Extraspinal osteoarticular multidrug-resistant tuberculosis in children: A case series

Firth, GB; Lescheid, J; Camacho, M; Esteves, Martene; Beylis, Natalie; Groome, Michelle; Madhi, Shabir A.

doi:10.7196/samj.2017.v107i11.12577

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…In a study examining extra-axial MSK TB in children, Firth et al reported a prevalence of 33.3% of HIV co-infection. 18 The reason for the low HIV co-infection rate in our patients remains elusive, but TB is endemic in our region, as is demonstrated by the four-times higher number of cases in our study than in that by Firth et al 18 over the same time period, and may be ascribed to different epidemiology and disease trends in our population.…”

Section: Discussionmentioning

confidence: 46%

Tuberculosis of the extra-axial skeleton in paediatric patients

Vajapey

Horn

2021

SA orthop. j.

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BACKGROUND: Musculoskeletal tuberculosis (MSK TB) is a disease entity that often mimics other orthopaedic conditions in its radiographic and clinical presentation, which can delay diagnosis and treatment. The purpose of this study is to examine the clinical and radiographic presentation as well as the accuracy of various diagnostic tests, treatment, complications and outcome in paediatric patients diagnosed with MSK TB. We aim to provide insight into typical presenting features in order to expedite diagnosis in this perplexing disease. METHODS: We retrospectively reviewed 77 consecutive patients with extra-axial MSK TB treated at our institution over a ten-year period from 2008 to 2018. We collected data on initial clinical presentation, laboratory values, radiographic findings, diagnostic testing, treatment and outcomes. We performed quantitative and qualitative analysis to look for patterns in presentation that can help with diagnosis and factors affecting the clinical outcomes. RESULTS: The most common clinical presentation was pain of the affected limb. Constitutional symptoms were uncommon. Our patients presented with thrombocytosis and anaemia, but normal white cell counts. Inflammatory markers were mildly elevated. Of diagnostic tests employed, the Mantoux skin test yielded the most positive results (70%) followed by tissue PCR (53%). The hip was most frequently involved, followed by the knee and elbow. Most patients presented with normal appearing X-rays. We had a medical compliance rate of 94% with all patients followed up to completion of treatment having resolution of active disease. Thirty-nine per cent of our patients had residual joint stiffness or deformity following completion of treatment, ranging from ankylosis to mildly decreased joint range. CONCLUSION: Patients with MSK TB usually present with non-specific symptoms and signs, and a high index of suspicion should be maintained in endemic areas. Typical haematological findings are an elevated ESR and CRP accompanied by anaemia and thrombocytosis. Radiographs at presentation are non-specific in more than 50% of patients. A combination of diagnostic modalities should be employed as no single test is 100% sensitive or specific. Compliance with medical treatment reliably leads to resolution of the disease. Residual joint pathology is common and needs to be addressed secondarily. Level of evidence: Level 4 Keywords: musculoskeletal tuberculosis, paediatric tuberculosis, joints, anti-tuberculosis treatment, deformity, GeneXpert

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Section: Discussionmentioning

confidence: 46%

Tuberculosis of the extra-axial skeleton in paediatric patients

Vajapey

Horn

2021

SA orthop. j.

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“…Consistently low study samples were reported by Firth et al (also from our Institution) looking at extra-spinal osteoarticular TB in 19 paediatric cases over a 16 years year period. 9 Our study had one paediatric case out of 34 cases over 5 years. Studies with large sample sizes over a short duration were reported in China and Thailand with 43 and 99 osteoarticular TB cases recorded in just two years respectively, this is possibly due to a large population and ailing sanitation measures, respectively.…”

Section: Discussionmentioning

confidence: 99%

Osteoarticular TB specimen yield rates. Large joint analysis at a single centre.

Kgagudi,

Hlapolosa,

Jingo

et al. 2024

Orthopedic Reviews

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Tuberculosis (TB) remains endemic in South Africa. The spine, hip, and knee joints are common extra-pulmonary TB sites. Sound history taking, clinical examination, and basic laboratory and pathological tests remain key important steps in osteoarticular TB diagnosis. In our resources-stricken context cost is everything, if we can make a diagnosis cheaply that would go a long way. The diagnostic yield of standard laboratory tests compared to a real-time polymerase chain reaction (PCR) for osteoarticular TB diagnosis in a single orthopaedic unit has not been analysed. We conducted a retrospective record review of extra-spinal osteoarticular TB infection at our hospital from 01 June 2016 to 31 December 2021. Patient demographics, clinical history, and laboratory test results were analysed. A total of 34 cases were identified, with 32 of the cases being articular and two osseous involvement. The knee was the most common joint affected followed hip joint. Acid Fast Bacilli were detected in 32% of cases with microscopy, while TB culture was positive in 29% of samples. Histopathological examination and real-time PCR diagnosed TB in 66% and 63% of the cases, respectively. Our findings suggest that in the right context of a suggestive history and examination, histological analysis is as good as PCR for diagnosing osteoarticular TB.

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“…The most important aspect of the treatment is choosing the correct course of anti-tubercular drugs due to the massive arising issue of multi-drug resistant tuberculosis, which is defined as MTB that is resistant to both isoniazid and rifampicin, regardless of other susceptibilities. 12 , 13 One of the recommended treatment regimens for OA-TB is a minimum of 3 drugs, including isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol, to which MTB is susceptible, and at least one of these drugs must be bactericidal. 13 Other studies recommend a therapy with 4 drugs, since the frequency of isoniazid resistance, for a duration of at least 9 months and longer in immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

Silent Case of Pediatric Osteoarticular Tuberculosis: A Case Report and Review of the Literature

Alshrouf,

Elifranji,

Halayqeh

et al. 2024

Clin Med Insights Case Rep

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Introduction: Tuberculosis (TB) is one of the most prevalent infectious diseases globally, often presenting with nonspecific symptoms that can obscure diagnosis, especially when it manifests in uncommon sites such as osteoarticular tuberculosis (OA-TB). Case presentation: We report a rare case of a 9-year-old male diagnosed with right knee tuberculosis after enduring severe symptoms for several months. Despite multiple negative biopsies and aspirates during initial debridement surgeries, a biopsy taken 6 months later confirmed the presence of Mycobacterium tuberculosis (MTB). The patient was subsequently treated with debridement and anti-tubercular therapy. Conclusion: This case underscores the critical need to consider tuberculosis in patients presenting with chronic bone pain to avoid misdiagnosis, particularly in the developing world. The atypical presentation of osteoarticular tuberculosis in this young patient emphasizes the need for healthcare professionals to recognize subtle symptoms. Advanced imaging studies like MRI and microbiological evaluations, including site biopsies, are essential for accurate diagnosis. Increased awareness and collaborative research are crucial to improving the understanding and management of pediatric osteoarticular tuberculosis and extrapulmonary tuberculosis.

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Extraspinal osteoarticular multidrug-resistant tuberculosis in children: A case series

Cited by 6 publications

References 21 publications

Tuberculosis of the extra-axial skeleton in paediatric patients

Tuberculosis of the extra-axial skeleton in paediatric patients

Osteoarticular TB specimen yield rates. Large joint analysis at a single centre.

Silent Case of Pediatric Osteoarticular Tuberculosis: A Case Report and Review of the Literature

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