Extra spinal bone tuberculosis: report of 19 cases
Pan African Medical Journal - Conference Proceedings. 2017:4(142).05
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Keywords: Extraspinal, tuberculosis, bone, infection
Extraspinal bone tuberculosis: report of 19 cases
Rym Abid1, Najeh Boussetta1, Habiba Naija2,&, Salim Asli2, Mohamed Ben Moussa2, Riadh Battikh1, Salah Othmani1
1Internal Medicine Department of the Military Hospital of Tunis, Tunisia, 2Department of Microbiology, the Military Hospital of Tunis, Tunisia
Habiba Naija, Department of Microbiology, the Military Hospital of Tunis, Tunisia
Introduction: extra-pulmonary tuberculosis (TB) is increasingly frequent. Extraspinal bone infection is often misleading with clinical features depending on the affected joint/Bone. The aim of the present work was to describe clinical, diagnostic, therapeutic and evolutionary aspects of extra spinal bone TB according to an internal medicine department's experience.
Methods: retrospective study, conducted from January 2000 to January 2016 in the internal medicine department of the Military Hospital of Tunis, Tunisia. We included patients with peripheral osteoarticular tuberculosis. The diagnosis was either confirmed on histological or bacteriological findings or retained based on presumptive arguments. Nineteen patients met the inclusion criteria: 7 men and 12 women. The average age was 40 years (ranging between 15 to 77 years). Eight patients had history of diabetes mellitus. Tuberculosis contagion was found in 7 cases and personal history of tuberculosis in 3 cases. The majority of patients (82%) were from rural areas. The average consultation delay was at 5 months. The onset of symptoms was progressive in almost all cases (96.3%). Signs of tuberculous impregnation were noted in 65% of cases. Clinical signs were dominated by pain: it was inflammatory or mixed in most cases (96%). Tuberculous localizations were represented by sacroiliac joints in first place with (10 cases) then knee in 3 cases and ankles and sacrum in 2 cases each. Iliac bone, clavicle, sternum and shoulder were affected in one case each. Six patients had an associated extra bone damage.
Results: the TST (Tuberculin Skin Test) was performed in all patients and was found to be positive only in 64% of cases. Imaging CT and/or MRI was pathological in all cases. The diagnosis was confirmed in 11 patients by histological examination and in 2 patients by bacteriology (isolation of BK on direct examination in 1 case and culture in other case). All patients received TB treatment for a median of 14 months. The outcome was always favorable.
Conclusion: extraspinal localization osteoarticular TB is an insidious disease. An early diagnosis and care are crucially needed to prevent serious complications. Medical treatment remains effective to date.