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Gouveia C, Cabral MF, Jordão P, Campagnolo J, Mineiro J, Peres H, Conceição C, Silva TM, Varandas L, Brito MJ. Bone and joint tuberculosis in paediatrics: a 13-year retrospective study. J Med Microbiol 2022; 71. [PMID: 36748626 DOI: 10.1099/jmm.0.001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction. Bone and joint tuberculosis (BJTB) is rare in developed countries, particularly in the paediatric population.Hypothesis/Gap Statement. The clinical features and sequelae of paediatric BJTB in Europe are not well characterized and should be assessed to achieve a better approach.Aim. To assess the management and outcomes of paediatric BJTB.Methodology. Longitudinal observational study of all paediatric patients (0-17 years old) diagnosed with BJTB between 2008 to 2020 in a tertiary-care hospital.Results. We identified 18 patients with BJTB, with a median age of 10 years (IQR 6-14.8), 66.7 % male. Most (72 %) were diagnosed after 2015 and were foreign-born (88.9 %), mainly from Portuguese-speaking African countries, and none had HIV. The most common symptoms were pain (77.8 %), fever (50 %) and bone deformity (44.4 %). Spinal TB (STB) affected 13 (72.2 %) and extra-spinal TB (ESTB) 9 (50 %) patients, and 4 (27.7 %) had both conditions. Diagnostic positive procedures included positive nucleic acid amplification technique (NAAT) (44.4 %), Mycobacterium tuberculosis isolation (44.4 %) and compatible histology (33.3 %). All completed antituberculous drugs for a median of 12 months (IQR 12-13) and nine (50 %) had surgery. Overall, acute complications occurred in 16 (88.9 %) patients - 11/13 (84.6 %) with STB and 5/5 (100 %) with ESTB - and included abscesses, spinal compression, spine deformity and pathological fractures. Sequelae were still present at the 12-month follow-up in seven cases (46.7 %), and were more common in foreign-born patients sent to Portugal to receive medical treatment (66.7 vs 20 %).Conclusions. Paediatric BJTB is difficult to diagnose and has high morbidity, requiring long-term follow-up. Over the last decade, foreign-born TB seems to be increasing, with still longer treatment courses and more acute complications and sequelae.
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Affiliation(s)
- Catarina Gouveia
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Mafalda Félix Cabral
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal
| | - Pedro Jordão
- Paediatric Orthopaedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - João Campagnolo
- Paediatric Orthopaedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Jorge Mineiro
- Paediatric Orthopaedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Helena Peres
- Clinical Pathology, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Carla Conceição
- Neuroradiology Unit, Hospital Dona Estefânia, CHULC, Lisbon, Portugal
| | - Tiago Milheiro Silva
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal
| | - Luís Varandas
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria João Brito
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal
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Kishan H, Kashyap A, Kadur S, Soni A, Sehrawat S. Tuberculosis of the Hand with Isolated Hamate Involvement: An Unusual Presentation. Case Rep Orthop Res 2019. [DOI: 10.1159/000502733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Osteoarticular tuberculosis accounts for 1–5% of all tuberculosis cases, rarely involving the wrist or hand. Wrist and hand tuberculosis usually presents with multiple carpal bone involvement with impaired wrist and hand function. Isolated involvement of the carpal bone, particularly the hamate, is very rare. We report a 12-year-old female child with isolated hamate bone involvement without any limitation of wrist function. The patient was managed conservatively on antitubercular drugs. Such a case has not been reported in the past.
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Kumar P, Aggarwal S, Rajnish RK, Agarwal S. Tuberculosis of lunate as an isolated intraosseous osteolytic lesion in an adult: a diagnostic challenge. BMJ Case Rep 2019; 12:12/7/e229597. [PMID: 31289163 DOI: 10.1136/bcr-2019-229597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In an endemic zone of tuberculosis (TB), osseous involvement is a relatively common presentation. Spine and long bones are the the most common nidus of TB. Smaller bones and joints are relatively less involved. Thorough clinical examination and history of typical constitutional symptoms like weight loss, fever and loss of appetite are the diagnostic aids for initiating early treatment. Wrist and hand involvement is a rare occurrence and often presents atypically without any obvious symptoms or signs. This results in delayed diagnosis and worse outcome. TB of lunate without articular involvement is a very rare subset and we present such an isolated case of TB involving the lunate, without any typical symptoms, with the patient complaining of vague pain without any restriction of joint mobility. TB was diagnosed with the aid of radiology, haematology and histopathology. 18 months of multidrug antitubercular treatment was given, to which the patient responded well.
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Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Agarwal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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