Characteristics and Clinical Outcome of Bone and Joint Tuberculosis From 1994 to 2011: A Retrospective Register-based Study in Denmark

Johansen, Işik Somuncu; Nielsen, Stig Lønberg; Hove, M F van den; Kehrer, Michala; Shakar, Shakil; Wøyen, Arne V T; Andersen, Peter Henrik; Bjerrum, Stephanie; Wejse, Christian; Andersen, Åse Bengård

doi:10.1093/cid/civ326

Cited by 90 publications

(113 citation statements)

References 26 publications

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“…In a Danish study of patients with spinal TB, 54/133 (40.6%) had neurological deficits on admission and 17.3% presented with cauda equina syndrome, requiring surgical intervention. 84 In a Filipino study of TB meningitis in children, the mortality rate was 16%, and 71% of patients exhibited signs of hydrocephalus. 93 Thus, neurosurgeons have a role to intervene in CNS TB for biopsy, spinal decompression and stabilization, and CSF diversion.…”

Section: Tuberculosis-related Cns Diseasementioning

confidence: 99%

Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide

Robertson

Lepard

Mekary

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Central nervous system (CNS) infections cause significant morbidity and mortality and often require neurosurgical intervention for proper diagnosis and treatment. However, neither the international burden of CNS infection, nor the current capacity of the neurosurgical workforce to treat these diseases is well characterized. The objective of this study was to elucidate the global incidence of surgically relevant CNS infection, highlighting geographic areas for targeted improvement in neurosurgical capacity. METHODS A systematic literature review and meta-analysis were performed to capture studies published between 1990 and 2016. PubMed, EMBASE, and Cochrane databases were searched using variations of terms relating to CNS infection and epidemiology (incidence, prevalence, burden, case fatality, etc.). To deliver a geographic breakdown of disease, results were pooled using the random-effects model and stratified by WHO region and national income status for the different CNS infection types. RESULTS The search yielded 10,906 studies, 154 of which were used in the final qualitative analysis. A meta-analysis was performed to compute disease incidence by using data extracted from 71 of the 154 studies. The remaining 83 studies were excluded from the quantitative analysis because they did not report incidence. A total of 508,078 cases of CNS infections across all studies were included, with a total sample size of 130,681,681 individuals. Mean patient age was 35.8 years (range: newborn to 95 years), and the male/female ratio was 1:1.74. Among the 71 studies with incidence data, 39 were based in high-income countries, 25 in middle-income countries, and 7 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income countries, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65 cases/100,000 people), neurocysticercosis (650/100,000), and tuberculous spondylodiscitis (55/100,000), whereas Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000), and Europe had the highest pooled incidence of nontuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported data on deaths associated with infection. The limited case fatality data revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.1%) and the lowest for neurocysticercosis (5.5%). In all five disease categories, funnel plots assessing for publication bias were asymmetrical and suggested that the results may underestimate the incidence of disease. CONCLUSIONS This systematic review and meta-analysis approximates the global incidence of neurosurgically relevant infectious diseases. These results underscore the disproportionate burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high-quality neurosurgical care.

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Section: Tuberculosis-related Cns Diseasementioning

confidence: 99%

Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide

Robertson

Lepard

Mekary

et al. 2019

Journal of Neurosurgery

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“…The rate of extrapulmonary TB (EPTB) worldwide has reached 20%–40% (20% in children), as reported in recent studies [ 3 4 5 ]. Young patients, females, and people of African or Asian origin seem to have a higher risk of developing EPTB [ 6 7 ]. Of cases with EPTB, 10%–25% have musculoskeletal TB [ 1 8 ], leading to an estimated global prevalence of 19–38 million cases [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Musculoskeletal Tuberculosis in an Area with High Disease Prevalence

et al. 2017

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Study DesignRetrospective observational study.PurposeThe aim of this study was to assess the distribution of age and site of infection in patients with musculoskeletal tuberculosis (TB) and determine the number of TB/human immunodeficiency virus (HIV) coinfections as well as the incidence of multidrugresistant (MDR) TB.Overview of LiteratureOf all TB cases, 1%–3% show skeletal system involvement and 30% are HIV coinfected. Although the reported distribution of skeletal TB is majorly in the spine, followed by the hip, knee, and foot/ankle, the epidemiology of extrapulmonary TB and especially musculoskeletal TB remains largely unknown, particularly in areas with a high prevalence of the disease.MethodsThis is a retrospective study of a consecutive series of patients admitted to a tertiary care facility in an area with the highest prevalence of TB worldwide. TB was confirmed on tissue biopsy with polymerase chain reaction testing (Xpert for Mycobacterium tuberculosis and rifampicin resistance), culturing, or histological analysis. Data were analyzed regarding demographic information, location of the disease, HIV coinfections, and drug resistance.ResultsIn all, 125 patients (44 children; 35%) with a mean age of 27 years (range, 1–78 years) were included. Age peaks were observed at 5, 25, and 65 years. Spinal disease was evident in 98 patients (78%). There were 66 HIV-negative (53%) and 29 (23%) HIVpositive patients, and in 30 (24%), the HIV status was unknown. Five patients (4%) showed MDR TB.ConclusionsThe age distribution was trimodal, spinal disease was predominant, MDR TB rate in our cohort was high, and a large portion of TB patients in our hospital were HIV coinfected. Hence, spinal services with sufficient access to operating facilities are required for tertiary care facilities in areas with a high TB prevalence.

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“…In Scandinavia approximately 70% of new TB cases occur in immigrants from TB high-endemic countries and the majority are infected in their country of origin [3]. Pulmonary TB is the most frequent manifestation, however extrapulmonary TB is common among people from TB high-endemic countries and a high level of medical awareness must be encouraged [4]. Spinal- and perianal TB are rare manifestations of TB and in line with our findings a diagnostic delay is frequently reported in patients with abscesses [5], [6].…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of severe tuberculous spondylodiscitis in an asylum seeker; patient or doctors delay?

Kristensen

Podlekareva

Ravn

2017

Respiratory Medicine Case Reports

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The still increasing global migration affects the epidemiology of tuberculosis (TB) in European countries. We present the case of an asylum seeker from a TB high-endemic country, who presented with severe TB spondylodiscitis and need for emergency surgery. The patient had a history of recurrent sterile axillary and perianal abscesses for years, but TB was never properly ruled out. The patient underwent surgery, responded well to antibiotics and regained the ability to walk. After 6 month of treatment the patient was lost to follow-up. In light of the increasing migration from TB high-endemic countries to low-endemic countries, this case illustrates the paramount importance of minding TB as a differential diagnosis.

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Characteristics and Clinical Outcome of Bone and Joint Tuberculosis From 1994 to 2011: A Retrospective Register-based Study in Denmark

Abstract: BJ-tuberculosis was rare and seen mainly in younger immigrants in Denmark. More than half of cases were spinal tuberculosis, presenting with more severe symptoms and worse outcome, compared with other forms of BJ-tuberculosis.

Cited by 90 publications

References 26 publications

Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide

Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide

Epidemiology of Musculoskeletal Tuberculosis in an Area with High Disease Prevalence

Delayed diagnosis of severe tuberculous spondylodiscitis in an asylum seeker; patient or doctors delay?

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