Click here to sign up. Download Free PDF. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study: Osteoarticular tuberculosis Clinical Microbiology and Infection, Patricia Khashayar.
A short summary of this paper. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study: Osteoarticular tuberculosis. Hadadi1, M. Rasoulinejad2, P. Khashayar3, M. Mosavi3 and M. Diagnosis is dif- ficult, because the lungs are rarely involved and there are no specific signs or symptoms.
The purpose of this study was to assess the frequency and clinical and laboratory findings in osteoarticular TB in two referral hospitals in Tehran, Iran.
The hospital dataset of patients admitted with osteoarticular TB during — was reviewed. Knee, ankle, hip and shoulder joints were the most frequent sites for TB arthritis. In osteomyelitis, long and short bones were equally affected. In TB spondylitis, the lumbar The most frequently reported complications were sphincter disorder TB osteo- myelitis must always be borne in mind in countries where TB has high prevalence.
According to E-mail: hadadiaz tums. Thus, TB is one of the fundamental health challenges in Iran. Although several studies of TB have Introduction been conducted in Iran [3,5], there is limited published litera- ture on the epidemiology and clinical features of osteoarticu- Tuberculosis TB is one of the most important infectious lar TB in Tehran.
The purpose of the present study was to diseases, causing two million to three million deaths annually investigate the frequency of osteoarticular TB in two referral worldwide. Osteoarticular TB accounts for presentations of affected patients.
About 19 million to 38 million people suffer from Materials and Methods different forms of osteoarticular TB, including spinal TB, arthritis with synovial disease, osteomyelitis, and soft tissue diseases [1]. Hospital data on patients hospitalized with osteoarticular TB Confirming the diagnosis of osteoarticular TB is difficult, in two teaching hospitals referral centres for orthopaedic because there are no specific clinical manifestations and the and spinal surgery and infectious diseases in Tehran during lungs are not simultaneously involved in most cases.
Thus, — were reviewed. The diagnosis of osteoarticular many patients are misdiagnosed as having other osteoarticular TB was established, following full clinical, laboratory and diseases, such as brucellosis, tumour metastases, and rheuma- radiological investigation, on the basis of the routine hospital toid arthritis.
This delay in diagnosis leads to complications guidelines. Suggestive diagnostic criteria for TB included a such as joint destruction, spondylitis, and even paralysis [2,3]. Osteoarticular tuberculosis culture or pathology in one or more samples bone biopsy and osteomyelitis.
Just over one-quarter of patients had con- or synovial biopsy and compatible imaging reports simple current pulmonary symptoms. Table 2 shows the patient X-ray, computed tomography scan or magnetic resonance data according to the type of involvement. Patients were cate- hip Long bones femur and gorized as having arthritis, spondylitis or osteomyelitis on tibia and short bones calcaneus and toes were equally the basis of radiological presentations and anatomical site.
We used an inde- In TB spondylitis, the lumbar All statistical calculations were All of the cases except one were reported to have performed with SPSS v. The to be significant. Results Blood leukocyte counts fell within the normal range in most cases The mean haemoglobin concentration Following review of records of patients diagnosed as and erythrocyte sedimentation rate ESR were Articular fluid analysis were eligible to enter the study.
Table 1 outlines the demographic data of the Purified protein derivative PPD skin test findings were studied cases. There were 22 patients with TB spondylitis positive in 16 of 29 patients One patient had simultaneous arthritis osteomyelitis.
Demographic information of 36 patients with the intervertebral cavity, anterior collapse, wedge-shaped osteoarticular tuberculosis in the present study deformity of the vertebra, disk involvement, or paravertebral Gender abscess were noted in The most fre- Male 19 Female 17 quent findings in these patients were disk destruction Radiological findings consistent with arthri- Afghan 16 tis, including osteoporosis adjacent to joints, osteopathic ero- TABLE 2.
The formation of new subperiosteal bone and lytic manifestations in the patients of the present study. In our study, the mean time interval between disease Chest radiographic evidence of previous pulmonary TB or onset and diagnosis or referral for complications was compatible changes were reported in Ruiz et al. There that of our study. No synovial fluid culture was involved in adult TB spondylitis.
It is notable that paravertebral of patients, respectively. Independent-samples t-test involved site The thoracic, lumbar and thoracolumbar verte- demographic characteristics, clinical manifestations, site and brae were the most common sites of vertebral infection [5]. Para- of L3 and L4 vertebrae [3]. The mean ESR was but this difference did not quite reach statistical significance.
In the pres- ent study, the mean ESR was Discussion Radiological images can also contribute to the suspicion or confirmation of TB. Wedge-shaped necrotic areas are Osteoarticular TB emerges following the haematogenous commonly seen on both sides of affected joints. Bone sclero- spread of TB bacilli or the direct spread of TB from an adja- sis and periostitis occur in late stages, and severe joint cent infectious focus.
The most common age for osteoarticu- destruction occurs commonly at the end-stages. Patients and methods A retrospective study included 12 unusual OA-TB locations observed over a year period from to TB was diag- nosed on histology or by presumption: history of TB, TB in another location, impaired general health status, fever and night sweats.
For each patient, history, clinical, biological and radiological signs and diagnostic factors were recorded, as well as treatment and evolution data Table 1.
Mean age was 7 years 4 months range, 10 months patient 3 , showing talocrural joint-line impingement with sub- to 14 years. Only one patient had history of TB. TB infec- chondral osteocondensation. Two patients had traumatic etiology. All patients were managed according to the Moroccan Mean time to consultation was 32 months range, 2 months national TB protocol, which has been regularly updated, to 5 years. For OA- consultation.
Gen- TB, the protocol comprises four anti-TB agents isoniazid, eral signs were always accorded secondary importance. Three course. A second location was found in three patient 2, with TB of the femoral neck. Mean follow-up was Both cases of OA-TB concerned the knee. Osteitis locations were calcaneus two case , ulna two cases , iliac bone two cases , femoral neck one case , lateral cuneiform one case , greater trochanter one case , radius one case , talus one case , tibia one case and 4th rib one case.
In OA-TB, radiologic signs comprised joint- line impingement, and irregular edges and subchondral cysts Fig. CT, performed in three cases, gave a better view of the bone lesions seen on X-ray Fig. One patient had an MRI of the forearm, showing radial diaphysis bone loss Fig.
No patients underwent bone scintigraphy. Nine patients showed elevated sedimen- tation rate 10— mm at hour 1. Total blood count was performed in 11 patients and found hyperleukocytosis in two cases patients 4 and 6 and moderate anemia in four patients 2, 3, 4 and 6.
Tuberculin intradermal reaction was performed in 10 patients and was positive in six and neg- ative in four. Diagnosis was confirmed on histology of the joint synovial membrane, harvested bone or abscess wall, performed in 11 cases and systematically finding epithelioid- giant-cell granuloma; in the remaining case of cutaneous TB with foot tumefaction, fistulas and lateral cuneiform bone- loss on plain X-ray , diagnosis was founded on history-taking, Figure 2 Lytic calcaneal image with peripheral condensation clinical and radiological findings.
Unusual locations of osteoarticular tuberculosis in children: A report of 12 cases Table 1 The 12 cases. OA-TB is rare in developed countries, thanks to generalized BCG vaccination and, above all, improved living standards.
Positive diagnosis of atypical and unusual forms of OA-TB is difficult, often requiring a range of clinical, biological and radiological findings.
Symptomatology is typically chronic and insidious. Clinical signs such as pain, functional impo- tence, fever and night sweats are systematically reported [8].
General signs are often put in the background by parents. Few studies have reported series of unusual OA-TB locations. Teklali [1] reported rare locations: elbow 10 cases ankle 10 cases , shoulder one case , wrist one case , skull, trochanter and ribs, with some double three cases or even multiple involvement five cases. Unlike in the present series, most cases were of osteoarthritis.
Plain X-ray is very useful for diagnosis, but may be nor- mal at early stages [9]. OA-TB presents a Phemister triad, regardless of location, associating osteoporosis next to the joint, bone erosion at the peripheral site and progressive joint-line impingement; the radiological aspect, however varies according to stage at diagnosis [10]. The radiological aspects of tuberculous osteitis vary, although some may be highly suggestive; the most frequent is of a clearly or some- times irregularly contoured osteolytic lesion, sometimes surrounded by a thin area of osteocondensation [10,11] Fig.
In forms involving the periphery of the bone, there is early destruction of cortical bone, so that infection and bone debris spread to adjacent soft tissue with develop- ment of an abscess [10]. In long bones, periosteal reaction is possible. CT provides detailed analysis of the joint line and adjacent bone and visualization of microcalcifications within Figure 4 Left forearm MRI, showing a lesional process in the abscesses highly suggestive of tuberculous etiology [12]. In radial diaphysis with extensive periosteal reaction, in an OA-TB, CT is useful in certain locations: sacro-iliac, stern- year-old girl patient 9.
In tuberculous osteitis, it is useful in case of involvement of flat bones such as the pelvis, ribs or sternum [13]. MRI is the optimal imaging examination 6 years. Technetium Discussion bone scintigraphy allows exploration for other clinically silent OA-TB locations [15].
Biologically, inflammation and Peripheral osteoarticular tuberculosis constitutes nearly 1 leukocyte assessment is often normal. Risk factors for OA-TB include trauma acti- bone biopsy. Presse Med sidered mandatory [7,16], and was usually early, with a ;—5. Extrapulmonary tuberculosis revisited: ling the tuberculous infection to conserve joint function, a review of experience at Boston city and other hospitals.
Medicine ;— Tuberculose osseuse et are: evolved osteoarthritis, bone sequestration, presence articulaire des membres. Progressive shoulder arthropathy. Ann 6 months [2]. Rheum Dis ;— Les aspects diagnostiques de la tuberculose reduction concerned only one patient. Sem Hop Paris ;— Peripheral osteoarticular tion or stabilization, with a choice between arthrodesis and tuberculosis in children: tumor-like bone lesion. Pediatr Orthop implant.
0コメント