection can manifest itself.

Immune system

TB is commonly classified as pulmonary and extra-pulmonary. The former has many forms but it normally manifests itself in the lungs and is the most common form. According to Dr Chakaya, 80 per cent of the cases reported in Kenya manifest this way.

Apart from affecting the lungs, the bacteria can also affect the space between the lungs and the chest wall, causing chest pain and difficulty in breathing.

Larnyx TB occurs when the bacteria affects the vocal cords though it is not common.

The extrapulmonary tuberculosis occurs in several other areas of the body and takes different forms.

In the lymph node, the bacteria can affect the body’s immune system where it replicates in an uncontrolled way in the lymph nodes, causing them to enlarge.

The bacteria can also affect outer linings of the intestines and abdominal walls in a condition is referred to as tuberculosis peritonitis. Patients suffer abdominal pains and fluid can fill between the linings causing the abdomen to be distended.

It is also possible for the membrane surrounding the heart to get TB attack, what is commonly referred to as pericarditis which causes the space between the heart and the pericardium to fill with fluid and prevent the heart from efficiently pumping blood.

Renal TB is normally identified easily when a patient’s urine contains white blood cells. If left unattended it can affect the reproductive organs in both females and males.

A patient suffering from TB meningitis may show signs similar to a stroke or having a brain tumour and it is caused when the bacteria attack the membrane surrounding the brain and spinal cord. Severe cases lead to permanent brain damage or even death.

The different forms of TB manifest after one inhales air with bacteria mostly exhaled by an infected individual when they cough or sneeze.

It is also possible that the inhaled bacteria can remain inactive in the body for a long period of time without developing into TB.

“There is no harm in having an X-ray to confirm whether the symptoms are for TB or not,” Dr Chakaya said.