Bone and joint mycobacterial infection: a retrospective review of cases presenting to a UK district hospital

Everden, Angharad J. T.; Mamo, JP; Somasunderam, Donald; McKee, Alexis M.; Brij, SO; Enoch, David

doi:10.1099/jmm.0.000867

Cited by 3 publications

(12 citation statements)

References 20 publications

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“…Long-term sequelae were present in 7/14 (50 %) patients, 5/10 (50 %) in STB patients and 3/7 (42.9 %) in ESTB patients. Among STB patients, one had an irreversible paraparesis and the others 4 (30.7 %) had residual symptoms, similar to other European countries (26-47 %) [8,9,18]. Persistent back pain, functional limitation, spinal deformity and neurological deficit are the most common findings, similar to our data.…”

Section: Discussionsupporting

confidence: 90%

“…BJTB is an indolent infection, with a variable and nonspecific presentation. Clinical characteristics were comparable to those previously described in European populations that included adults and children [3, 8, 18, 21], with back pain as the main complaint, followed by systemic symptoms (40–50 %), variable neurological deficits (24–50 %) and fistulation (10 %) [9, 10, 18]. Indeed, constitutional symptoms were present in 50 % of our cases, while pain was more common (77.8 %) and chronic sinus tracts (fistulae) less frequent (16.7 %).…”

Section: Discussionsupporting

confidence: 85%

“…Also, the sensitivity of our cases for positive NAAT (44.4 %) and culture (44.4 %) was lower than reported in other European studies (55-72.4 and 50-87 %, respectively) [3, 8-10, 18, 28], but similar to other paediatric studies (55 and 15%, respectively) [21]. Furthermore, although histology can detect either necrotizing or non-necrotizing granulomas, with a sensitivity of 65-95 % [9,10,18], it was only 33 % sensitive in our cases. In our study, CT scan-or ultrasonography-guided bone sampling for diagnosis was only undertaken in three cases and surgery only in more complicated cases, probably justifying this low microbiological and histological yield.…”

Section: Discussionsupporting

confidence: 58%

“…However, a negative TST test or IGRA test should not exclude the presence of BJTB, since the sensitivity is only ~50 % in paediatric patients [2, 21], as in our series. Also, the sensitivity of our cases for positive NAAT (44.4 %) and culture (44.4 %) was lower than reported in other European studies (55–72.4 and 50–87 %, respectively) [3, 8–10, 18, 28], but similar to other paediatric studies (55 and 15%, respectively) [21]. Furthermore, although histology can detect either necrotizing or non-necrotizing granulomas, with a sensitivity of 65–95 % [9, 10, 18], it was only 33 % sensitive in our cases.…”

Section: Discussionsupporting

confidence: 49%

“…Confirmed BJTB was based on positive bone biopsy or synovial fluid specimens, either by culture and/or acid nucleic amplification techniques for Mycobacterium tuberculosis or in the presence of compatible bone lesions plus documented microbiological isolation of TB in another location. The diagnosis of probable TB was established as follows: (1) Osteoarticular involvement (mainly spinal); (2) At least one of the following: history of previous TB exposure, positive tuberculin sensitivity test (TST), positive interferon gamma release assay (IGRA) or histopathological features (necrotizing or non-necrotizing granulomas) and (3) Clinical improvement after antituberculosis treatment [3, 9]. Chronic joint effusion was considered to be persistent more than a month after antibiotic therapy and arthrocentesis.…”

Section: Methodsmentioning

confidence: 99%

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Bone and joint tuberculosis in paediatrics: a 13-year retrospective study

Gouveia

Cabral

Jordão

et al. 2022

Journal of Medical Microbiology

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Introduction. Bone and joint tuberculosis (BJTB) is rare in developed countries, particularly in the paediatric population. Hypothesis/Gap Statement. The clinical features and sequelae of paediatric BJTB in Europe are not well characterized and should be assessed to achieve a better approach. Aim. To assess the management and outcomes of paediatric BJTB. Methodology. Longitudinal observational study of all paediatric patients (0–17 years old) diagnosed with BJTB between 2008 to 2020 in a tertiary-care hospital. Results. We identified 18 patients with BJTB, with a median age of 10 years (IQR 6–14.8), 66.7 % male. Most (72 %) were diagnosed after 2015 and were foreign-born (88.9 %), mainly from Portuguese-speaking African countries, and none had HIV. The most common symptoms were pain (77.8 %), fever (50 %) and bone deformity (44.4 %). Spinal TB (STB) affected 13 (72.2 %) and extra-spinal TB (ESTB) 9 (50 %) patients, and 4 (27.7 %) had both conditions. Diagnostic positive procedures included positive nucleic acid amplification technique (NAAT) (44.4 %), Mycobacterium tuberculosis isolation (44.4 %) and compatible histology (33.3 %). All completed antituberculous drugs for a median of 12 months (IQR 12–13) and nine (50 %) had surgery. Overall, acute complications occurred in 16 (88.9 %) patients – 11/13 (84.6 %) with STB and 5/5 (100 %) with ESTB – and included abscesses, spinal compression, spine deformity and pathological fractures. Sequelae were still present at the 12-month follow-up in seven cases (46.7 %), and were more common in foreign-born patients sent to Portugal to receive medical treatment (66.7 vs 20 %). Conclusions. Paediatric BJTB is difficult to diagnose and has high morbidity, requiring long-term follow-up. Over the last decade, foreign-born TB seems to be increasing, with still longer treatment courses and more acute complications and sequelae.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 85%