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Tuan HX, Huyen NT, Hung ND, Anh NTH, Duc NM. Imaging features of shoulder tuberculosis with rice bodies formation: A case report. Radiol Case Rep 2024; 19:1608-1613. [PMID: 38333900 PMCID: PMC10850118 DOI: 10.1016/j.radcr.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Osteoarticular tuberculosis is less common than pulmonary tuberculosis and is often overlooked in the differential diagnosis of people with joint disease. In this article, we present a case of a 71-year-old female patient admitted to the hospital because of pain and limited movement of her right shoulder for a year. The patient had diabetes for 10 years, and no history of tuberculosis or previous history of tuberculosis exposure. Blood test results showed inflammatory condition and positive IGRA test. X-ray, ultrasound and magnetic resonance imaging images revealed osteolytic and sclerotic lesions of the humeral head, diffuse thickening of the synovial membrane, and loose bodies in the joint and bursa. The clinical diagnosis was tuberculous inflammatory osteoarthritis of the right shoulder. The patient underwent arthroscopy surgery to remove loose bodies and the inflamed portion of the synovium and send them to the pathology department. Histopathological examination of the loose bodies and synovial membrane revealed features suggestive of tuberculosis of the shoulder joint. Afterward, the patient was treated with antituberculosis drugs according to the guideline and rehabilitation exercises. After 3 months of treatment, the clinical symptoms were reduced, the pain rating was decreased and the range of motion was increased.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Radiology, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Nguyen-Thi Huyen
- Department of Radiology, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen-Thi Hai Anh
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
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2
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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024:10.1007/s00256-023-04556-5. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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3
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Dhodapkar MM, Patel T, Rubio DR. Imaging in spinal infections: Current status and future directions. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100275. [PMID: 37822347 PMCID: PMC10562850 DOI: 10.1016/j.xnsj.2023.100275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/27/2023] [Accepted: 09/02/2023] [Indexed: 10/13/2023]
Abstract
Imaging plays an important role in the diagnosis of spinal infections. Early diagnosis is paramount in the treatment of spinal infections and leads to improved outcomes. This article reviews the imaging and relevant clinical details of infections of the spine: pyogenic spondylodiscitis, tuberculous spondylodiscitis, septic facet arthritis, epidural abscess, and subdural abscess. Though radiographs can reveal subtle changes with infections, advanced imaging modalities have increased sensitivity to aid in early diagnosis. Magnetic resonance imaging (MRI) is emphasized given it is generally the most sensitive and specific advanced imaging modality. However, nuclear medicine imaging and computer tomography (CT) play a role diagnosis in cases where MRI is not available or contra-indicated. Additionally, CT is also important for image-guided biopsy to guide antimicrobial treatment.
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Affiliation(s)
- Meera M. Dhodapkar
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Tamanna Patel
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Daniel R. Rubio
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
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4
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Rahim Khan S, Ahmad A, Saqib M, Iftikhar M. Cervical Pott's Disease Presenting As Quadriplegia in a Young Patient: A Case Report. Cureus 2023; 15:e46949. [PMID: 38022183 PMCID: PMC10640701 DOI: 10.7759/cureus.46949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Cervical Pott's disease, a form of spinal tuberculosis (TB), is a significant concern in low- and middle-income countries (LMICs). Early detection and treatment are critical to preventing complications like vertebral collapse. Clinical and radiological features of cervical Pott's disease can resemble other spinal conditions, posing diagnostic challenges. We present a case of a 28-year-old female who initially presented with quadriplegia, cervical instability, and high-grade fever. Through multidisciplinary collaboration and prompt intervention, the patient was diagnosed with cord compression syndrome secondary to a cervical abscess and probable cervical Pott's disease. Anti-tuberculosis treatment (ATT) and steroids were initiated, leading to significant improvement in symptoms and disease resolution. In summary, this case underscores the diagnostic challenge of cervical Pott's disease and the importance of imaging in TB diagnosis in resource-limited settings. The positive treatment response emphasizes early intervention's significance.
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Affiliation(s)
- Sana Rahim Khan
- Department of Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Afaq Ahmad
- Department of Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Muhammad Saqib
- Department of Medicine, Khyber Teaching Hospital, Peshawar, PAK
- Department of Clinical Research, Kahuta Research Laboratory (KRL) Hospital, Islamabad, PAK
| | - Muhammad Iftikhar
- Department of Medicine, Khyber Teaching Hospital, Peshawar, PAK
- Department of Clinical Research, Kahuta Research Laboratory (KRL) Hospital, Islamabad, PAK
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5
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Brehm TT, Terhalle E. [Extrapulmonary tuberculosis]. Dtsch Med Wochenschr 2023; 148:1242-1249. [PMID: 37793616 DOI: 10.1055/a-1937-8186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Extrapulmonary tuberculosis (TB) presents unique diagnostic and therapeutic challenges. The site of involvement can vary widely, with common sites including the lymph nodes, pleura, skin, ear, nose and throat, genitourinary system, pericardium, gastrointestinal tract, bones and joints, and central nervous system. Clinical manifestations of extrapulmonary TB are diverse and often non-specific. Diagnosis is based on a combination of clinical suspicion, imaging, histopathology, and microbiology. Treatment of extrapulmonary TB generally follows similar principles to pulmonary TB, but the duration of treatment depends on the site of involvement and the extent of the disease. Increased awareness among healthcare providers is essential for the timely recognition and effective management of extrapulmonary TB cases.
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Sood A, Kashikar SV, Mishra GV, Parihar P, Khandelwal S, Suryadevara M, Manuja N, Saboo K, Batra N, Ahuja A. The Spectrum of Shoulder Pathologies on Magnetic Resonance Imaging: A Pictorial Review. Cureus 2023; 15:e44801. [PMID: 37809114 PMCID: PMC10558894 DOI: 10.7759/cureus.44801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.
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Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivali V Kashikar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishtha Manuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitish Batra
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhinav Ahuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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7
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Singh M, Jeyaraman M, Jeyaraman N, Jayakumar T, Iyengar KP, Jain VK. Mycobacterium Tuberculosis infection of the wrist joint: A current concepts review. J Clin Orthop Trauma 2023; 44:102257. [PMID: 37841656 PMCID: PMC10568419 DOI: 10.1016/j.jcot.2023.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/09/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023] Open
Abstract
Background Osteoarticular Tuberculosis (TB) of wrist joint is a rare, often misdiagnosed form of site affected by Mycobacterium Tuberculosis infection that can lead to severe disability and morbidity. This review aims to summarize the current literature on the diagnosis and management of Mycobacterium Tuberculosis infection of the wrist joint. Materials and methods A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted on PubMed, Google Scholar, and Web of Science databases from 1967 to 2022, excluding single case reports and correspondence articles. The keywords used for the search included 'Mycobacterium tuberculosis' 'osteoarticular' and 'wrist'. Clinical presentation, demographic details, complementary investigations undertaken, trends, and complications of different management interventions were recorded to generate this review. Results Osteoarticular Tuberculosis (TB) of the wrist joint accounts for fewer than 1% of all skeletal TB cases across a spectrum of age ranges. Magnetic Resonance Imaging (MRI) represents an excellent modality to reveal the extent of the disease at an early stage of the condition. Synovial fluid analysis has been recommended for microbiological diagnosis. Treatment options include anti-tubercular therapy (ATT), incision and drainage, debridement, synovectomy, and arthrodesis. Conclusion Early diagnosis and treatment of wrist tuberculosis is crucial for achieving good functional outcomes in patients with this uncommon condition. Polymerase Chain Reaction (PCR) and GeneXpert technology for the detection of Mycobacterium tuberculosis (MTB) have improved diagnostic accuracy in detecting MTB DNA and rifampicin resistance. Anti-Tubercular Therapy (ATT) regime remains a foundation pillar in the overall management of these patients with focused surgical interventions leading to improved clinical outcomes.
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Affiliation(s)
- Mohit Singh
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India
| | - Tarun Jayakumar
- Department of Orthopaedics, KIMS-Sunshine Hospital, Hyderabad, 500003, Telangana, India
| | | | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
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Barrached M, Tebbaa El Hassali A, Lachkar A, Abdeljaouad N, Yacoubi H. Tuberculosis of the Pubic Symphysis: A Case Report. Cureus 2023; 15:e44205. [PMID: 37767264 PMCID: PMC10521877 DOI: 10.7759/cureus.44205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Tuberculosis of the pubic symphysis is rare; the diagnosis is often difficult but guided by CT and confirmed by histopathological examination. We report the case of a 25-year-old female with no particular past medical history, presenting with pain at the level of the pubic symphysis. Clinical examination showed a small renitent mass and pain on palpation without inflammatory signs. Radiological investigation showed demineralization, lysis, and diastasis of the pubic symphysis with a cystic image in favor of tuberculosis. A biopsy followed by resection was performed, and histopathology confirmed the diagnosis. The patient received medical care for nine months using the 2RHZE/7RH protocol (rifampicin, isoniazid, pyrazinamide, ethambutol), with good results at follow-up. Bone lesions of the pubic symphysis may exceptionally reveal tuberculosis, and the positive diagnosis is based on a histopathological test.
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Affiliation(s)
- Mohammed Barrached
- Orthopedics and Traumatology, Mohammed VI University Hospital, Oujda, MAR
| | | | - Adnane Lachkar
- Orthopedics and Traumatology, Mohammed VI University Hospital, Oujda, MAR
| | - Najib Abdeljaouad
- Orthopedics and Traumatology, Mohammed VI University Hospital, Oujda, MAR
| | - Hicham Yacoubi
- Orthopedics and Traumatology, Mohammed VI University Hospital, Oujda, MAR
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El Farhaoui A, Batou Y, Benalia K, Lachkar A, abdeljaouad N, Yacoubi H. Tuberculosis of navicular bone: An exceptional localization of osteoarticular tuberculosis. Radiol Case Rep 2023; 18:1989-1992. [PMID: 36994220 PMCID: PMC10040447 DOI: 10.1016/j.radcr.2023.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 03/28/2023] Open
Abstract
Osteoarticular tuberculosis (OAT) is defined by the set of pathological manifestations secondary to the attacks of osteoarticular structures of the locomotor system by the Bacillus of Koch (BK). We report a case of tuberculosis of the navicular bone, which is a rare location of OAT, on a female patient who consulted for chronic pain (mixed appearance) evolving for more than 7 years and for whom we realized a radiological assessment based on standard radiography and magnetic resonance imaging and a biological assessment. The foot is rarely involved, accounting for about 10% of cases of osteoarticular tuberculosis. The diagnosis is often made at a late stage because osteoarticular tuberculosis is paucibacillary, and it is difficult to isolate or culture Koch's bacillus. Clinical manifestations are aspecific; pain and joint swelling are the 2 usual signs. Pain may be mechanical, inflammatory, or mixed. The standard radiography allows first to orient the diagnosis by the demonstration of a lytic process; a biological inflammatory syndrome and the magnetic resonance imaging allow to give more arguments in favor, then the biopsy comes to confirm the diagnosis. Tuberculosis of the navicular bone is a rare localization of OAT; its diagnosis is the same as well as the treatment.
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Affiliation(s)
- Amine El Farhaoui
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
- Corresponding author.
| | - Yassin Batou
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Kamal Benalia
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Adnane Lachkar
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Najib abdeljaouad
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Hicham Yacoubi
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
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10
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Rastogi A, Saini U, Jude E. Ankle Charcot Mimics: Tubercular Rheumatism to Complex Regional Pain Syndrome. J Am Podiatr Med Assoc 2022; 112:21-122. [PMID: 36525329 DOI: 10.7547/21-122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Charcot Foot is often misdiagnosed because of its varied presentation that mimics other common disorders including tubercular rheumatism, complex regional pain syndrome or gout. We present a case of ankle swelling and discuss the differential diagnosis, radiological findings, and management. We also discuss the approach to diagnosis and provide differences in clinical presentations, magnetic resonance imaging,and bone scan findings for various differentials considered for Charcot foot.
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Affiliation(s)
- Ashu Rastogi
- *Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uttam Saini
- *Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Edward Jude
- †Tameside and Glossop Integrated Care NHS Foundation Trust, University of Manchester, United Kingdom
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11
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Tian Q, Na L, Cao S, Tian Z, Guo Z. Clinical features and surgical management of tuberculous arthritis of the sacroiliac joint: a retrospective analysis of 33 patients. BMC Surg 2022; 22:322. [PMID: 35996098 PMCID: PMC9396852 DOI: 10.1186/s12893-022-01759-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background We reviewed 3 different types of tuberculous sacroiliitis via anterior and posterior approaches to determine the efficacy and safety of this surgical approach by describing clinical presentation, imaging, and surgical treatment. Methods We reviewed 33 patients with 3 different types of severe tuberculous sacroiliitis, of which 16 patients with anterior iliac abscess underwent anterior debridement. 17 patients underwent posterior debridement. Among them, 5 patients with lumbar tuberculosis underwent lesion debridement through fenestration, joint fusion, and interbody fusion and internal fixation. The mean postoperative follow-up was 16.9 months (12–25 months).Erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to judge the postoperative condition and functional recovery.
Results All patients’ hip, back and lower back pain symptoms were significantly relieved after surgical treatment. At 3 months after operation, the VAS and ODI scores of all patients decreased significantly. Conclusion Surgical treatment of tuberculous sacroiliitis should be performed as soon as possible under the adjuvant chemotherapy of anti-tuberculosis drugs. According to the different characteristics of sacroiliac joint tuberculosis, appropriate surgical operations should be adopted according to our classification criteria.
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Affiliation(s)
- Qi Tian
- Xi'an Ninth Hospital, Xi'an, China.
| | - Linhao Na
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
| | - Shicong Cao
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
| | - Zheng Tian
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
| | - Zheng Guo
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
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12
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He G, Chen CY, Zhang X, Ding PP, Hu CZ, Huang XF, Zhang X, Gong X, Zhen PL, Zhang L. Clinical performance of quantitative PCR for the molecular identification of skeletal tuberculosis from formalin-fixed paraffin-embedded tissues. BMC Infect Dis 2022; 22:651. [PMID: 35902828 PMCID: PMC9331151 DOI: 10.1186/s12879-022-07641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background At present, skeletal tuberculosis (TB) diagnosis is mostly by histopathology, but the positivity rate is low. There is a need to develop new methods for the molecular identification of this disorder. Therefore, we aimed to investigate the clinical utility of quantitative PCR (qPCR)-based diagnosis of skeletal TB from formalin-fixed paraffin-embedded (FFPE) tissues and its comparative evaluation with acid-fast bacillus staining (AFS). Methods We detected Mycobacterium tuberculosis (M. tuberculosis/MTB) DNA using qPCR and AFS in FFPE tissue samples from 129 patients suspected of having skeletal TB. The sensitivity, specificity as well as area under the curve (AUC) of qPCR and AFS were calculated. Meanwhile, some factors potentially affecting qPCR and AFS results were investigated. Results Overall, qPCR outperformed AFS in detecting M. tuberculosis. The AUC of qPCR was higher than that of AFS (0.744 vs.0.561, p < 0.001). Furthermore, decalcification of bone tissues did not affect the sensitivity and specificity of qPCR tests. Whereas it impacted the performance of AFS, decalcification increased AFS's specificity and decreased its sensitivity (p < 0.05). Moreover, qPCR had a significantly larger AUC than AFS in decalcified and non-decalcified groups (0.735/0.756 vs. 0.582/0.534, p < 0.001) respectively. Similarly, the AUC of PCR was more extensive than that of AFS regardless of skeletal TB patients with concomitant pulmonary TB or not (0.929 vs. 0.762; 0.688 vs. 0.524, p < 0.01). Conclusions Our data demonstrate that qPCR offers superior accuracy for the detection of mycobacteria in FFPE tissues compared to traditional AFS, indicating its clinical value in osteoarticular TB diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07641-7.
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Affiliation(s)
- Gang He
- Department of Infection, Jiangmen Central Hospital, Jiangmen, 529000, China
| | - Chun-Yu Chen
- Department of Infection, Guangdong Medical University, Zhanjiang, 524000, China
| | - Xin Zhang
- Department of Science and Education, Jiangmen Central Hospital, Jiangmen, 529000, Guangdong, China
| | - Pei-Pei Ding
- Department of Science and Education, Jiangmen Central Hospital, Jiangmen, 529000, Guangdong, China
| | - Chang-Zheng Hu
- Department of Science and Education, Jiangmen Central Hospital, Jiangmen, 529000, Guangdong, China
| | - Xiu-Fang Huang
- Department of Science and Education, Jiangmen Central Hospital, Jiangmen, 529000, Guangdong, China
| | - Xian Zhang
- Department of Infection, Guangdong Medical University, Zhanjiang, 524000, China
| | - Xu Gong
- Department of Infection, Guangdong Medical University, Zhanjiang, 524000, China
| | - Pei-Lin Zhen
- Department of Science and Education, Jiangmen Central Hospital, Jiangmen, 529000, Guangdong, China.
| | - Liang Zhang
- Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, China.
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Baykan AH, Sayiner HS, Aydin E, Koc M, Inan I, Erturk SM. Extrapulmonary tuberculosıs: an old but resurgent problem. Insights Imaging 2022; 13:39. [PMID: 35254534 PMCID: PMC8901940 DOI: 10.1186/s13244-022-01172-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) primarily affects the lungs, but some of its most devastating clinical consequences arise because of its ability to spread from the lungs to other organs. Extrapulmonary TB (EPTB) constitutes 15–20% of all TB cases. Imaging findings are not always specific and can mimic many diseases; therefore, EPTB should be considered in the differential diagnosis, particularly in patients with immune system disorders (AIDS, patients receiving chemotherapy, etc.) and those in other high-risk groups including people with diabetes. The bacterium's passage to the regional lymph nodes is essential for developing a protective T-cell-mediated immune response, but the bacterium can spread hematologically and via the lymphatic system, leading to extrapulmonary involvement. Diagnosis of EPTB in high-risk patients is made based on suspected clinical and radiological findings, but further positive culture and histopathological confirmation may be required in some instances. Radiological evaluations are critical for diagnosis and crucial in planning the treatment and follow-up. This paper aims to review the typical and atypical imaging features and the differential diagnosis of EPTB.
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14
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Yan YY, Dous YNB, Ouellette HA, Munk PL, Murray N, Mallinson PI, Sheikh MA. Periarticular calcifications. Skeletal Radiol 2022; 51:451-475. [PMID: 34155550 DOI: 10.1007/s00256-021-03842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
Periarticular calcification and ossification is a frequent finding on imaging and may sometimes pose a diagnostic challenge. The differential diagnoses for this radiological finding are wide and can be classified into broad groups such as idiopathic, developmental, trauma, burns, infection, tumor, connective tissue disease, crystalline, metabolic, vascular, and foreign bodies. With careful consideration of the clinical and imaging findings as well as awareness of mimickers of periarticular mineralization, the list of differential diagnoses can be narrowed down. This article aims to review the clinical-radiologic findings of periarticular calcified or ossified lesions with relevant imaging illustrations.
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Affiliation(s)
- Y Y Yan
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. .,Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - Y N Bin Dous
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - H A Ouellette
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - P L Munk
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - N Murray
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - P I Mallinson
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - M A Sheikh
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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15
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Royle LN, Muthee BW, Rosenbaum DG. Inflammatory conditions of the pediatric hand and non-inflammatory mimics. Pediatr Radiol 2022; 52:104-121. [PMID: 34415360 DOI: 10.1007/s00247-021-05162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Hand involvement can assume an outsized role in the perception and presentation of disease as a result of functional impairment, visual conspicuity and susceptibility to early structural damage. Rheumatologic referral for inflammatory conditions can be delayed because of assumptions of a traumatic, infectious or neoplastic etiology; conversely, initial rheumatologic evaluation might be pursued for many of the same non-inflammatory causes. This pictorial essay highlights inflammatory conditions affecting the pediatric hand, including juvenile idiopathic arthritis, infectious arthritis, systemic connective tissue disorders, and a variety of less common inflammatory diseases, as well as non-inflammatory congenital, vascular, neoplastic and metabolic differential considerations.
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Affiliation(s)
- Leanne N Royle
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Bernadette W Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Daniel G Rosenbaum
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.
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16
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Bone and Joint Infections: The Role of Imaging in Tailoring Diagnosis to Improve Patients' Care. J Pers Med 2021; 11:jpm11121317. [PMID: 34945789 PMCID: PMC8709091 DOI: 10.3390/jpm11121317] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Imaging is needed for the diagnosis of bone and joint infections, determining the severity and extent of disease, planning biopsy, and monitoring the response to treatment. Some radiological features are pathognomonic of bone and joint infections for each modality used. However, imaging diagnosis of these infections is challenging because of several overlaps with non-infectious etiologies. Interventional radiology is generally needed to verify the diagnosis and to identify the microorganism involved in the infectious process through imaging-guided biopsy. This narrative review aims to summarize the radiological features of the commonest orthopedic infections, the indications and the limits of different modalities in the diagnostic strategy as well as to outline recent findings that may facilitate diagnosis.
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17
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Ayele BA, Wako A, Tadesse J, Gulelat H, Ibrahim R, Molla S, Bati A. Pott's paraplegia and role of neuroimaging in resource limited setting: A case report and brief review of the literatures. J Clin Tuberc Other Mycobact Dis 2021; 25:100283. [PMID: 34729422 PMCID: PMC8546414 DOI: 10.1016/j.jctube.2021.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of morbidity and mortality in low and middle income countries (LMIC). Approximately 50% of cases of skeletal TB involve the spine. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. The clinical and radiologic features of Pott's disease may mimic other spine diseases such as, metastatic lesions and other infectious etiologies, this is especially imperative in older patients. CASE REPORT We report a 60-year-old right handed male patient presented with back pain, paraparesis, and sensory symptoms 2 weeks duration. He has history of dry cough, fatigue, and reduced appetite, but no history of weight loss, fever, night sweat, and bowel/bladder incontinence. No contact history with TB patients. He has a borderline hypertension and diabetes mellitus. Serology for HIV was negative. Thoraco-lumbar magnetic resonance image (MRI) showed destruction of L2 and L3 vertebral body and the inter-vertebral disc; with T2 hyper and T1 hypointensity of the affected vertebral bodies. Probable tuberculous spondylitis with paraparesis was considered and the patient was initiated on antituberculous regimen and short course steroid therapy. After five months treatment, the patient showed significant clinical and radiological improvement. CONCLUSION In summary, the present case describes, a patient with Pott's paraplegia due to probable spine tuberculosis and showed significant clinical and radiological improvement following initiation of antituberculous drugs and short course of steroid; indicating the crucial role of imaging in the diagnosis of TB, especially in resource limited settings.
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Affiliation(s)
- Biniyam A. Ayele
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Jarso Tadesse
- School of Medicine, Dilla University, Dilla, Ethiopia
| | | | - Riyad Ibrahim
- School of Medicine, Wolkite University, Wolkite, Ethiopia
| | - Sisay Molla
- Department of Internal Medicine, Haramaya University, Harar, Ethiopia
| | - Abdi Bati
- Medicine and Hepatology and Gastroenterology ALERT Hospital, Addis Ababa, Ethiopia
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18
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Feiler S, Fuhrmann RA, Gattenlöhner S, Sommer F. Tuberculosis of the Ankle in a Non-immunocompromised Male: A Case Report and Review of the Literature. J Foot Ankle Surg 2021; 59:1294-1300. [PMID: 32962924 DOI: 10.1053/j.jfas.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/26/2020] [Accepted: 08/09/2020] [Indexed: 02/03/2023]
Abstract
The prevalence and incidence of tuberculosis has declined rapidly in Western Europe during the last century, although a slight increase is being seen due to immigration from countries where tuberculosis is still a common disease. We present a very rare case of primary ankle tuberculosis in a 51-year-old native German male without any risk factors or prior lung manifestation. A delay in diagnosis and treatment when a patient presents with ankle arthritis caused by Mycobacterium tuberculosis should make one aware of the possibility of primary joint tuberculosis, which is extremely unusual and it can mimic various other joint diseases. If the diagnosis is in doubt, early biopsy should be mandatory.
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Affiliation(s)
- Stefan Feiler
- Foot and Ankle Surgeon, Private Practice for Orthopedic Surgery, Schweinfurt, Germany.
| | - Renée A Fuhrmann
- Head of Department, Campus Bad Neustadt, Department of Foot- and Ankle-Surgery, Bad Neustadt, Germany
| | - Stefan Gattenlöhner
- Professor, University Hospital Giessen and Marburg, Department of Pathology, Giessen, Germany
| | - Frank Sommer
- Assistant Professor, University Hospital Giessen and Marburg, Department of Microbiology, Marburg, Germany
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19
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Upadhyaya GK, Kumar A, Iyengar KP, Agarwal A, Jain VK. Current concepts in the diagnosis and management of tuberculosis of the elbow joint. J Clin Orthop Trauma 2021; 19:200-208. [PMID: 34150492 PMCID: PMC8185235 DOI: 10.1016/j.jcot.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Elbow is an uncommon joint to be affected by Mycobacterium tuberculosis infection. It is involved in approximately 1-5% of all cases with musculoskeletal tuberculosis (TB). Early diagnosis of TB of the elbow joint can be easily missed due to an indolent natural history, delay in presentation, and varied clinical features. Delay in diagnosis can lead to irreversible osteoarticular destruction and loss of joint function. Careful clinical assessment, adequate imaging, microbiological, and/or histopathological confirmation of Mycobacterium tuberculosis infection is essential for early diagnosis of TB of the elbow joint. Judicious and early administration of anti-tubercular therapy can lead to preservation of the joint and a satisfactory functional outcome. Surgical intervention may be needed in later stages of the disease to achieve control of the infection, correction of deformity, instability, and restoration of function.
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Affiliation(s)
- Gaurav Kumar Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India
| | - Amit Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India,All India Institute of Medical Sciences, Raebareli, UP, India
| | | | - Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Science, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
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20
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Busch MH, Aendekerk JP, Oude Lashof AML, van Paassen P. Spondylitis as a Rare Manifestation of Granulomatosis With Polyangiitis. Arthritis Rheumatol 2020; 73:294. [PMID: 33331086 PMCID: PMC7898716 DOI: 10.1002/art.41565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Matthias H Busch
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joop P Aendekerk
- Maastricht University Medical Center, Maastricht, The Netherlands
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21
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Sathish M, Eswar R. Trending Literature in Spinal Tuberculosis: Bibliographic Analysis of Top 250 Cited Articles. Int J Spine Surg 2020; 14:838-846. [PMID: 33097581 PMCID: PMC7671453 DOI: 10.14444/7119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This bibliographic analysis aims to identify the top 250 cited articles on spinal tuberculosis (TB) and report on their impact on the spinal field. METHODS All databases included in the Thomson Reuters Web of Science were searched for publications on spinal TB. The most cited articles published between 1950 and 2019, with the main focus on orthopaedic surgery, were identified using a multistep approach, and a total of 250 articles were included and analyzed for title, year of publication, total citations, citations in 2019, citation density, article age, journal, first author, senior author, geographic origin, and level of evidence. RESULTS The number of citations ranged from 31 to 257, with an average of 65.38. Studies were published from 31 different countries and published in 83 different journals. The top 3 countries, India, United States, and China published a total of 57.8% (n = 145) of all articles. Indian and Chinese researchers seem to be the most resourceful, as 17 of the 31 (54.8%) prospective studies were conducted by them. African centers produced only 3.2% (n = 8) of all included articles. Only 3.2% (n = 8) were of Level 1 evidence on the subject. A total of 37.8% (n = 95) were on diagnosis, while 46.6% (n = 117) dealt with surgery, and only 15.1% (n = 38) were about conservative management. Anil K Jain followed by S Rajasekaran were the most published authors on the subject. CONCLUSIONS Indian and Chinese researchers dominate evidence in spinal TB. Regions with high disease burden, such as Africa, do not contribute their data to the literature. Though these are the top cited articles in the subject, their level of evidence needs improvement for better impact of their results.
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Affiliation(s)
- Muthu Sathish
- Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India
- Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India
| | - Ramakrishnan Eswar
- Institute of Orthopaedics and Traumatology, Madras Medical College & Rajiv Gandhi Government General Hospital, Chennai, India
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22
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Ali HM, Shoshan HMA. Multifocal primary musculoskeletal tuberculosis in nonimmunocompromised patient from nonendemic area. BJR Case Rep 2020; 6:20190077. [PMID: 33029366 PMCID: PMC7526995 DOI: 10.1259/bjrcr.20190077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/27/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022] Open
Abstract
Iliopsoas primary tuberculous abscess is a rare clinical and imaging entity. Most reported imaging literature cases are secondary to tuberculous spondylodiscitis. Iliopsoas tuberculous inflammation and abscess constitutes a diagnostic challenge owing to its insidious onset and subtle non-specific symptoms. Here, in a case of right iliopsoas and thigh primary tuberculosis abscess complicated with right iliac bone osteomyelitis extended to the right hip joint. The conventional radiography, thigh and pelvic ultrasonography, MRI and CT examinations showed the whole right iliopsoas and thigh abscess compartments and right iliac bone osteomyelitis. No defined other pulmonary or abdominal tuberculous lesions. Percutaneous drainage of the thigh compartment under ultrasound guidance and microbiologic culture of the drained fluid elicited mycobacterium tuberculosis.
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23
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Multimodal imaging of Spina Ventosa (TB Dactylitis) of the foot. Radiol Case Rep 2020; 15:1373-1376. [PMID: 32636976 PMCID: PMC7327125 DOI: 10.1016/j.radcr.2020.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/22/2022] Open
Abstract
We present the case of a 29-year-old male healthcare worker with a 6 month history of progressive left foot pain resulting in presentation to the emergency department on 3 occasions. He denied systemic symptoms. Multimodal imaging demonstrated an expansile erosive inflammatory lesion centered on the neck of the second metatarsal with aggressive features. CT of the thorax, abdomen, and pelvis demonstrated calcified mediastinal lymph nodes and left inguinal adenopathy. The lesion was biopsied under ultrasound guidance demonstrating a necrotizing granulomatous osteomyelitis with acid fact bacilli. This is consistent with TB dactylitis (spina ventosa). Treatment with antimycobacterial drugs was commenced.
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24
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Wu W, Li Z, Lin R, Zhang H, Lin J. Anterior debridement, decompression, fusion and instrumentation for lower cervical spine tuberculosis. J Orthop Sci 2020; 25:400-404. [PMID: 31262450 DOI: 10.1016/j.jos.2019.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Antituberculosis chemotherapy have been widely used for lower cervical spine tuberculosis and brought out favorable outcomes. However, the contribution of surgical treatment is not well investigated yet. Therefore, this study aimed to evaluate the clinical efficacy and feasibility of surgical treatment for lower cervical spine tuberculosis by anterior debridement, decompression, fusion and instrumentation. METHODS From April 2011 to July 2016, 17 patients (9 males and 8 females, average age, 45.7 ± 16.8 years) with lower cervical spine tuberculosis (C4-C7) underwent anterior debridement, decompression, fusion and instrumentation. Frankel grading and visual analogue scale were used to assess neurological function and neck pain, respectively. Operating time, blood loss, erythrocyte sedimentation rate, C-reactive protein, kyphosis angle and postoperative complications were used to evaluate the clinical outcomes of surgery. RESULTS The surgery duration time range from 78 to 322 min (average 136.2 ± 61.1 min) and the blood loss range from 50 to 500 ml (average 127.7 ± 110.9 ml). Kyphosis angle was 10.8 ± 11.8°on average preoperative and returned to -6.3 ± 10.4° postoperative (P < 0.001, t = 12.3) and remained -4.4 ± 9.9°at final follow-up (P < 0.001, t = 11.8). The average preoperative and final follow-up visual analogue scale scores were 4.6 ± 1.3 and 0.6 ± 0.5 respectively (P < 0.001, t = 13.5). The erythrocyte sedimentation rate and C-reactive protein decreased gradually postoperative and returned to normal at final follow-up. No postoperative severe complications and no recurrence of tuberculosis occurred in all cases and neurologic function was improved in various degrees. CONCLUSION Anterior debridement, decompression, fusion and instrumentation could serve as an effective treatment in the management of the lower cervical spine tuberculosis.
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Affiliation(s)
- Wence Wu
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Zhechen Li
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Renqin Lin
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Hongjie Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Jianhua Lin
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China.
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25
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Hamard A, Burns R, Miquel A, Sverzut JM, Chicheportiche V, Wybier M, Bousson V. Dactylitis: A pictorial review of key symptoms. Diagn Interv Imaging 2020; 101:193-207. [PMID: 32001209 DOI: 10.1016/j.diii.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/21/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Dactylitis refers to a global swelling of a finger or a toe giving it a clinical sausage-shape presentation. It is an extremely suggestive symptom as it guides the rheumatologist towards a shortlist of diagnoses. However, radiologists are less familiar with dactylitis. The aim of this review is to detail and illustrate the main causes of dactylitis using standard X-ray imaging, ultrasound, computed tomography and magnetic resonance imaging in order to make radiologists more familiar with this symptom by illustrating the various conditions that are associated with dactylitis including infection, peripheral spondyloarthritis, sarcoidosis, microcrystalline deposition, osteoid osteoma, and sickle cell disease.
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Affiliation(s)
- A Hamard
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France; Department of Radiology, EA 2415, Medical Imaging Group, Nimes University Hospital, 30029 Nîmes, France.
| | - R Burns
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - A Miquel
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - J M Sverzut
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - V Chicheportiche
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - M Wybier
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - V Bousson
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France; Université de Paris, Diderot Paris 7, B30A CNRS UMR 7052, 75010 Paris, France
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26
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Diagnosis and treatment of tuberculosis of the foot and ankle-A literature review. Foot (Edinb) 2018; 37:105-112. [PMID: 30359882 DOI: 10.1016/j.foot.2018.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/04/2023]
Abstract
Foot osteoarticular tuberculosis is uncommon. Late diagnosis and sub-optimal management can lead to significant morbidity, deformity and even death. Preservation of life, limb and function can be achieved with prompt diagnosis and treatment. In 1882, Robert Koch published his discovery of mycobacterium tuberculosis as the causative agent of tuberculosis (TB), and showed the disease was infectious rather than inherited. Over two centuries later, TB remains one of the top 10 causes of death worldwide. Whilst in 90% of cases TB infects the respiratory system, in 10% it is extrapulmonary and can infect the skeletal, nervous, lymphatic and genitourinary systems. The spine is the most frequently affected site in the musculoskeletal system and this is known as Pott's disease. The foot and ankle is affected in only 0.13% cases of extrapulmonary TB. A high index of suspicion is thus required. This infrequency in incidence, heterogeneity of its presentation along with the difficulty in early diagnosis often causes significant delays in its treatment and hence results in a considerable disability. The medical treatment is well established but the role of surgery, its usefulness and its correct timing remain controversial. The main diagnostic issues include imaging being non-specific. Plain radiographs remain the first line imaging modality. MRI and CT scans provide greater detail and capture the disease at an earlier stage. Microbiological testing has low sensitivity and specificity becasue TB lesions are paucibacillary. Bone biopsy is of significant diagnostic value as it not only allows histological examination to detect granulomas but enables sensitivity and resistance testing of anti-tuberculous therapy (ATT). Issues relating to treatment include timing, duration, combination of chemotherapy and the challenge of multi drug resistant tuberculosis MDR-TB. The selection and timing of appropriate surgical techniques and optimal duration of follow-up are further points to consider. In this article we aim to review the literature on diagnosis and treatment of foot and ankle TB.
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27
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Tuberculous Distal Biceps Tendon Rupture: Case Report and Review of the Literature. Case Rep Orthop 2018; 2018:6374784. [PMID: 30498614 PMCID: PMC6222221 DOI: 10.1155/2018/6374784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/16/2018] [Indexed: 12/05/2022] Open
Abstract
Tuberculous distal biceps tendon rupture is a rare condition in orthopedics. Musculoskeletal tuberculosis usually presents with bursitis, synovitis, myositis, and osteomyelitis, conditions which demonstrate an excellent response to antituberculosis chemotherapy. Tendon rupture is often associated with delayed diagnosis and treatment. We report a rare manifestation of musculoskeletal tuberculosis in the distal biceps tendon with delayed diagnosis.
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28
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Goh JLK, Chong CY, Lim SZR, Lim KBL, Tan NWH. A Case of Tuberculosis Spondylodiscitis With Paraspinal Abscess in a 2-Year-Old Child. Glob Pediatr Health 2018; 5:2333794X18805614. [PMID: 30349870 PMCID: PMC6195007 DOI: 10.1177/2333794x18805614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/16/2018] [Accepted: 08/25/2018] [Indexed: 11/16/2022] Open
Abstract
In this article, we report a case of tuberculosis spondylodiscitis in a 2-year-old child. Imaging of her spine showed a paraspinal abscess. The diagnosis of spinal tuberculosis remains difficult, and we discuss its salient features and current management within the pediatric population.
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Affiliation(s)
| | - Chia Yin Chong
- KK Women's and Children's Hospital, Singapore, Singapore.,National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore
| | | | - Kevin Boon Leong Lim
- KK Women's and Children's Hospital, Singapore, Singapore.,National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore
| | - Natalie Woon Hui Tan
- KK Women's and Children's Hospital, Singapore, Singapore.,National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore.,Nanyang Technological University, Singapore, Singapore
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29
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The spectrum of tuberculosis of the spine in pediatric age group: a review. Childs Nerv Syst 2018; 34:1937-1945. [PMID: 30006692 DOI: 10.1007/s00381-018-3891-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Pediatric spinal tuberculosis is characterized by rapid bone destruction and carries the risk of rapid onset neurological deficits and severe deformity of the spine. Behavior of spinal deformity over time is affected by growth of spine. Owing to this dynamic behavior of pediatric spinal tuberculosis both in active phase and in healed phase, it presents with challenges which are quite different from adults with caries spine. A clinician must have high index of suspicion for accurate and early diagnosis of spinal tuberculosis in the pediatric population and should also have a thorough knowledge of differences in natural history between adult and pediatric spinal tuberculosis. DISCUSSION This is based on the senior author's experience of dealing with tuberculosis of the spine in children over the last two decades. Recent advances in field of rapid diagnosis of tuberculosis based on nuclear material-related diagnostic tests have further improved the management of tuberculosis. At the same time, the basic treatment principles remain the same. However, the threshold for surgical vs conservative treatment have subtle differences when compared to adult population. The importance of long-term follow-up after treatment must be appreciated. CONCLUSION Tuberculosis in the spine in children needs early attention. Prompting to diagnostic and medical therapy measures can avoid neurological sequellae and delayed deformity.
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30
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Yin XH, He BR, Liu ZK, Hao DJ. The clinical outcomes and surgical strategy for cervical spine tuberculosis: A retrospective study in 78 cases. Medicine (Baltimore) 2018; 97:e11401. [PMID: 29979434 PMCID: PMC6076153 DOI: 10.1097/md.0000000000011401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 06/09/2018] [Indexed: 11/26/2022] Open
Abstract
Literature on the treatment of cervical spinal tuberculosis (CSTB) is uncommon, the surgical approaches to cervical spinal tuberculosis were controversial. The aim of the study was to evaluate the clinical outcomes of 3 surgical techniques in CSTB patients, and to determine the most appropriate approach for CSTB patients. Between April 2006 and June 2012, we performed a retrospective review of clinical and radiographic data that were collected from 850 consecutive spinal tubercular patients, including 87 patients who were diagnosed and treated for CSTB in our hospital. Apart from 9 patients being treated conservatively, the remainder (78 cases) underwent surgery by anterior debridement, interbody fusion and instrumentation (A group), posterior instrumentation and anterior debridement, fusion and instrumentation in a single or two-stage operation (AP group), or posterior debridement, fusion and posterior instrumentation (P group). The patients were evaluated preoperatively and postoperatively on the basis of hematologic, radiographic examinations, and neurologic function. The 78 patients were followed up for a mean duration of 41.2 ± 7.2 months (range, 24-65 months). Postoperatively, the preoperative erythrocyte sedimentation rate (ESR) value returned to normal within 3 to 6 months in all patients, and solid bone fusion was achieved in 3 to 8 months. The patients exhibited significant improvement in deformity and neurological deficit postoperatively, while the visual analog scale for pain showed significant improvement in all patients at the last follow up visit. The follow-up outcomes demonstrated that all 3 surgical methods were viable management options for CSTB. Individualized therapeutic strategies should be selected according to the patient's general condition, focal characteristics, and the surgeon's experience.
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Held M, Castelein S, Bruins MF, Laubscher M, Dunn R, Keel M, Ahmad S, Hoppe S. Most Influential Literature in Spinal Tuberculosis: A Global Disease Without Global Evidence. Global Spine J 2018; 8:84-94. [PMID: 29456919 PMCID: PMC5810894 DOI: 10.1177/2192568217707182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
STUDY DESIGN Bibliometric review of the literature. OBJECTIVE This bibliometric analysis aims to give an overview of the most influential academic literature written on spinal tuberculosis. METHODS All databases included in the Thomson Reuters Web of Knowledge were searched for the most influential publications in spinal tuberculosis. The most cited articles published between 1950 and 2015, with the main focus on orthopedic surgery, were identified using a multistep approach, and a total of 100 articles were included. The publications were then analyzed in this bibliometric analysis. RESULTS The number of citations ranged from 243 to 36, with an average of 77.11. The articles were published in 34 different journals, and the studies were conducted in 20 different countries. The top 3 countries, India, the United States, and China, published a total of 51% (n = 51) of all articles. Low-burden countries produced 60% (n = 60) of all articles in our list. African centers produced only 4% (n = 4) of all included articles. CONCLUSIONS Indian and Chinese researchers dominate evidence in spinal tuberculosis. Other areas with high disease burden, such as Africa, do not feature. Most publications are retrospective studies with a low level of evidence.
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Affiliation(s)
- Michael Held
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa,Michael Held, Orthopaedic Research Unit, Groote Schuur Hospital, University of Cape Town, 7925 Observatory, Cape Town, South Africa.
| | - Sophie Castelein
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Marie-Fien Bruins
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maritz Laubscher
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Robert Dunn
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Marius Keel
- Inselsspital, Universiry of Bern, Bern, Switzerland
| | - Sufian Ahmad
- Inselsspital, Universiry of Bern, Bern, Switzerland
| | - Sven Hoppe
- Inselsspital, Universiry of Bern, Bern, Switzerland
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Sacroiliac joint tuberculosis: surgical management by posterior open-window focal debridement and joint fusion. BMC Musculoskelet Disord 2017; 18:504. [PMID: 29187182 PMCID: PMC5708174 DOI: 10.1186/s12891-017-1866-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022] Open
Abstract
Background Sacroiliac joint tuberculosis(SJT) is relatively uncommon, but it may cause severe sacroiliac joint destruction and functional disorder. Few studies in the literature have been presented on SJT, reports of surgical treatment for SJT are even fewer. In this study, we retrospectively reviewed surgical management of patients with severe SJT of 3 different types and proposed to reveal the clinical manifestations and features and aim to determine the efficiency and security of such surgical treatment. Methods We reviewed 17 patients with severe SJT of 3 different types who underwent posterior open-window focal debridement and bone graft for joint fusion. Among them,five patients with anterior sacral abscess had anterior abscess curettage before debridement. Two patients with lumbar vertebral tuberculosis received one-stage posterior tuberculous debridement, interbody fusion and instrumentation. Follow-up was performed 36 months (26 to 45 months) using the following parameters: erythrocyte sedimentation rate(ESR), status of joint bony fusion on CT scan, visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Results Buttock pain and low back pain were progressively relieved with time. 6 months later, pain was not obvious, and ESR resumed to normal levels within 3 months. Solid fusion of the sacroiliac joint occurred within 12 months in all cases. No complications or recurrence occurred. At final follow-up, all patients had no pain or only minimal discomfort over the affected joint and almost complete functional recovery. Conclusions Posterior open-window focal debridement and joint fusion is an efficient and secure surgical method to treat severe SJT. If there is an abscess in the front of the sacroiliac joint, anterior abscess curettage should be performed as a supplement. Electronic supplementary material The online version of this article (10.1186/s12891-017-1866-9) contains supplementary material, which is available to authorized users.
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De Mulder P, Harth C, Ide L, Vallaeys J, Baelde N, De Bo T. An uncommon cause of sciatic pain: tuberculous osteomyelitis of the ischial tuberosity. Acta Clin Belg 2017; 72:357-360. [PMID: 28074705 DOI: 10.1080/17843286.2016.1271499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 66-year-old Caucasian female presented with insidious sciatic pain leading to an uncommon diagnosis of tuberculous osteomyelitis with unknown portal entry. The patient did not report a history of a previous tuberculosis (TB) infection and her chest X-ray was negative for TB. Considering TB in the differential diagnosis of a 'bone abscess', it is of paramount importance to come to a correct diagnosis. Conventional radiographs still remain the first-line imaging modality for evaluation of skeletal symptomatology. However, biopsies or aspirates are often needed to yield the definitive diagnosis. The lack of awareness of the potential extrapulmonary involvement of TB leads to an important delay in diagnosis and treatment. Antituberculous drugs should be started at the time of biopsy and continued during 12-18 months, due to poor drug penetration into osseous and fibrous tissues.
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Affiliation(s)
| | | | - Louis Ide
- Department of Microbiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Jurgen Vallaeys
- Department of Pathology, Jan Palfijn Hospital, Ghent, Belgium
| | - Nick Baelde
- Department of Radiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Thomas De Bo
- Department of Orthopaedic surgery, Jan Palfijn Hospital, Ghent, Belgium
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Osteoraticular Tuberculosis-Brief Review of Clinical Morphological and Therapeutic Profiles. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:171-190. [PMID: 30595874 PMCID: PMC6284841 DOI: 10.12865/chsj.43.03.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Abstract
Osteoarticular tuberculosis (OATB) is a rare form of tuberculosis (TB) whose incidence rose significantly nowadays especially in the underdeveloped countries. The main risk factors predisposing to this new challenge for the medical system are the Human Immunodeficiency Virus (HIV) epidemic, the migration from TB endemic areas and the development of drug and multidrug-resistant strains of Mycobacterium tuberculosis (Mt). The disease affects both genders and any age group although the distribution depending on gender is controversial and that depending on age has a bimodal pattern. In most cases the initial focus is elsewhere in the organism and the most frequent pathway of dissemination is lympho-haematogenous. The clinical picture includes local symptoms as pain, tenderness and limitation of motion, with some particularities depending on the segment of the osteoarticular system involved, sometimes accompanying systemic symptoms specific for TB and other specific clinical signs as cold abscesses and sinuses. The radiographic features are not specific, CT demonstrates abnormalities earlier than plain radiography and MRI is superior to plain radiographs in showing the extent of extraskeletal involvement. Both CT and MRI can be used in patient follow-up to evaluate responses to therapy. TBhas been reported in all bones of the body, the various sites including the spine (most often involved) and extraspinal sites (arthritis, osteomyelitis and tenosynovitis and bursitis). Two basic types of disease patterns could be present: the granular type (most often in adults) and the caseous exudative type (most often in children) one of which being predominant. The algorithm of diagnosis includes several steps of which detection of Mt is the gold standard. The actual treatment is primarily medical, consisting of antituberculosis chemotherapy (ATT), surgical interventions being warranted only for selected cases. It is essential that clinicians know and refresh their knowledge about manifestations of OATB.
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Pelletier-Galarneau M, Martineau P, Zuckier LS, Pham X, Lambert R, Turpin S. 18 F-FDG-PET/CT Imaging of Thoracic and Extrathoracic Tuberculosis in Children. Semin Nucl Med 2017; 47:304-318. [DOI: 10.1053/j.semnuclmed.2016.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Musculoskeletal tuberculosis (TB) accounts for approximately 10% of all extrapulmonary TB cases in the United States and is the third most common site of extrapulmonary TB after pleural and lymphatic disease. Vertebral involvement (tuberculous spondylitis, or Pott's disease) is the most common type of skeletal TB, accounting for about half of all cases of musculoskeletal TB. The presentation of musculoskeletal TB may be insidious over a long period and the diagnosis may be elusive and delayed, as TB may not be the initial consideration in the differential diagnosis. Concomitant pulmonary involvement may not be present, thus confusing the diagnosis even further. Early diagnosis of bone and joint disease is important to minimize the risk of deformity and enhance outcome. The introduction of newer imaging modalities, including MRI (imaging procedure of choice) and CT, has enhanced the diagnostic evaluation of patients with musculoskeletal TB and for directed biopsies of affected areas of the musculoskeletal system. Obtaining appropriate specimens for culture and other diagnostic tests is essential to establish a definitive diagnosis and recover M. tuberculosis for susceptibility testing. A total of 6 to 9 months of a rifampin-based regimen, like treatment of pulmonary TB, is recommended for the treatment of drug susceptible musculoskeletal disease. Randomized trials of tuberculous spondylitis have demonstrated that such regimens are efficacious. These data and those from the treatment of pulmonary TB have been extrapolated to form the basis of treatment regimen recommendations for other forms of musculoskeletal TB.
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Primary Tuberculous Pyomyositis of the Calf Muscles. Am J Med Sci 2017; 353:187-188. [PMID: 28183421 DOI: 10.1016/j.amjms.2016.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 01/26/2023]
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Affiliation(s)
- S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - L Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Abstract
The prevalence of tuberculosis (TB) has increased in developing and developed countries as a consequence of the AIDS epidemic, immigration, social deprivation, and inadequate TB control and screening programs. Spinal TB may be osseous or nonosseous. Classic findings of multiple contiguous vertebral body involvement, gibbus formation, and subligamentous spread with paravertebral abscesses are optimally evaluated with MR imaging. Nonspondylitic spinal TB is less well described in the literature, may develop in the absence of TB meningitis, and is often associated with meningovascular cord ischemia. Radiologists should be familiar with the spectrum of imaging findings, allowing early diagnosis and treatment of this serious condition.
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Lin CH, Huang CY. Extrapulmonary Tuberculosis on Chest X-rays. Intern Med 2016; 55:2517-8. [PMID: 27580562 DOI: 10.2169/internalmedicine.55.6447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Chou-Han Lin
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taiwan
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41
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Abstract
Predisposing factors for developing spinal infections include: immunodeficiency; drug abuse; the widespread use of broad-spectrum antibiotics, corticosteroids, and immunosuppressive drugs; diabetes mellitus; and spinal surgery. Infections can be bacterial, fungal, parasitic, or viral in origin. This chapter reviews current knowledge in clinical and imaging findings in the most common spinal infections divided according to the compartment primarily involved.
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Affiliation(s)
- Majda M Thurnher
- Department of Radiology, University Hospital Vienna, Vienna, Austria.
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Gbané-Koné M, Koné S, Ouali B, Djaha KJM, Akoli EO, Nseng IN, Eti E, Daboiko JC, Touré SA, Kouakou NM. [Osteo articular tuberculosis (Pott disease excluded): about 120 cases in Abidjan]. Pan Afr Med J 2015; 21:279. [PMID: 26587129 PMCID: PMC4634031 DOI: 10.11604/pamj.2015.21.279.6115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/23/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction La tuberculose ostéoarticulaire (TOA) représente 2 à 5% de l'ensemble des tuberculoses. Elle demeure d'actualité surtout dans les pays à forte endémicité tuberculeuse. L'objectif était de déterminer la prévalence, les aspects topographiques, radiologiques de la TOA en milieu hospitalier ivoirien. Méthodes Les auteurs rapportent une expérience de 11 ans, à travers une étude rétrospective de 120 dossiers de patients atteints de la tuberculose ostéoarticulaire (le mal de Pott est exclu de cette étude). N'ont pas été inclus dans l’étude les dossiers ne comportant pas d'imagerie. Résultats L'atteinte extra vertébrale représentait 09,2% de la tuberculose ostéoarticulaire. Il s'agissait de 54 hommes et 66 femmes, l’âge moyen était de 43,13 ans. On notait 123 cas d'ostéoarthrites, et 8 cas d'ostéites des os plats. L'atteinte des membres inférieurs prédominait dans 91,87% des cas. La hanche était la première localisation (45,04%), suivie du genou (25,19%). Les atteintes étaient multifocales dans 20% des cas. L'atteinte osseuse était associée à une tuberculose pulmonaire dans 05,83% des cas. Des localisations inhabituelles ont été rapportées: poignet (n = 2), branches ischiopubiennes (n = 4), atteinte sternoclaviculaire (n = 4), médiopieds (n = 2). Les lésions radiologiques étaient avancées (stades III et IV) dans 55,73% des cas. A la TDM, la prévalence des abcès était de 77%. Un geste chirurgical a été réalisé sur 16 articulations (2 épaules, 13 genoux, une cheville). Conclusion La TOA des membres est peu fréquente contrairement à l'atteinte vertébrale. La hanche est la principale localisation. Le retard au diagnostic explique l’étendue des lésions anatomoradiologiques.
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Affiliation(s)
| | - Samba Koné
- Service de Traumatologie -Orthopédie CHU Cocody, Abidjan, Cote d'Ivoire
| | - Boubacar Ouali
- Service de Rhumatologie CHU Cocody, Abidjan, Cote d'Ivoire
| | | | | | | | - Edmond Eti
- Service de Rhumatologie CHU Cocody, Abidjan, Cote d'Ivoire
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Prakash M, Gupta P, Sen RK, Sharma A, Khandelwal N. Magnetic resonance imaging evaluation of tubercular arthritis of the ankle and foot. Acta Radiol 2015; 56:1236-41. [PMID: 25332444 DOI: 10.1177/0284185114552882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/30/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ankle and foot tuberculosis is relatively uncommon. Magnetic resonance imaging (MRI) is highly sensitive in detecting the changes but there is limited experience with MRI evaluation and differentiation from other mono-articular arthritis, particularly pyogenic arthritis, is a challenge. PURPOSE To report MRI findings in ankle and foot tuberculosis. MATERIAL AND METHODS MRI was performed in 17 selected patients with ankle and foot tuberculosis. T1-weighted, proton density (PD) weighted, T2-weighted, and postcontrast sequences were performed in multiple imaging planes. Recorded findings included: number of bones involved; specific bones involved; extent of involvement; erosions; joint effusion, synovial thickening, tenosynovitis; joint effusion; adjacent soft-tissue changes; and involvement of sinus tarsi. Clinical data of all patients were also reviewed. Radiographic correlation at the time of MRI was available in selected patients. RESULTS The most common abnormality was synovial thickening. Signal abnormality was noted most frequently in the talus (n = 14). Erosions and intra-osseous abscesses were noted in 10 (58%) and eight (47%) patients, respectively. Tenosynovitis was present in eight (47%) patients. Soft tissue changes were noted in all patients, including abscesses in 13 patients (76%). CONCLUSION A multiplicity of findings (both osseous and extra-osseous) on MRI favors the diagnosis of tuberculosis. Three findings (intra-osseous abscess, soft tissue abscess, tenosynovitis), when present together, have a high sensitivity and specificity.
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Affiliation(s)
- Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramesh Kumar Sen
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Computed tomography detection of clinically unsuspected skeletal tuberculosis. Clin Imaging 2015; 39:1056-60. [PMID: 26338020 DOI: 10.1016/j.clinimag.2015.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 07/18/2015] [Accepted: 07/30/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report the frequency of clinically unsuspected axial skeletal tuberculosis (STB) and findings on computed tomography (CT). MATERIALS AND METHODS An evaluation of CT chest, abdomen, and pelvis of patients with tuberculosis was done. Bone window images were evaluated for skeletal involvement. RESULTS Of the 726 CT studies, 34 (4.7%) patients had skeletal involvement. Thoracic spine was the most commonly affected site with involvement of body in 58% cases. Intervertebral disc involvement, soft tissue abscess, and epidural extension were identified in 83%, 53%, and 39% of cases, respectively. CONCLUSION Evaluation of bone window on CT can detect axial STB.
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Prakash M, Gupta P, Dhillon MS, Sen RK, Khandelwal N. Magnetic resonance imaging findings in tubercular arthritis of elbow. Clin Imaging 2015; 40:114-8. [PMID: 26372351 DOI: 10.1016/j.clinimag.2015.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate magnetic resonance imaging (MRI) features of tubercular involvement of elbow joint. METHODS Fourteen patients with tubercular arthritis of elbow were evaluated. The following findings were recorded on MRI (n=12): bones involved; erosions, intraosseous abscesses, synovial thickening, and effusion; hypointensity within the thickened synovium on T2-weighted images; and periarticular soft tissue changes. RESULTS The common abnormalities on MRI were synovial thickening and bone erosions (n=12), soft tissue (n=9)/intraosseous (n=5) abscesses, and T2 hypointensity within the thickened synovium (n=5). CONCLUSIONS A diagnosis of elbow tuberculosis should be considered if there is a combination of findings involving bone and soft tissue.
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Affiliation(s)
- Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Mandeep Singh Dhillon
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ramesh Kumar Sen
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Abstract
Pediatric skeletal (extraspinal) tuberculosis may mimic pyogenic infections and bone tumors. The aim of this study was to show a multimodality approach to the correct diagnosis and to evaluate the long-term clinical and radiological results of curettage and antituberculosis treatment. Between 2004 and 2012, we treated eight children (five boys, three girls) with histologically proven solitary cystic tuberculosis of the proximal tibia and distal femur. The average age at presentation was 4 years (range, 2-6 years). Except for one case with metadiaphyseal involvement, all lesions were located in the metaphysis and crossed the physis in three. The patients were managed by curettage without bone grafting, followed by antituberculosis therapy. The average follow-up was 4 years (range, 2-7 years). All children achieved complete clinical and radiological healing without any residual lesion or recurrence. In three cases with epiphyseal involvement, the growth plate maintained its function and gradually remodeled within 24 months, without any deformity. No surgical complication was observed. The diagnosis of pediatric skeletal tuberculosis can be made with a good correlation of clinical, radiological, and histological findings. High healing rates can be achieved with surgical debridement and chemotherapy.
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Abstract
Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory. Considerable advances have occurred in diagnostic techniques in the recent decades resulting in better treatment outcomes in patients with infective arthritis. Detection of emerging arthritogenic viruses has changed the epidemiology of infection-related arthritis. The role of viruses in the pathogenesis of chronic inflammatory arthritides such as rheumatoid arthritis is increasingly being recognized. We discuss the various causative agents of infective arthritis and emphasize on the approach to each type of arthritis, highlighting the diagnostic tests, along with their statistical accuracy. Various investigations including newer methods such as nucleic acid amplification using polymerase chain reaction are discussed along with the pitfalls in interpreting the tests.
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Affiliation(s)
- Ashish Jacob Mathew
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
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Bayhan GI, Tanir G, Gayretli Aydın ZG, Yildiz YT. Miliary tuberculosis disease complicated by Pott's abscess in an infant: Seven year follow-up. Lung India 2015; 32:258-61. [PMID: 25983412 PMCID: PMC4429388 DOI: 10.4103/0970-2113.156246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 20-month-old boy presented with 1-year history of persistent fever, cough, and progressive abdominal distention. Abdominal ultrasonography showed hepatomegaly and multiple calcifications in the liver and spleen. Thoracic computed tomography showed multiple mediastinal lymph nodes and consolidation in both lungs. Additionally, there was a 2-cm thick retroperitoneal soft tissue mass destroying the T7-8 and L1-L2 vertebral bodies. The patient was preliminarily diagnosed with miliary tuberculosis (TB) and Pott's disease, and began administering anti-TB treatment consisting of isoniazid, rifampin, ethambutol, and pyrazinamide. Acid-resistant bacilli analysis and mycobacterial culture of the biopsy specimen of Pott's abscess were positive. Mycobacterial culture and PCR of gastric aspirate were also positive. The patient's condition progressively improved with anti-TB treatment and he received 12 months of antiTB therapy. At the end of the treatment all of the patient's symptoms were relieved and he was well except for kyphosis. Miliary TB complicated by Pott's abscess is a very rare presentation of childhood TB. The presented case shows that when Pott's abscess is diagnosed and surgically corrected without delay, patients can recover without squeal.
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Affiliation(s)
- Gulsum Iclal Bayhan
- Department of Pediatric Infectious Disease, Dr. Sami Ulus Maternity and Children's Health Education and Research Hospital, Ankara, Turkey
| | - Gonul Tanir
- Department of Pediatric Infectious Disease, Dr. Sami Ulus Maternity and Children's Health Education and Research Hospital, Ankara, Turkey
| | - Zeynep Gokce Gayretli Aydın
- Department of Pediatric Infectious Disease, Dr. Sami Ulus Maternity and Children's Health Education and Research Hospital, Ankara, Turkey
| | - Yasemin Tasci Yildiz
- Department of Pediatric Radiology, Dr. Sami Ulus Maternity and Children's Health Education and Research Hospital, Ankara, Turkey
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Marquez J, Espinoza LR. Infectious arthritis II. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Osteoarticular tuberculosis was frequent throughout the world a decade ago but antituberculous chemotherapy and prophylactic measures have clearly contributed to the reduction of its frequency. However, Pott's disease is frequently complicated by an abscess and some locations are exceptional on account of their gravity. We report a case of dorsal spondylodiscitis with a voluminous Pott's abscess compressing the mediastinal structures with a risk of perforating into the trachea.
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Affiliation(s)
- C Dahou Makhloufi
- Service de rhumatologie, CHU de Bab El Oued, université d'Alger, boulevard Saïd Touati, Alger, Algérie.
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