Osteoarticular tuberculosis of wrist 166 int j res med. Unusual locations of osteoarticular tuberculosis in children. Osteoarticular tuberculosis in a general hospital during. Osteoarticular tuberculosisa three years retrospective study. This field guide for the management of drugresistant tuberculosis is a practical tool intended to help health workers in the clinical and operational management of the disease with special focus on the introduction, implementation and management of the 9month treatment regimen for multidrugresistant tuberculosis. Osteoarticular tuberculosis oa tb is defined by a set of pathological signs secondary to involvement of. Tuberculosis is still endemic disease in developing country 2. Imaging of the shoulder revealed destruction of the acromioclavicular. He was treated as a new acute onset of gouty arthritis with. Osteoarticular tuberculosis is a great masquerader presenting in varied forms and in atypical locations, and it is prone to misdiagnosis and missed diagnosis. This field guide for the management of drugresistant tuberculosis is a practical tool intended to help health workers in the clinical and operational management of the disease with special focus on the introduction, implementation and management of the 9month. Osteoarticular tuberculosis mimicking rheumatoid arthritis.
The diagnosis of tb arthritis was made by synovial fluid culture, genexpertpcr, and confirmed by histopathology of a synovial biopsy. Prevalence of osteoarticular tb in different regions of iran advertisement. Osteoarticular tuberculosis in iran, 2002 to 2011 mohammad javad nasiri 1, mohammad varahram 1, mahdi shams 1, kimia taghavi 1, parissa farnia 1 and ali akbar velayati 1 1 mycobacteriology research centre, national research institute of tuberculosis and lung disease nritld, masih daneshvari hospital, shahid beheshti university of medical. Atypical infections with mycobacteria are unusual in the developed countries and tuberculous involvement of the wrist or carpal bones is a rare presentation. Rare osteoarticular tuberculosis locations often cause diagnostic problems.
Five patients with osteoarticular tuberculosis were presented as diagnostic problems because each was initially thought to have some other disease. Review article updated diagnosis and management of. For osteoarticular tuberculosis the ultimate aim of treatment should be to restore joint function and. Similar findings were published in study of national and district level survey conducted under revised national tuberculosis control. Musculoskeletal system is involved in 2030% of cases of extrapulmonary tuberculosis. Mar 05, 2002 osteoarticular tuberculosis usually starts as osteomyelitis in the growth plates of bones, where the blood supply is best, and then spreads locally into the joint spaces. India rank 1 in world total tuberculosis case load 4. Introduction africa alone has 31% of cases of tuberculosis 1. The diagnosis tends to be delayed because of a nonspecific initial early manifestations andor low degree of suspicion. Jun 19, 2012 bone and joint tuberculosis has increased in the past two decades in relation with aids epidemics. Osteoarticular tuberculosis of the wrist case report. N a, ahmad f, huda n 20 osteoarticular tuberculosisa three years retrospective study. Reported tb cases united states, 19822011 ses year cdc.
Tuberculosis continues to occur frequently in some underdeveloped regions. Early diagnosis is essential to prevent significant functional disability. National journal of community medicinevolume 4issue 1jan mar 20 page 117 original article a study of osteoarticular tuberculosis in a tertiary care hospital of bhopal, madhya pradesh saurabh sharma1, sanjay kumar gupta2, atul varshney3, archa sharma4, akhil bansal5, ashlesh choudhary1 financial support. It is associated with significant morbidity and can lead to severe functional impairment. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious tb case are key factors. We conducted a study of osteoarticular tuberculosis in patients from private and public settings in a disease endemic area. The lesion has been described in a few case reports. To assess the extent of the problem and its impact on tb control programs, a nationwide survey of programs was conducted in january 20 by the national tuberculosis controllers association ntca.
Orthopedics tuberculosis of the clavicle is a rare lesion, accounting for less than 1% of all osteoarticular tuberculosis. One in three people in the world is infected with latent tb. It is estimated that india alone has got one fifth global burden of tuberculosis. It is a genusspecific marker and present in both typical and atypical mycobacteria. Today, osteoarticular tuberculosis is a condition mostly associated with the elderly in europe and america, but which still affects children in developing countries, the highest frequency being around 30 years of age 8. Tuberculosis tb is best known as a pulmonary disease but can infect any organ system.
The localization in the foot is rare and accounts for less than 10% of osteoarticular tb. Ocular tuberculosis is a difficult diagnosis and thus requires thorough multidisciplinary investigations. Screening and identification of serum biomarkers of. A 19yearold man presented with a chronic, mild pain, nonhealing ulcer in right shoulder. The ministry of health and family welfare has issued the standard treatment guidelines critical care for osteoarticular tuberculosis. The patient started to develop severe right midfoot pain and tenderness with swelling on january 20. An extraspinal bone tuberculosis was observed in cases touching knees in 5 cases, hip in 5 cases, wrist in one case. Multifocal osteoarticular tuberculosis and pleuropulmonary involvement in an immunocompetent patient breast and osteoarticular tuberculosis in a male patient osteoarticular tuberculosis in tehran, iran.
A useful primer on the evolution, administration and interpretation of the. Fourteen cases of bone and joint tuberculosis in unusual locations are presented. This is a new rare case of tuberculosis of the wrist joint in a nonimmunocompromised 24yearold male without concomitant pulmonary tuberculosis. Diagnosis and the surgical management of hip and knee. Tuberculosis can present many manifestations, with multi systemic involvement. Osteoarticular tuberculosis in patients with systemic. N a, ahmad f, huda n 20 osteoarticular tuberculosis a three years retrospective study. Tuberculous coxitis with trochanteric bursitis manifesting. The full text of this article is available in pdf format. Unusual locations of osteoarticular tuberculosis springerlink.
We report a case of osteoarticular and genitourinary tuberculosis in a. Extraspinal osteoarticular multidrugresistant tuberculosis. Osteoarticular tuberculosis tb, an uncommon form of extrapulmonary tb, is a universal mimicker and thus represents a potential differential diagnosis of any osteolytic lesion. National journal of community medicinevolume 4issue 1jan mar 20 page 117 original article a study of osteoarticular tuberculosis in a tertiary care hospital of bhopal, madhya pradesh saurabh sharma1, sanjay kumar gupta2, atul. Pdf pdf icon 492 kb provisional cdc guidelines for the use and safety monitoring of bedaquiline fumarate sirturo for the treatment of multidrugresistant tuberculosis mmwr 20.
Oatb is an aggressive disease and leads to joint destruction by spread of the infection from bone into adjacent joints and surrounding soft tissue. Bone and joint tb comprises a group of serious infectious diseases whose incidence has increased in the past two decades, especially in underdeveloped countries, in part due to the aids epidemic. Problems in diagnosing osteoarticular tuberculosis jama. Nasiri mj, varahram m, shams m, taghavi k, farnia p, velayati aa. We used serum samples from 30 osteoarticular tuberculosis patients and 30 healthy adults to conduct this experiment, the concentrations of cfhr2 in osteoarticular tuberculosis patients and healthy adults were 97. However, tuberculosis of flat bones like scapula is.
The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a twostage process governed by both exogenous and endogenous risk factors. Among them, approximately onehalf of cases show spinal involvement, and the remaining involve the extraspinal osteoarticular joint 57. Specific skeletal involvement is observed in 1% to 3% of patients with tb 4. Tuberculous spondylodiscitis was diagnosed in 29 patients. Copyright 20 journal of clinical and diagnostic research. Osteoarticular tuberculosisa three years retrospective. Unusual locations of osteoarticular tuberculosis in. Extraspinal osteoarticular multidrugresistant tuberculosis in children. Tb test publications, by area of interest, up to 31st august 2017 category description key findings publication background. Presentation of extrapulmonary tb is often nonspecific and slow in onset, though morbidity is often significant. People infected with tb bacteria have a 10% lifetime risk of. Definitions and reporting framework for tuberculosis 20 revision.
Pdf pdf icon 1 mb managing drug interactions in the treatment of hivrelated tuberculosis june 20. Osteoarticular tuberculosis oat represents 2% to 5% of all tuberculosis 4. Osteoarticular tuberculosis tb represents 15% of all cases of tuberculous disease and 1018% of extra pulmonary involvement 4, 5. Herein, we describe a 71yearold man presented with progressive right wrist pain and swelling, worsened for the last 9 months. In cote divoire, according to world health organisation, the incidence of tuberculosis was 104 cases per 100,000 populations in 20122. Open in new tab the frequency of tb in our sle cohort is higher than that reported in tb endemic areas of asia and probably a reflection of the highbackground incidence of tb in south africa, estimated to be 600100 000.
Tb arthritis commonly manifest as monoarthritis of weightbearing joints. Osteoarticular tuberculosis in a general hospital during the last decade. Osteoarticular tuberculosis, biology, imaging, abidjan 1. In six cases complications occurred kyphosis, they stopped walking and deformities, which are more common in late diagnosis.
Guidance for national tuberculosis programmes on the management. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. Osteoarticular tuberculosis usually starts as osteomyelitis in the growth plates of bones, where the blood supply is best, and then spreads locally into the joint spaces. Even with adequate medical and surgical treatment, osteoarticular tb can be associated with morbidity and mortality.
Moreover, up to 50% of patients do not show concurrent. It is a highly efficient and rapid method for diagnosis of the disease 24a72 hr. We report a rare presentation of osteoarticular tb involving multiple small joints of the hands, which mimicked rheumatoid arthritis ra. Diagnostic role of multiplex cytokine assay for osteoarticular. Among these cases of musculoskeletal tuberculosis, vertebral column is most commonly involved followed by long bones. In 6 cases an arthrodesis of the affected joint was carried out. Among these cases of musculoskeletal tuberculosis, vertebral column is most commonly involved followed by. Bone and joint tuberculosis is less common than the pulmonary form. We report the case of a 47yearold female patient with rheumatoid arthritis and hiv infection presenting with a 3week history of a painful swollen knee, increased serum inflammatory markers, and a low cd4 lymphocyte count.
Profile of osteoarticular tuberculosis in children pdf. Department of health and human services, cdc, october 2012. Sequeira w, co h, block ja 2000 osteoarticular tuberculosis. Isolated acromioclavicular joint tuberculosis has been reported rarely. Original article unusual locations of osteoarticular tuberculosis in children. Pdf osteoarticular tuberculosis diagnostic solutions. Oct 01, 2014 orthopedics tuberculosis of the clavicle is a rare lesion, accounting for less than 1% of all osteoarticular tuberculosis. Pigrauserrallach c, rodriguezpardo d 20 bone and joint tuberculosis. Osteoarticular tuberculosis can cause significant morbidity and a high index of suspicion is needed for early diagnosis so as to avoid destruction and disability 2,4,10. For purposes of description osteoarticular tuberculosis can be discussed under the following heads. Jan 07, 2018 osteoarticular tuberculosis standard treatment guidelines by supriya published on 7 jan 2018 1. Tuberculostatic treatment and surgical approach were associated in all the patients.
Health, general antitubercular agents blood medical examination blood tests creactive protein children health aspects drug resistance in microorganisms epidemiology hiv infection hiv infections hiv testing usage hiv tests microbial. The present study describes a case of multifocal osteoarticular tb in an immunocompetent young man who presented with swelling and extremity pain. Profile of osteoarticular tuberculosis in children pdf free. The past medical history was nonspecific and chest xray was. Multifocal osteoarticular tuberculosis and pleuropulmonary involvement in an immunocompetent patient breast and osteoarticular tuberculosis in a male patient osteoarticular tuberculosis in. Peripheral osteoarticular tuberculosis constitutes nearly 1 to 5% of cases of tb, taking all locations together. Development and in vitro characterization of drug delivery system of rifapentine for osteoarticular tuberculosis article pdf available in drug design, development and therapy 9default. Tuberculosis remains a major source of morbidity and mortality worldwide, and orthopaedic surgeons working in developing nations, especially in south east asia, are likely to encounter patients with osteoarticular manifestations of the disease. Diagnosis of osteoarticular tuberculosis sciencedirect. He then underwent two months course of intraarticular steroid injections and. Musculoskeletal tuberculosis is a relatively rare extrapulmonary complication of mycobacterium tuberculosis. Eptb usually takes the form of arthritis or osteomyelitis. The most common involvement is in the form of pulmonary tuberculosis.
Jun 11, 2014 tuberculosis osteoarticular raniele monteiro. Osteoarticular skeletal tuberculosis as a form of extra pulmonary tb forms 14. Osteoarticular tuberculosis, unusual location, child. Pdf development and in vitro characterization of drug. Paraclinical, therapeutic and evolutionary profile of. Osteoarticular tuberculosis in an hivpositive patient. Unusual locations other than the spine potts disease, knee or hip have been little studied and raise problems of differential diagnosis, notably with granulomatous and metastatic pathologies. Several factors were cited as reasons for the delay, including unusual sites of involvement, the lack of detectable pulmonary involvement, secondary. Multifocal osteoarticular tuberculosis of the extremities. Tuberculosis is an endemic disease of worldwide concern. Pdf osteoarticular tuberculosis in iran, 2002 to 2011. Our objective was to assess the role of mycobacterial culture and polymerase chain reaction pcr in the diagnosis of. We describe a 19yearold patient presented with progressive right wrist pain and swelling, worsened.
A lot of studies have been carried out upon epidemiology, clinical aspects and therapeutic. Several factors were cited as reasons for the delay, including unusual sites of involvement, the lack. Tuberculosis tb remains a global burden despite extensive efforts to control it. Tuberculous coxitis with trochanteric bursitis manifesting a year after immigration to germany. Chemotherapy is effective, and surgery serves as an adjunct for specific indications. Pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Osteoarticular tuberculosis standard treatment guidelines. Osteoarticular tuberculosis is an infrequent form of the disease and monoarthritis of the wrist accounts for 1% of all cases of skeletal involvement. Musculoskeletal involvement occurs in 1% to 3% of all cases of tuberculosis, with involvement of the hip joint in 15% of osteoarticular tuberculosis and is the secondmost common location after spinal tuberculosis.
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