Osteoarticular Tuberculosis-A Three Years’ Retrospective Study

Abstract

Introduction: Extra pulmonary TB can be encountered in various organ systems, like lymph nodes, serous cavities, genitourinary tract, skeletal. Musculoskeletal TB can cause significant functional impairment. The clinical symptoms are variable, pain and swelling being common symptomatology. Investigations for suspected cases include radiological imaging, histopathological examination, bacteriological examination, and polymerase chain reaction.The mainstay of treatment is multidrug antitubercular chemotherapy. Aim:To study the cases of osteoarticular TB diagnosed on biopsy, to analyse the various microscopic patterns, results of microbiological investigations, correlate the clinical and radiological features and the response to ATT. Setting and Designs:A teaching tertiary medical institute in North India in catchment area, where prevalence of tuberculosis is high. A retrospective study of cases with a biopsy diagnosis of bone and/joint TB, retrieved from Histopathology section of Department of Pathology of the tertiary institute. Material and Methods:The study was retrospective and the data was collected for the preceding 3 years. The cases were retrieved from the records of the department of Pathology. A total of 16 cases were diagnosed as/suspected to be tuberculosis of bones and/joints. The clinical information were noted from the case files. Results of laboratory investigations along with relevant microbiologic investigations were noted. The biopsy samples were processed according to protocol. Ziehl-Neelsen stain to detect tubercle bacilli and PAS stain to rule out fungal infection were done. Microscopic features were noted. Results and Conclusion:Sixteen cases with a diagnosis of bone and/joint tuberculosis were found. The average age was 23.6 years. The most common presentation was pain and swelling. Knee joint was most commonly involved (7 cases) followed by spine and ankle (3 each). All the cases showed epithelioid granulomas which was necrotising in 11. AFB positivity was found only in 4 cases. ATT was started in 12 cases with a good response.

Needle Aspiration and Cytology for Suspected Osteoarticular Tuberculosis in Children

“…Various studies have been conducted for diagnosis of OATB by demonstration of tubercle bacilli ( Table III ). Needle aspiration is a sensitive technique and has high positivity rates for detection of AFB as observed in our study as well as by Arathi et al (75%) and Masood et al (63%) 16 , 17 . However, Mousa et al found a low rate (27%) of positivity for AFB in their study.…”

A biphasic nanohydroxyapatite/calcium sulphate carrier containing Rifampicin and Isoniazid for local delivery gives sustained and effective antibiotic release and prevents biofilm formation

“…Tuberculosis (TB) is a global disease that caused an estimated 1.2 million deaths in 2018 and around 10 million new TB cases were reported globally in the same year, with the incidence being stable in the recent years as per World Health Organization (WHO) report 1 Osteoarticular tuberculosis is a common manifestation accounting for 10–15% of all extrapulmonary TB (EPTB) 2 , 3 cases and 1–4% of all TB cases 4 – 6 . The bone and joint TB is most often found in spine and weight bearing extremities resulting in neurological complications and joint destruction 7 .…”

Tuberculous coxitis with trochanteric bursitis manifesting a year after immigration to Germany: a case report

“…However, in view of the recent developments in migration of refugees from Africa and Arabic countries to Europe, tuberculosis may become a more frequent entity in central and northern Europe in the future [ 4 ]. At present, osteoarticular tuberculosis accounts for 1–4.3% of all cases of tuberculosis [ 3 ]. In Germany, approximately 20% of newly diagnosed cases of tuberculosis had an extrapulmonary focus [ 5 ].…”

“…Osteoarticular tuberculosis accounts for 8.1% of newly diagnosed cases and is more common among patients of Asian or African origin. Tuberculous coxitis is thought to arise as a consequence of prior pulmonary tuberculosis through hematogenous spread of mycobacteria [ 3 , 6 ]. Retrograde lymphatic or contiguous dissemination are also possible but less common.…”

“…Extrapulmonary tuberculosis may affect various organs, causing a broad range of clinical manifestations [ 1 – 3 ]. It provides an important source of mortality, especially if not diagnosed in time.…”