Increase of bone and joint tuberculosis in The Netherlands

Abstract

There has been an increase in the incidence of bone and joint tuberculosis (BJTB) in The Netherlands and we have carried out an epidemiological study in order to find an explanation for this increase. Data from 1993 to 2000 from The Netherlands Tuberculosis Register (NTR) were used. In 1993 there was a total of 52 patients with BJTB. This figure increased gradually to 80 in 1999 before decreasing to 61 in 2000. There was a total of 12447 patients with tuberculosis; BJTB was found in 532, accounting for 4.3% of all cases and 10.6% of all extrapulmonary cases. Localisation in the spine occurred in 56%. Certain immigrants, in particular from Somalia, were more likely to have BJTB than other immigrants or the native Dutch population. Increased age and female gender were associated with BJTB. Only 15% of BJTB patients also suffered from pulmonary tuberculosis. The usual long delay in the diagnosis of BJTB may be shortened if physicians are more aware of tuberculosis.

Bone and joint tuberculosis

“…Bone and joint TB shows a bimodal age distribution: in natives of developed countries, the disease commonly affects people older than 55 years, whereas in immigrants, it is more common in younger individuals (20-35 years old) [14,28,35,53]. In our experience, we have also seen this bimodal distribution.…”

“…In Europe and the USA, extrapulmonary tuberculosis (EPTB) has increased from 7.6 % of all TB cases in the 1960s to 20-40 % in recent studies [28,35,53]. In children, around 20 % of all mycobacterial infections are EPTB [43].…”

“…In children, around 20 % of all mycobacterial infections are EPTB [43]. This increase has been attributed to the epidemic of AIDS, a condition that predisposes to EPTB, and to immigration, EPTB being more common in Asian and African countries [28,35,53].…”

Expression of Alpha Crystallin Protein in Osteoarticular Tuberculosis in Latent Phase: A Review of Evidences

“…Osteoarticular tuberculosis is a rare form of EPTB comprises of 10-15% in all EPTB cases and nearly 1-6% in total TB cases [6][7][8][9] The load bearing joint (i.e. spine, hip and knee) are the recurrent sites of the disease [10].…”

“…Initially the infection is insidious, hence it takes several months and sometimes years from the appearance of first symptom to the diagnosis [7,[11][12][13]. It is differentially diagnosed with other skeleton infections mainly because of its paucibacillary nature and less disease related symptoms.…”