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. 2017 Jun;11(3):405-411.
doi: 10.4184/asj.2017.11.3.405. Epub 2017 Jun 15.

Epidemiology of Musculoskeletal Tuberculosis in an Area with High Disease Prevalence

Michael F G Held  1 , Sven Hoppe  1 , Maritz Laubscher  1 , Stewart Mears  1 , Stewart Dix-Peek  1 , Heather J Zar  2 , Robert N Dunn  1
Affiliations

Epidemiology of Musculoskeletal Tuberculosis in an Area with High Disease Prevalence

Michael F G Held et al. Asian Spine J. 2017 Jun.

Abstract

Study design: Retrospective observational study.

Purpose: The aim of this study was to assess the distribution of age and site of infection in patients with musculoskeletal tuberculosis (TB) and determine the number of TB/human immunodeficiency virus (HIV) coinfections as well as the incidence of multidrugresistant (MDR) TB.

Overview of literature: Of all TB cases, 1%-3% show skeletal system involvement and 30% are HIV coinfected. Although the reported distribution of skeletal TB is majorly in the spine, followed by the hip, knee, and foot/ankle, the epidemiology of extrapulmonary TB and especially musculoskeletal TB remains largely unknown, particularly in areas with a high prevalence of the disease.

Methods: This is a retrospective study of a consecutive series of patients admitted to a tertiary care facility in an area with the highest prevalence of TB worldwide. TB was confirmed on tissue biopsy with polymerase chain reaction testing (Xpert for Mycobacterium tuberculosis and rifampicin resistance), culturing, or histological analysis. Data were analyzed regarding demographic information, location of the disease, HIV coinfections, and drug resistance.

Results: In all, 125 patients (44 children; 35%) with a mean age of 27 years (range, 1-78 years) were included. Age peaks were observed at 5, 25, and 65 years. Spinal disease was evident in 98 patients (78%). There were 66 HIV-negative (53%) and 29 (23%) HIVpositive patients, and in 30 (24%), the HIV status was unknown. Five patients (4%) showed MDR TB.

Conclusions: The age distribution was trimodal, spinal disease was predominant, MDR TB rate in our cohort was high, and a large portion of TB patients in our hospital were HIV coinfected. Hence, spinal services with sufficient access to operating facilities are required for tertiary care facilities in areas with a high TB prevalence.

Keywords: Bone and joint; Epidemiology; HIV; Spine; Tuberculosis.

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Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Magnetic resonance imaging with spinal tuberculosis.
Fig. 2
Fig. 2. Age distribution of tuberculosis and human immunodeficiency virus (HIV) co-infections.
See this image and copyright information in PMC

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