Diagnosis and Treatment Particularities in Osteoarticuar Tuberculosis

Abstract

Osteoarticular tuberculosis (OATB) is a secondary chronic infection with paubacillary bacillus Koch (BK) that has bone and joint interest. Today in Romania, tuberculosis is a primary public health problem, according to World Health Organization (WHO) in 2015 alone, there have been 10.4 million new cases of tuberculosis (TB) in the world, of which 15.195 in Romania. Pulmonary and extrapulmonary tuberculosis, especially the osteoarticular form, with multiple outbreaks should of had a minimal impact, but because of the multiple characteristics such as: epidemiological, geographic, associated diseases, diagnosis capacity, therapeutic options, gene pool and racial evolutiv traits, the disease spreading and management in both developed and underdeveloped countries, the TB infection has seen an increase in the number of cases (e.g. Africa and Asia). Today there is a fecundity upsurge of BK infection, especially pronounced in low income populations, country side people being the most affected. There are multiple breakthroughs in the understanding of Mycobacterium tuberculosis physiopathology. This fact offers us a modern and genetically guided approach in the diagnosis, evolutive patterns and treatment involving the OATB.

Keywords: epidemiology; genetics; osteoarticular tuberculosis.

Figure 1

Features of clinical and imagistic diagnosis. (a, b) Ossifluent hip abscess: a-posterior view; b-anterior view; Phemister triad: (c) X-ray anteroposterior view of the knee joint: 1-Juxta-articular osteopaenia/osteoporosis (red arrow). 2-Peripheral osseous erosions (green arrow) (d) 3-Gradual narrowing of joint space (blue arrow); (e, f) Mirror like vertebral erosions-MRI sagital views; Scintigraphic examination. (g) Scintigraphic aspects of OATB-anteroposterior view (left) and posteroanterior view (right) [Collection of the Department of Orthopedics]

Figure 2

Inflammatory response to tuberculosis bacillus(left) and the absence of the inflammatory respons (right) [modified after Mecabih, 2016 [29]]

Figure 3

(a) Surgical biopsy of the spine. Sagital view. (b) Punctual biopsy under radiographic guidance. Anteroposterior view. [Collection of the Department of Orthopedics] (c)MRI aspect of multifocal metallic stability implant after vertebral curettage and segmental stabilization system with somatic graft. (d) Consolidate bone aspect after osteosynthesis material removal (right) [Abdelkefi, 2016 [33]]