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Joint Tuberculosis

Joint Tuberculoses


Presentation

  • This case shows both an atypical presentation of TB and the difficulties in managing a transplant patient with this disease. Copyright 2014 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Its object is to chart the changing pattern of clinical presentation of this disease, and details of 129 patients are presented.[ncbi.nlm.nih.gov]
  • Tuberculosis is a great masquerader presenting in varied forms and in atypical locations. The myriad presentations of tuberculosis may complicate its diagnosis.[ncbi.nlm.nih.gov]
  • The most common presenting symptoms were pain (29/31, 94%) and swelling (26/28, 93%). 'Typical' symptoms of TB, such as fever, sweats and weight loss, were uncommon.[ncbi.nlm.nih.gov]
  • Low back pain and difficulty in walking were the most common presenting features. Two patients presented with a buttock abscess and spondylitis of the lumbar spine was noted in two patients.[ncbi.nlm.nih.gov]
Difficulty Walking
  • The clinical symptoms were buttock and low back pain in all patients, and most had difficulty walking (68.6%) and had radicular pain in their lower limbs (50%).[ncbi.nlm.nih.gov]
Shivering
  • Shivering may be because of a highfever, or because of urine infection or malaria. As of now use the below medication. Syrup Crocin DS (Paracetamol) 5 ml/240 mg, 4 ml if fever greater than 100 F every sixth hourly.[icliniq.com]
Arthritis
  • What is tuberculosis arthritis? Tuberculosis arthritis is an infection of the joints caused due to tuberculosis (TB).[credihealth.com]
  • Tubercular arthritis affecting the foot is uncommon. Isolated calcaneocuboid joint tuberculosis has never been reported in the literature.[ncbi.nlm.nih.gov]
  • We reported a 72-year-old patient suffering shoulder pain for the last 2 years who was diagnosed with glenohumeral joint TB arthritis associated with multiple cold abscesses in adjacent soft tissues; emphasising significant clinical and imaging findings[ncbi.nlm.nih.gov]
  • Minor trauma, a short hospitalization time and a short post-operative rehabilitation period combined with good cosmetic and clinical results favor the use of the arthroscopic technology in the surgical treatment of tuberculous arthritis of the knee.[ncbi.nlm.nih.gov]
  • At the age of 14 years, the patient had isolated tuberculosis arthritis of the left knee. Reactivation occurred after total knee arthroplasty 61 years later, at the age of 75.[ncbi.nlm.nih.gov]
Joint Effusion
  • effusion may be the only finding but is non-specific.[radiopaedia.org]
  • Radiologically, the tubercular arthropathy in early stage of synovitis and arthritis shores periarticular demineralization, widening of joint space due to joint effusion, and early subchondral erosion. [9] , [10] , [11] As the tubercular arthropathy advanced[ruralneuropractice.com]
  • In addition, reactive sclerosis, periosteal reaction and joint effusion are described. Pathological changes include synovial thickening and joint effusion. Slow insidious type of disease or dry variety is known as caries sicca.[ispub.com]
  • effusion (widenedjoint space) 114.[slideshare.net]
  • Signs of moderate right coxofemoral joint effusion. DIscussIon Presently, coxofemoral joint tuberculosis shows rare prevalence in the pediatric setting, mainly when it does not impair other systems 4 .[ramb.elsevier.es]
Joint Swelling
  • TB arthritis shows persistent joint swelling over a period of time, and the pain is restricted to a single joint, and does not respond to antibiotics.[credihealth.com]
  • The affected joint swells and becomes painful. Movement stiffens, and range of motion is limited. In severe and chronic cases, abscesses develop in the affected joints.[justdoc.com]
  • Figure 12 Sternoclavicular Joint swelling may show soft tissue and altered marrow signals involving underlying bones. Figure 13 Elbow Joint tuberculosis showing altered marrow signals with synovial thickening and effusion..[ispub.com]
  • Most patients only present with joint swelling and pain.[springerplus.springeropen.com]
  • Presentation is indolent with pain, joint swelling, and decreased range of motion. Draining sinuses and abscesses are seen in chronic cases. Systemic symptoms usually are absent.[aafp.org]
Hip Pain
  • CASE SUMMARY A 46-year-old Hmong woman presented with complaints of right foot pain and a rash, increased right hip pain, and fever. Findings were concerning for vasculitis with septic emboli from an infected right hip.[appliedradiology.com]
  • In the patient's first visit to the hospital presenting the clinical picture of hip pain, an X-ray was requested, which did not evidence any alteration.[ramb.elsevier.es]
Frozen Shoulder
  • Consequently, 14 (87.5%) of the patients in our study with glenohumeral joint tuberculosis were likely misdiagnosed as having frozen shoulder.[ncbi.nlm.nih.gov]
  • Tuberculosis of the shoulder is rare and its diagnosis is likely to be delayed because its symptoms often resemble those of the primary frozen shoulder or rotator cuff syndrome.[ncbi.nlm.nih.gov]
Neurologic Manifestation
  • Surgery combined with prolonged specific antituberculous chemotherapy is mainly indicated in patients with neurological manifestations or deformities, and provides satisfactory results in most cases.[ncbi.nlm.nih.gov]
Radiculomyelopathy
  • Extraosseous extradural granuloma - rare variant Hematogenous route more common in men than women dorsal epidural space and in the thoracic segment Clinically compressive radiculomyelopathy Pathology - a granulomatous membrane is found ensheathingand[slideshare.net]

Workup

  • However, unsuspecting doctors and incomplete workup frequently contributed to a further delay in diagnosis. A significant fraction of aberrant management was also found with undue surgical intervention in many cases.[ncbi.nlm.nih.gov]
  • (See Workup.) The usual treatment regimen for TB cases from fully susceptible M tuberculosis isolates consists of 6 months of multidrug therapy.[emedicine.medscape.com]
  • Routine laboratory workup revealed that the erythrocyte sedimentation rate was 56 mm in the first hour. Hemoglobin level was 9.8 g/dL. The full blood count showed normocytic normochromic anemia, and a normal total and differential white cell count.[bone.imedpub.com]
Skin Test Positive
  • Verhagen et al demonstrated that large clusters of TB are associated with an increased number of tuberculin skin testpositive contacts, even after adjusting for other risk factors for transmission. [24] The number of positive contacts was significantly[emedicine.medscape.com]
Elevated Sedimentation Rate
  • Of note, 95% of the patients with spinal tuberculosis had an elevated sedimentation rate. Imaging methods have an important role in diagnosing BJ-tuberculosis, and MRI remains the method of choice, especially in spinal tuberculosis [ 21 ].[academic.oup.com]
  • sedimentation rate, and hyponatremia. 40 Examination of the sputum, bronchoalveolar lavage, gastric washings, CSF, blood culture, or biopsies of liver and bone marrow may be necessary for diagnosis. 16 A tuberculin skin test result is positive in less[aafp.org]

Treatment

  • CONCLUSION: Diagnosis and treatment of adolescent TB is different from that of other TB patients.[ncbi.nlm.nih.gov]
  • The antibody titre was found to be most helpful in diagnosis and in assessing the activity of the disease after treatment was completed.[ncbi.nlm.nih.gov]
  • Public Health England reports that patients with TB experience delays in diagnosis and treatment.[ncbi.nlm.nih.gov]
  • The standard treatment is principally antituberculous chemotherapy plus débridement, if necessary.[ncbi.nlm.nih.gov]
  • Drug treatment was used in all cases, combined with biopsy in 21 cases and more radical surgery in 28 cases. The results of treatment were good with low morbidity and mortality, long-term problems have been few, and no relapses have occurred.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis is affected favorably by two factors in particular: (a) Adequate treatment of abscesses, so as to prevent secondary infection of bone,—the existence of an uncontaminated tuberculous abscess need not affect the prognosis adversely.[journals.lww.com]
  • They concluded that the radiological appearances at presentation was predictable of outcome and that a narrowed joint space was the most reliable sign of poor prognosis, that immobilisation or mobilisation or CPM did not influence the outcome, and that[ijoonline.com]
  • […] para-articular abscess, tenosynovitis, bursitis, skin ulceration or sinus tract formation): sinus tracts appear linear T2 hyperintensity with marginal ‘tram-track enhancement’ para-articular abscesses have thin, smooth and enhancing wall Treatment and prognosis[radiopaedia.org]
  • DISCUSSION The principal finding of the present study is that even in a low-incidence, high-resource setting with free and equal access to healthcare, spinal tuberculosis has a poor prognosis with debilitating sequelae and high mortality.[academic.oup.com]
  • Prognosis Tuberculosis that is not resistant to medication is almost always cured if the person complies with the treatment regimens and antibiotics are started before major parts of the lung are destroyed.[drugs.com]

Etiology

  • An adequate therapeutic response also constitutes a counter-proof of the etiology. Treatment of musculoskeletal tuberculosis is essentially clinical (medication based).[ramb.elsevier.es]
  • These positive results aid in the diagnosis in that a repeated negative tuberculin test practically eliminates tuberculosis as a possible etiology of a lesion. Scientific Diagnosis A scientific diagnosis was obtained in 506 cases.[healio.com]
  • Any factor which modifies the state of local resistance and resultant activation of dormant tubercle bacilli, microtrauma has been proposed as a mechanism, however no case could it be established that trauma was an etiological factor.[radiopaedia.org]
  • It is the most common etiology in our day to day work. All Indian radiologists would agree to the same as they have seen tuberculosis in various forms.[ispub.com]
  • […] elements a well-defined para-spinal lesion disproportionally large para-spinal masses, especially withcalcification or a thick rim of enhancement subligamentous spread to three or more vertebral levels andpresence of skip lesions favor a tubercular etiology[slideshare.net]

Epidemiology

  • Abstract Epidemiologic data on 100 patients with bone and joint tuberculosis reported in Denmark from 1980 to 1984 are presented.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • Atypical tuberculous osteoarticular manifestations involving the extraspinal skeleton, a prosthetic joint, or the trochanteric area, and nontuberculous mycobacterial infections should be considered in favorable epidemiological contexts.[ncbi.nlm.nih.gov]
  • A high index of suspicion based on epidemiologic considerations was also important.[ncbi.nlm.nih.gov]
  • Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty[mdedge.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Infection with M tuberculosis results most commonly through exposure of the lungs or mucous membranes to infected aerosols.[emedicine.medscape.com]

Prevention

  • BACKGROUND: The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated.[ncbi.nlm.nih.gov]
  • Joint TB/HIV interventions seek to 1) prevent HIV infection, 2) prevent TB, 3) provide care for PLWHA and 4) provide care for people with TB. Many potentials for overlap will occur.[who.int]
  • Antituberculous chemotherapy should be given for at least 1 year to prevent recurrence of the disease.[ncbi.nlm.nih.gov]
  • […] and dihydrostreptomycin with isonicotinic acid hydrazid and para-aminosalicylic acid is of extreme value in the eradication of draining sinuses and in the advancement of the ideal surgical date; but general physical and mental hygiene, rest and the prevention[ncbi.nlm.nih.gov]
  • In TB spondylitis, early diagnosis and treatment should aim to minimize deformity and prevent paraplegia.[ncbi.nlm.nih.gov]

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