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Dhagey IA, Liu ZX, Zhong HF, Chen P, Qalalwa M, Martin VT, Ulrich M, Jiang N, Yu B. Pediatric calcaneal osteomyelitis: an analysis of literature-reported 128 cases. BMC Infect Dis 2024; 24:998. [PMID: 39294568 PMCID: PMC11409617 DOI: 10.1186/s12879-024-09887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 09/05/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Calcaneal osteomyelitis (CO) poses a formidable challenge in treatment due to the distinct anatomical structure and functional properties of the calcaneus. The present study endeavors to furnish a thorough and comprehensive understanding of the clinical manifestations, therapeutic strategies, and therapeutic outcomes pertaining to pediatric calcaneal osteomyelitis (PCO) by conducting a meticulous synthesis and analysis of cases reported in the literature. METHODS A systematic search of the PubMed, Embase, and Cochrane Library databases was conducted to identify English-language studies analyzing PCO between 2000 and 2021. The quality of the included studies was assessed using the National Institutes of Health (NIH) assessment scale. Effective data were extracted and analyzed. RESULTS A total of 42 studies, encompassing 128 patients, fulfilled the established inclusion criteria. The gender distribution revealed a male-to-female ratio of 2:1 (81 boys and 40 girls). The median age at the time of diagnosis was 8 years, while the median duration of symptoms was 0.6 month. Trauma emerged as the primary etiology (41 cases, 54%), and limited activity was the most prevalent symptom (68 cases). The positive rate for pathogen culture was 75.4% (49/65), with Staphylococcus aureus being the most commonly isolated pathogen (28 cases, 57.1%). Surgical intervention was performed in 51% (64/126) of the patients, with debridement serving as the primary surgical strategy. The rate of infection recurrence was 6.8% (8/118), and the risk of below-knee amputation was 0.8% (1/124). CONCLUSIONS PCO occurred more frequently in male patients, with trauma being the primary underlying cause and Staphylococcus aureus being the most prevalent bacterial pathogen isolated. Over half of the patients underwent surgical intervention. Nonetheless, it is imperative that treatment strategies undergo further refinement, as approximately 7% of patients experienced infection recurrence.
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Affiliation(s)
- Ismail Ahmed Dhagey
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
- Guangdong Provincial Institute of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Xian Liu
- The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Hong-Fa Zhong
- Department of Trauma Emergency Center, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Peng Chen
- Department of Orthopaedics, Hainan General Hospital, Hainan Hospital affiliated to Hainan Medical University, Haikou, China
| | - Mahmoud Qalalwa
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Vidmi Taolam Martin
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Mizero Ulrich
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Nan Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China.
- Guangdong Provincial Institute of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- Department of Trauma Emergency Center, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China.
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China.
- Guangdong Provincial Institute of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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2
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Agyapong Osman K, Amoah E, Annan GK, Bannerman E. Multiple Joint Pain Progressing to Inability to Walk in a 12-year-old Boy. Pediatr Rev 2024; 45:108-110. [PMID: 38296774 DOI: 10.1542/pir.2020-004919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Kwabena Agyapong Osman
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
- University of Ghana Medical School, Accra, Ghana
| | - Evelyn Amoah
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
- University of Ghana Medical School, Accra, Ghana
| | - George K Annan
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
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3
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Rafaoui A, Lamris MA, El Kassimi C, Fnini S, Rafai M. Diagnosis and treatment of osteo-articular tuberculosis of the foot and ankle (a five case series). Int J Surg Case Rep 2023; 111:108739. [PMID: 37690276 PMCID: PMC10498164 DOI: 10.1016/j.ijscr.2023.108739] [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: 07/12/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Osteo-articular tuberculosis is a rare manifestation of this disease, often posing diagnostic challenges that necessitate additional diagnostic imaging modalities such as radiography, CT, and MRI. This article presents a series of five cases involving tuberculosis affecting the bones of the foot and ankle, diagnosed at various stages. The patients received appropriate anti-tuberculosis medical treatment following national protocols, along with surgical interventions when necessary. CASE STUDIES In this series, we describe the clinical characteristics and management of five cases of foot and ankle bone tuberculosis. These cases were diagnosed at different stages, and all patients received standard anti-tuberculosis medical therapy according to national treatment guidelines. Surgical interventions were performed when deemed necessary to optimize patient outcomes. DISCUSSION The diagnosis of bone tuberculosis should be considered in any clinical scenario that presents with uncertain features, persistent symptoms, or resistance to conventional treatment approaches. It is crucial to employ a multidisciplinary approach involving medical and surgical management to effectively address this challenging disease. However, it is important to note that surgical intervention cannot replace the necessity of proper medical treatment. CONCLUSION Tuberculosis involving the bones of the foot and ankle remains an infrequent occurrence. However, considering the endemic context, prompt therapeutic interventions are essential to prevent significant osteoarticular damage. Early diagnosis, adherence to established treatment protocols, and a comprehensive approach encompassing both medical and surgical modalities are crucial for successful management of this rare entity.
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Affiliation(s)
- A Rafaoui
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
| | - M A Lamris
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco.
| | - C El Kassimi
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
| | - S Fnini
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
| | - M Rafai
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
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4
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Igbokwe V, Ruby LC, Sultanli A, Bélard S. Post-tuberculosis sequelae in children and adolescents: a systematic review. THE LANCET. INFECTIOUS DISEASES 2023; 23:e138-e150. [PMID: 36963920 DOI: 10.1016/s1473-3099(23)00004-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 03/26/2023]
Abstract
In 2020, an estimated total of 155 million people had survived tuberculosis. Among this number, a sizable proportion have considerable post-tuberculosis morbidity, as shown for the adult population. This systematic review aims to identify the spectrum and prevalence of post-tuberculosis sequelae in children and adolescents. Four databases were systematically searched from database inception to Feb 7, 2022, for literature on post-treatment outcomes of tuberculosis acquired during childhood. Of the 4613 identified publications, 71 studies were included in this systematic review. Studies on cohorts with comparably rare (most of which were extrapulmonary) tuberculosis presentations, such as spinal tuberculosis and tuberculous meningitis were over-represented; however, no study assessed long-term sequelae in a cohort with an average childhood tuberculosis spectrum. The descriptive analysis includes long-term outcomes of 3529 paediatric patients 1 month to 36 years after confirmed (47%) or clinical (53%) tuberculosis. In a considerable proportion of children, a broad spectrum of post-tuberculosis sequelae were identified, ranging from radiological residua after pulmonary tuberculosis, to disabling deformities after musculoskeletal and cutaneous tuberculosis, to somatic and psychosocial impairment after tuberculous meningitis. A better understanding and comprehensive assessment of post-tuberculosis sequelae in children are needed to improve tuberculosis care beyond antituberculous treatment.
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Affiliation(s)
- Vanessa Igbokwe
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lisa C Ruby
- Department of Infectious Diseases, and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ayten Sultanli
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; German Center for Infection Research, Tübingen, Germany
| | - Sabine Bélard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; German Center for Infection Research, Tübingen, Germany.
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5
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Gupta S, Parihar A, Singh S, Agarwal A, Agarwal S. Pediatric Osteoarticular Tuberculosis as a Diagnostic Dilemma and a Review of Literature. Cureus 2022; 14:e23053. [PMID: 35308187 PMCID: PMC8926030 DOI: 10.7759/cureus.23053] [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] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Despite tuberculosis being rampant in the Indian subcontinent, most cases of osteoarticular (OA) tuberculosis (TB) are missed until significant bony destruction has occurred. Initial presentation of extra-pulmonary TB mimics many other disease entities while many diseases mimic TB. This may lead to an incorrect diagnosis and sometimes creates a dilemma in reaching the correct diagnosis. The aim of this study was to evaluate a series of pediatric cases of osteoarticular TB, which posed a diagnostic challenge to us. Material and methods Retrospective analysis of case records of pediatric OA-TB patients who had presented to two tertiary level centers of urban India between February 2016 and December 2020 was done. There were a total of 69 patients. Observations There were 37 males and 32 females. The age range was from two to 17 years. Forty-four patients showed evidence of disease within the spine (dorsal region followed by lumbar, followed by the cervical spine), 16 showed disease of the extremities, six had disease of the girdle bones, and three showed disease of the short bones of hands or foot. In our series, patients presented to us between 15 days to six months from the onset of symptoms. From our series, six cases with atypical clinical pictures have been selected for presentation purposes. In all six cases, the initial presentation was not that of OA-TB. However, with a high degree of suspicion, differential diagnosis of TB was kept in mind, and the diagnosis was confirmed microbiologically. Conclusion A high degree of suspicion is required to avoid missing the diagnosis of osteoarticular TB. Non-invasive advanced radiological investigations such as MRI and microbiological analysis of biopsy specimens aid in arriving at the correct diagnosis.
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Balasubramaniyan M, Verma S, Dhawan SR, Saxena AK. Chest wall tuberculosis in children: a mimicker of bone tumour. BMJ Case Rep 2021; 14:e242802. [PMID: 33888483 PMCID: PMC8070852 DOI: 10.1136/bcr-2021-242802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
Osteoarticular tuberculosis of flat bones of the chest wall such as sternum, scapula and rib is extremely rare in children. Because of its atypical clinical presentation mimicking malignant bone tumours, diagnosis remains a challenge. Histological and microbiological diagnosis remains confirmatory. Antitubercular therapy is the cornerstone in management.
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Affiliation(s)
- Muthuvel Balasubramaniyan
- Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Verma
- Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumeet Rajendra Dhawan
- Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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7
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Lalwani P, Malik ZA. Sternal and metacarpal masses as the initial presentation of tuberculosis in a child. Int J Pediatr Adolesc Med 2021; 8:125-127. [PMID: 34084886 PMCID: PMC8144861 DOI: 10.1016/j.ijpam.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/29/2020] [Accepted: 01/31/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Priyanka Lalwani
- Al Jalila Children’s Specialty Hospital. Oud Metha, Al Jaddaf, Dubai, United Arab Emirates
| | - Zainab A. Malik
- Pediatric Infectious Diseases, Mediclinic City Hospital, Building 37, Dubai Healthcare City, Dubai, United Arab Emirates
- Mohamed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai, United Arab Emirates
- Corresponding author. Pediatric Infectious Diseases, Mediclinic City Hospital, Building 37, Dubai Healthcare City, Dubai, United Arab Emirates.
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8
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Bikoroti JB, Buteera AM, Manirakiza F, Munezero L, Nzarora J, Nyiraneza S. Tuberculosis of the Left Calcaneum and Collapsed Right Femoral Head: A Case Report. J Orthop Case Rep 2021; 11:55-58. [PMID: 34141643 PMCID: PMC8046462 DOI: 10.13107/jocr.2021.v11.i01.1962] [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: 11/30/2022] Open
Abstract
Introduction Tuberculosis (TB), one of the oldest diseases known to affect humans, is caused by the bacteria Mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one-third of cases, other organs are involved. TB of the bone mimics other clinical conditions such as chronic osteomyelitis, Madura mycosis and actinomycosis. Case Report A fifth child and last-born girl, in a family of living four children, aged 9 years, consulted Kigali University Teaching Hospital (CHUK) on December 7, 2017, from Kibuye Referral Hospital (Western of Rwanda) for ulcerated, infected left heel with swollen foot 4 months before our consultation. Physical examination revealed a patient with swollen and tender foot discharging serous bloody fluids accompanied by inability to stand with a painful right hip. Small left inguinal lymph nodes were present. Blood work-up, computed tomography scan of the left foot, and an incisional biopsy at the level of the left calcaneus were performed and revealed extrapulmonary TB. The histopathological features for TB were scanty, but the high index suspicion of possible extrapulmonary TB led to the confirmation of the diagnosis using auramine-rhodamine special stain. Anti-TB therapy for 12 months course was initiated and the monthly follow-up for 11 months was done. Conclusion Although calcaneal TB is very rare, in countries with high incidence of TB, clinicians must have a high suspicion index and skeletal TB must be included in differential diagnosis of bone masses whenever possible bone mass biopsy and special staining technique in addition to most common diagnosis means should be done to rule out the possibility of bone TB.
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Affiliation(s)
| | | | - Felix Manirakiza
- Department of Pathology, Kigali University Teaching Hospital, Rwanda.,Department of Clinical Biology, School of Medicine and Pharmacy, University of Kigali
| | - Louise Munezero
- Department of Clinical Biology, School of Medicine and Pharmacy, University of Kigali
| | - Josué Nzarora
- Department of Anaesthesia, Kigali University Teaching Hospital, Rwanda
| | - Sabine Nyiraneza
- Department of Radiology, Kigali University Teaching Hospital, Rwanda
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9
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Miloudi M, Arsalane L, Kharrab A, El Kamouni Y, Zouhair S. Bilateral tuberculous psoas abscess. Access Microbiol 2020; 2:acmi000135. [PMID: 32974598 PMCID: PMC7497824 DOI: 10.1099/acmi.0.000135] [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: 01/24/2020] [Accepted: 03/25/2020] [Indexed: 12/02/2022] Open
Abstract
The unilateral psoas abscess is a rare disease that is often caused by common germs, including Staphylococcus aureus. Tuberculous origin and bilateral involvement are even rarer, especially in developed countries. It may be primary or secondary to a neighbourhood focus. We report a case of bilateral tuberculous abscess of psoas in an immunocompetent patient secondary to spondylodiscitis.
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Affiliation(s)
- Mouhcine Miloudi
- Department of Microbiology, Avicenne Military Hospital, Marrakech, Morocco
| | - Lamiae Arsalane
- Department of Microbiology, Avicenne Military Hospital, Marrakech, Morocco
| | - Anas Kharrab
- Departement of Rhumatology, Avicenne Military Hospital, Marrakech, Morocco
| | - Youssef El Kamouni
- Department of Microbiology, Avicenne Military Hospital, Marrakech, Morocco
| | - Said Zouhair
- Department of Microbiology, Avicenne Military Hospital, Marrakech, Morocco
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10
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González Saldaña N, Macías Parra M, Arias de la Garza E, Solorzano Morales S, Galvis Trujillo D, Juarez Olguin H, Carmona Vargas AJ, Palavicini Rueda ME, Castillo Bejarano JI. Case Report: Chest Wall Tuberculosis without Pulmonary Involvement in Three Pediatric Immunocompetent Patients. Am J Trop Med Hyg 2020; 101:1073-1076. [PMID: 31549617 DOI: 10.4269/ajtmh.19-0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Primary rib cage tuberculosis (TB) is an infrequent form of presentation and represents 1% of all cases of osteoarticular TB. We report three cases of children who were previously healthy and who began with swelling of the anterior surface of the rib as initial manifestation of TB. The most important clinical presentations in this series were swelling and pain, with lytic lesions and a soft tissue mass in image studies simulating oncologic pathologies. Because none of the cases had positive epidemiological contact, TB was initially not considered, so the delay in diagnosis from the onset of symptoms was 4, 1, and 2 months, respectively. The diagnosis was made through histomorphological analyses. Treatment was administered during 12, 10, and 9 months. Posttreatment studies did not show any evidence of extrapulmonary TB and until date, the patients remained without relapse or active disease. The findings in our cases illustrate that the diagnosis of chest wall TB should be suspected in all patients from endemic areas who present rib injury.
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Affiliation(s)
| | | | | | | | | | - Hugo Juarez Olguin
- Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.,Laboratory of Pharmacology, National Institute of Pediatrics, Mexico City, Mexico
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11
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Kumar P, Dhillon MS, Rajnish RK, Jindal K. Tubercular involvement of the lateral malleolus and adjacent calcaneus: presentation of a rare case and review of the literature. BMJ Case Rep 2019; 12:12/12/e231533. [PMID: 31826905 DOI: 10.1136/bcr-2019-231533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteoarticular tuberculosis (TB), despite being on the wane in the developed world, stays a problem of significance in the developing world. The issue is compounded by unusual presentations, inadequate diagnostic skills and limited understanding of its management. For foot infections, despite an increased awareness, many patients may be misdiagnosed, with associated treatment delays. A 19-year-old man presented with pain and swelling on lateral aspect of right ankle for 2 months. The patient had an undermined discharging sinus with surrounding induration and the skin adherent to the underlying bone. Patient was diagnosed as a case of ipsilateral TB lateral malleolus and calcaneus, managed with antitubercular drugs with complete resolution at 3 years of follow up. Foot and ankle TB can have atypical presentations causing delay in diagnosis. Contiguous spread of infection occurs through the synovium or the joint; however, extra-articular spread along the tendon sheaths or other soft tissues is possible, which is highlighted by the present case.
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Affiliation(s)
- Prasoon Kumar
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Singh Dhillon
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar Rajnish
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karan Jindal
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Cheng J, Feng S, Lei H, Huo W, Feng H. Tuberculosis of acromioclavicular joint: a case report. BMC Infect Dis 2019; 19:111. [PMID: 30717689 PMCID: PMC6360657 DOI: 10.1186/s12879-019-3760-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/29/2019] [Indexed: 12/02/2022] Open
Abstract
Background Osteoarticular tuberculosis is a great masquerader presenting in varied forms and in atypical locations, and it is prone to misdiagnosis and missed diagnosis. Isolated acromioclavicular joint tuberculosis has been reported rarely. Case presentation A 19-year-old man presented with a chronic, mild pain, non-healing ulcer in right shoulder. Imaging of the shoulder revealed destruction of the acromioclavicular joint and histopathology confirmed the diagnosis of acromioclavicular tuberculosis. The patient underwent debridement, synovectomy and drainage of the abscess and recovered well with antitubercular therapy postoperatively. Conclusions Awareness of this uncommon presentation of osteoarticular tuberculosis may assist in earlier diagnosis. Especially, in endemic countries, osteoarticular tuberculosis should be considered as a differential diagnosis in all atypical presentations to avoid residual problems.
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Affiliation(s)
- Jian Cheng
- Department of Orthopedics, The Affiliated Xuzhou Hospital of Medical College of Southeast University (Xuzhou Central Hospital), No.199, Jiefang South road, Quanshan District, Xuzhou, 221009, Jiangsu Province, China.,The First Clinical Medical College, Nanjing University of Chinese Medicine, No.138, Xianlin road, Qixia District, Nanjing, 210046, Jiangsu Province, China
| | - Shiming Feng
- Department of Orthopedics, The Affiliated Xuzhou Hospital of Medical College of Southeast University (Xuzhou Central Hospital), No.199, Jiefang South road, Quanshan District, Xuzhou, 221009, Jiangsu Province, China
| | - Huining Lei
- Department of Orthopedics, The Affiliated Xuzhou Hospital of Medical College of Southeast University (Xuzhou Central Hospital), No.199, Jiefang South road, Quanshan District, Xuzhou, 221009, Jiangsu Province, China
| | - Weiling Huo
- Department of Orthopedics, The Affiliated Xuzhou Hospital of Medical College of Southeast University (Xuzhou Central Hospital), No.199, Jiefang South road, Quanshan District, Xuzhou, 221009, Jiangsu Province, China
| | - Huanhuan Feng
- The First Clinical Medical College, Nanjing University of Chinese Medicine, No.138, Xianlin road, Qixia District, Nanjing, 210046, Jiangsu Province, China. .,Department of Orthopedics, The Affiliated Taicang Hospital of Nanjing University of Chinese Medicine, No.140, People's South road, Taicang, Suzhou, 215400, Jiangsu Province, China.
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13
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Ehua AM, Moulot MO, Konvolbo J, Agbara KS, Ajoumissi IT, Konan JM, Traoré I, Konan L, Sable S, Bankole R. Pseudotumors from tuberculosis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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14
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Ankle tuberculosis. A case in childhood. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Navarrete FE, Gómez-Alessandri J, Tintó M, Sánchez-González M, Vicent V. Ankle tuberculosis. A case in childhood. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:319-323. [PMID: 28755924 DOI: 10.1016/j.recot.2017.04.002] [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: 02/14/2017] [Revised: 04/09/2017] [Accepted: 04/23/2017] [Indexed: 11/26/2022] Open
Abstract
Articular tuberculosis of the ankle joint is a rare presentation of skeletal tuberculosis (10% of cases). This unusual location and the low index of clinical suspicion leads to delays in diagnosis and treatment. Radiographic and analytic studies are unspecific in the first stage. CAT and MRI are useful in diagnosis. Chemotherapy is the mainstay of treatment and surgery is often required to establish the diagnosis and in the treatment. We report a case of ankle tuberculosis in a 22 month-old child. The diagnosis was confirmed by synovial biopsy. There was no patient or family contact with tuberculosis patients. There was no risk factor. There was no lung disease. Diagnosis was made 1 year after onset of symptoms. The treatment was with chemotherapy and surgery was performed as preventive treatment of equinus deformity and osteoarthritis. Good clinical and functional outcome was achieved after 20 years of follow up.
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Affiliation(s)
- F E Navarrete
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - J Gómez-Alessandri
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Tintó
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Sánchez-González
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - V Vicent
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
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16
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Agarwal A, Bhandari A, Maheshwari R. Tuberculosis of Acromioclavicular Joint. J Clin Diagn Res 2017; 11:RD03-RD04. [PMID: 28511468 DOI: 10.7860/jcdr/2017/23186.9588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
Tuberculosis (TB) arthritis accounts for approximately 1%-3% of all cases of TB and for approximately 10%-11% of extra pulmonary cases. Isolated acromioclavicular joint TB has been reported rarely with varied presentations as case series of one to three cases none of them being large studies. In our case, patient presented with pain in left shoulder since one month. Patient was investigated and was diagnosed to have acromioclavicular joint TB on basis of positive Acid Fast Bacilli (AFB) stain and cytology. Patient recovered well with antitubercular therapy. Thus, it is important to send Ziehl-Neelsen (ZN) stain in all cases in an endemic country like India.
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Affiliation(s)
- Archit Agarwal
- Senior Resident, Department of Orthopaedics, Himalayan Institute of Medical Sciences, Dehradun, Uttrakhand, India
| | - Amish Bhandari
- Junior Resident, Department of Orthopaedics, Himalayan Institute of Medical Sciences, Dehradun, Uttrakhand, India
| | - Rajesh Maheshwari
- Professor and Head, Department of Orthopaedics, Himalayan Institute of Medical Sciences, Dehradun, Uttrakhand, India
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Aghoutane EM, Salama T, Fezazi RE. Isolated tuberculosis of metacarpal bone in a 3 year-old child. Pan Afr Med J 2017; 26:90. [PMID: 28491221 PMCID: PMC5410008 DOI: 10.11604/pamj.2017.26.90.11713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/31/2017] [Indexed: 11/11/2022] Open
Abstract
Primary tuberculosis osteomyelitis of metacarpal bone is rare. The majority of cases occur in children and young adults and there is difficulty in diagnosis mainly in young children. We report a new case in children aged of 3 years, presenting a swelling on the dorsal side of her right hand since 8 months. X-ray showed an expansile, cystic and lytic lesion involving the little finger metacarpal. Tuberculosis was confirmed on histological examination. No lesions in lung parenchyma or lymphadenopathy were associated. Patient was successfully managed by anti-tubercular drugs.
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Affiliation(s)
- El Mouhtadi Aghoutane
- Department of Pediatric Orthopedic Surgery, CHU Mohamed VI, Faculty of Medicine and Pharmacy, University Kadi Ayyad, Marrakech, Maroc
| | - Tarik Salama
- Department of Pediatric Orthopedic Surgery, CHU Mohamed VI, Faculty of Medicine and Pharmacy, University Kadi Ayyad, Marrakech, Maroc
| | - Redouane El Fezazi
- Department of Pediatric Orthopedic Surgery, CHU Mohamed VI, Faculty of Medicine and Pharmacy, University Kadi Ayyad, Marrakech, Maroc
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Agathangelidis F, Boutsiadis A, Fouka E, Karataglis D. Concomitant acromioclavicular and miliary tuberculosis. BMJ Case Rep 2013; 2013:bcr-2013-010026. [PMID: 23813516 DOI: 10.1136/bcr-2013-010026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 48-year-old man was being treated unsuccessfully for miliary tuberculosis for 5 months until he presented with acromioclavicular joint swelling. Imaging of the shoulder revealed destruction of the acromioclavicular joint and the patient was brought to the operating theatre and underwent the excision of the distal end of the clavicle, synovectomy and drainage of the abscess. Surgery was followed by prompt clinical, functional and radiological improvement. Histopathology confirmed the diagnosis of acromioclavicular tuberculosis. Resistance to appropriate antituberculous treatment in patients with miliary tuberculosis can sometimes be a result of undiagnosed extrapulmonary site of infection.
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Affiliation(s)
- Filon Agathangelidis
- First Orthopaedic Department of Aristotle University of Thessaloniki, G Pananikolaou Hospital, Thessaloniki, Greece.
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