Delays in the diagnosis and treatment of bone and joint tuberculosis in the United Kingdom

Broderick, Claire; Hopkins, Susan; Mack, Damien; Aston, Will; Pollock, Rob; Skinner, John; Warren, Simon

doi:10.1302/0301-620x.100b1.bjj-2017-0357.r1

Cited by 55 publications

(52 citation statements)

References 20 publications

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“…The spine is usually the most common site of BJTB, accounting for 59.5% in our cohort and 65% in a Danish cohort [8], but only 26% in the United Kingdom [15].…”

Section: Discussionmentioning

confidence: 60%

Treatment of Bone and Joint Tuberculosis in France: A Multicentre Retrospective Study

Guillouzouic

Andréjak

Peuchant³

et al. 2020

JCM

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Background: Nine percent of all cases of tuberculosis are bone and joint tuberculosis (BJTB). BJTB occurs in two main forms: spinal (STB) and extraspinal (ESTB). The aim of this study was to compare STB with ESTB in terms of diagnosis, treatment and outcomes. Methods: We collected demographic, clinical, microbiological, treatment duration and outcome data for patients with BJTB in a retrospective multicentre study over a 17-year period. Results: Of the 116 patients included in the study, 69 (59.5%) had STB and 47 (40.5%) had ESTB. The median age was higher in the ESTB group. There were significantly more foreign-born patients in the STB group. The median time for diagnosis was longer for ESTB (6 months) than STB (4 months) (p = 0.017). Magnetic resonance imaging was highly reliable for the diagnosis. Direct examination and histology allowed the diagnosis to be made in more than 80% of cases. The median treatment duration of 12 months, regardless of the type of BJTB, was longer than recommended. A favourable outcome was achieved in 91.9% of cases. Conclusion: The management of BJTB remains challenging. An earlier diagnosis should be more effective, reducing the total duration of treatment and leading to better tolerance.

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“…The spine is usually the most common site of BJTB, accounting for 59.5% in our cohort and 65% in a Danish cohort [8], but only 26% in the United Kingdom [15].…”

Section: Discussionmentioning

confidence: 60%

Treatment of Bone and Joint Tuberculosis in France: A Multicentre Retrospective Study

Guillouzouic

Andréjak

Peuchant³

et al. 2020

JCM

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“…Studies have shown that patient delay contributed more to total delay than did health system delays. However, health system delay has been reported to be longer in smear negative, extra pulmonary TB (EPTB) and among those who visited non TB service providing facilities [29][30][31]. This could be due to the severity of symptoms TB patients present with that resulted in repeated visits to health facilities, led to protracted diagnostic procedures, and further delayed due to unavailability of diagnostic facilities required to confirm TB diagnosis [32][33][34].…”

Section: Introductionmentioning

confidence: 99%

Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study

Datiko¹,

Jerene²,

Suarez

2020

BMC Public Health

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Background: Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. Methods: This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Results: Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10-45), 4 (2-10) and 2 (1-3) days respectively. The median (IQR) of total delay was 33 (19-67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay. Conclusion: TB patients' delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.

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“…Spinal TB accounts for almost half of the bone and joint TB, mainly affecting the anterior and middle column of the spine and leading to vertebral bone defects, collapse, compression, and kyphosis deformity [17]. The anterior-only approach is preferred for decompression and debridement in spinal TB as it allows direct access to the lesion site, complete debridement, su cient decompression, and reduces muscle trauma [18].…”

Section: Discussionmentioning

confidence: 99%

Single-stage transverse process resection, debridement, interbody fusion, and internal fixation for the treatment of lumbar spinal tuberculosis via posterior-only approach

Li¹,

Zhang²,

He³

et al. 2020

Preprint

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Background: Spinal tuberculosis (TB) is a less frequently reported infectious spinal pathology. There are controversies on the surgical intervention of lumbar spinal TB with neurological damage and paraspinal abscess. This retrospective study was conducted to determine the effectiveness of single-stage transverse process resection, debridement, interbody fusion, and internal fixation for the treatment of lumbar spinal TB via posterior-only approach.Methods: From January 2015 to June 2018, 32 consecutive patients (19 males and 13 females) with lumber spinal TB complicated with neurological damage and paraspinal abscess treated by single-stage transverse process resection, debridement, interbody fusion, and internal fixation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Anti-TB drugs with HREZ chemotherapy regimen was administered to all patients. Surgical outcomes were evaluated based on visual analogue scale (VAS), American Spinal injury Association (ASIA) classification. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria.Results: The mean follow-up period was 20.41 ± 5.19 months. No implant failures were observed in any patients. Wound infection was observed in one patient. Solid bony fusion was achieved in 9 cases at 6 months and 23 cases at 12 months after operation. Kyphosis angle was 11.28 ± 4.01° at final follow-up. The levels of ESR and CRP were returned to normal at the final follow-up. VAS scores were significantly improved (P < 0.05). According to ASIA classification, 6 cases were classified as with grade D and 26 cases were classified as grade E at the last follow-up.Conclusion: Single-stage transverse process resection, debridement, interbody fusion, and internal fixation via posterior-only approach is a feasible and effective surgical therapy for lumbar spinal TB with neurological damage and paraspinal abscess.

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Delays in the diagnosis and treatment of bone and joint tuberculosis in the United Kingdom

Cited by 55 publications

References 20 publications

Treatment of Bone and Joint Tuberculosis in France: A Multicentre Retrospective Study

Treatment of Bone and Joint Tuberculosis in France: A Multicentre Retrospective Study

Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study

Single-stage transverse process resection, debridement, interbody fusion, and internal fixation for the treatment of lumbar spinal tuberculosis via posterior-only approach

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