Musculoskeletal tuberculosis revisited: bone and joint tuberculosis in Austria

Differences in clinical, radiological and laboratory parameters between elderly and young patients with newly diagnosed smear-positive pulmonary tuberculosis in Vietnam

OBJECTIVES

To investigate the differences in clinical, radiological and laboratory parameters between elderly and young patients with newly diagnosed smear-positive pulmonary tuberculosis in Vietnam.

METHODS

This retrospective analysis included all patients hospitalised with newly diagnosed pulmonary tuberculosis with acid-fast bacilli-positive smear. Clinical symptoms, laboratory results and chest X-ray findings were collected using a standardised questionnaire. Elderly was defined as those patients aged 65 years and older.

RESULTS

A total of 183 patients diagnosed with new acid-fast bacilli-positive pulmonary tuberculosis were included in this study, with a mean age of 56.2 ± 16.3 years (minimum = 18 and maximum = 87 years). Seventy-seven participants were aged ≥65 years, accounting for 42.1% of participants. A total of 147 (80.3%) patients were male, and the sex ratio of male/female was 4.1. Night sweats were statistically more frequent among younger patients (34.9% vs. 20.8%, p = 0.04), whereas muscle and joint pain were more predominant among the elderly (7.6% vs. 22.1%, p = 0.01). A proportion of 67.0% of younger patients and 63.6% of the elderly group were bilaterally affected. Cavitation lesions were significantly more frequent in the younger group (55.7% vs. 39.0%, p = 0.03), whereas pulmonary fibrosis occurred more frequently in elderly patients (29.3% vs. 45.4%, p = 0.02). No other significant differences in clinical symptoms, laboratory results and chest X-ray findings were observed.

CONCLUSION

These findings underscore the importance of considering age-related variations in the clinical and radiological presentation of tuberculosis, which can guide tailored approaches in diagnosis, management and treatment strategies for different age groups.

Transcriptome analysis of the diseased intervertebral disc tissue in patients with spinal tuberculosis

OBJECTIVE

To investigate the differential expression genes (DEGs) in spinal tuberculosis using transcriptomics, with the aim of identifying novel therapeutic targets and prognostic indicators for the clinical management of spinal tuberculosis.

METHODS

Patients who visited the Department of Orthopedics at the Second Hospital, Lanzhou University from January 2021 to May 2023 were enrolled. Based on the inclusion and exclusion criteria, there were 5 patients in the test group and 5 patients in the control group. Total RNA was extracted and paired-end sequencing was conducted on the sequencing platform. After processing the sequencing data with clean reads and annotating the reference genome, FPKM normalization and differential expression analysis were performed. The DEGs and long non-coding RNAs (LncRNAs) were analyzed for Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment. The cis-regulation of differentially expressed mRNAs (DE mRNAs) by LncRNAs was predicted and analyzed to establish a co-expression network.

RESULTS

This study identified 2366 DEGs, with 974 genes significantly upregulated and 1392 genes significantly downregulated. The upregulated genes are associated with cytokine-cytokine receptor interactions, tuberculosis, and TNF-α signaling pathways, primarily enriched in biological processes such as immunity and inflammation. The downregulated genes are related to muscle development, contraction, fungal defense response, and collagen metabolism processes. Analysis of LncRNAs from bone tuberculosis RNA-seq data detected a total of 3652 LncRNAs, with 356 significantly upregulated and 184 significantly downregulated. Further analysis identified 311 significantly different LncRNAs that could cis-regulate 777 target genes, enriched in pathways such as muscle contraction, inflammatory response, and immune response, closely related to bone tuberculosis. There are 51 genes enriched in the immune response pathway regulated by cis-acting LncRNAs. LncRNAs that regulate immune response-related genes, such as upregulated RP11-451G4.2, RP11-701P16.5, AC079767.4, AC017002.1, LINC01094, CTA-384D8.35, and AC092484.1, as well as downregulated RP11-2C24.7, may serve as potential prognostic and therapeutic targets.

CONCLUSION

The DE mRNAs and LncRNAs in spinal tuberculosis are both associated with immune regulatory pathways. These pathways promote or inhibit the tuberculosis infection and development at the mechanistic level and play an important role in the process of tuberculosis transferring to bone tissue.

Recent Advances in Nanotechnology-Based Strategies for Bone Tuberculosis Management

Bone tuberculosis, an extrapulmonary manifestation of tuberculosis, presents unique treatment challenges, including its insidious onset and complex pathology. While advancements in anti-tubercular therapy have been made, the efficacy is often limited by difficulties in achieving targeted drug concentrations and avoiding systemic toxicity. The intricate bone structure and presence of granulomas further impede effective drug delivery. Nano-drug delivery systems have emerged as a promising alternative, offering the enhanced targeting of anti-tubercular drugs. These systems, characterized by their minute size and adaptable surface properties, can be tailored to improve drug solubility, stability, and bioavailability, while also responding to specific stimuli within the bone TB microenvironment for controlled drug release. Nano-drug delivery systems can encapsulate drugs for precise delivery to the infection site. A significant innovation is their integration with prosthetics or biomaterials, which aids in both drug delivery and bone reconstruction, addressing the infection and its osteological consequences. This review provides a comprehensive overview of the pathophysiology of bone tuberculosis and its current treatments, emphasizing their limitations. It then delves into the advancements in nano-drug delivery systems, discussing their design, functionality, and role in bone TB therapy. The review assesses their potential in preclinical research, particularly in targeted drug delivery, treatment efficacy, and a reduction of side effects. Finally, it highlights the transformative promise of nanotechnology in bone TB treatments and suggests future research directions in this evolving field.