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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024; 53:2081-2097. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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Li C, Wang S, Yu H, Wang J, Deng J, Wang H, Hua C, Zhuo Z, Chen L, Hao J, Gao W, Zhang H, Zhang T, Xu H, Wang C. Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China. Front Cell Infect Microbiol 2022; 12:1018699. [PMID: 36339333 PMCID: PMC9626968 DOI: 10.3389/fcimb.2022.1018699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/27/2022] [Indexed: 10/16/2023] Open
Abstract
The research of childhood tuberculosis is inadequate in china. The cross-priming amplification (CPA) of specific DNA in clinical samples is increasingly adopted for the diagnosis of childhood tuberculosis. In this study, a multicenter research was performed to investigate the incidence and characteristics of childhood tuberculosis in suspected populations mainly by CPA method. 851 children suspected of tuberculosis were enrolled in seven centers across China. All samples were tested by a CPA method and 159 subjects were tested by Xpert MTB/RIF and liquid culture method in parallel to assess the reliability of the CPA method. A positive result in any one of the three methods provided a definitive diagnosis of Mycobacterium tuberculosis complex (MTBC) infection. The MTBC-positive rate was 9.5% (81/851) by the combined methods; 93.8% of the cases were detected by CPA technology (76/81). The rate of pulmonary infection was significantly higher than that of extrapulmonary infection (7.1%, 60/851 vs 2.5%, 21/851; P < 0.001). Scrofula was the predominant type of extrapulmonary tuberculosis. The MTBC positive rates in 12-18-year-old group (middle school), was 28.4% (23/81), higher than in those under-six-year-old (preschool; 39/525) and the 6~11-year-old (primary school; 18/235) groups combined (P < 0.001). The MTBC positive rate in patients with a clear history of tuberculosis exposure was significantly higher than in cases in which there was no history of tuberculosis contact(35.3%, 18/51 vs 7.8%, 61/782; P < 0.001). In conclusion, this multicenter investigation showed that pulmonary tuberculosis and extrapulmonary tuberculosis are not uncommon in children in China, with teenagers being particularly susceptible to infection. The incidence of pulmonary tuberculosis in children is higher than that of extrapulmonary tuberculosis. History of exposure to tuberculosis is a high risk factor for childhood tuberculosis.
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Affiliation(s)
- Chunling Li
- Clinical Microbiology Laboratory, Children’s Hospital of Fudan University, Children’s National Medical Center, Shanghai, China
| | - Shifu Wang
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Children’s Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Hui Yu
- Division of Infectious Diseases, Children’s Hospital of Fudan University, Children’s National Medical Center, Shanghai, China
| | - Jiangxia Wang
- Department of Infection Diseases Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Hongmei Wang
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Chunzhen Hua
- Division of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhiqiang Zhuo
- Department of Infectious Diseases, Xiamen Children’s Hospital (Children’s Hospital of Fudan University Xiamen Branch), Xiamen, Fujian Province, China
| | - Lei Chen
- Department of Medical Laboratory Diagnosis Center, Xiamen Children’s Hospital (Children's Hospital of Fudan University Xiamen Branch), Xiamen, Fujian Province, China
| | - Jianhua Hao
- Department of Medical Laboratory Diagnosis Center, Children’s Hospital of Kaifeng City, Kaifeng, Henan Province, China
| | - Wei Gao
- Department of Infectious Diseases, Children’s Hospital of Kaifeng City, Kaifeng, Henan Province, China
| | - Hong Zhang
- Department of Medical Laboratory Diagnosis Center, Children’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Zhang
- Institue of Pediatric Infection, Immunity and Critical Care Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongmei Xu
- Department of Infection Diseases Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanqing Wang
- Clinical Microbiology Laboratory, Children’s Hospital of Fudan University, Children’s National Medical Center, Shanghai, China
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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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Akkara SA, Singhania A, Akkara AG, Shah A, Adalja M, Chauhan N. A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region. Indian J Otolaryngol Head Neck Surg 2013; 66:46-50. [PMID: 24605301 DOI: 10.1007/s12070-013-0661-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 05/13/2013] [Indexed: 10/26/2022] Open
Abstract
Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.
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Affiliation(s)
- Stani Ajay Akkara
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Ankit Singhania
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Ajay George Akkara
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India ; C-1, Staff Quarters, Sumandeep Vidyapeeth Campus, Vadodara, 391760 Gujarat India
| | - Arti Shah
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Mayur Adalja
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Nirali Chauhan
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
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Pigrau-Serrallach C, Rodríguez-Pardo D. Bone and joint tuberculosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 4:556-66. [PMID: 22711012 DOI: 10.1007/s00586-012-2331-y] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 04/17/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Bone and joint tuberculosis has increased in the past two decades in relation with AIDS epidemics. MATERIAL AND METHODS A literature review of bone and joint tuberculosis, focusing on Pott's disease. RESULTS Bone and joint TB comprises a group of serious infectious diseases whose incidence has increased in the past two decades, especially in underdeveloped countries, in part due to the AIDS epidemic. Tuberculous spinal infections should be suspected in patients with an insidious, progressive history of back pain and in individuals from an endemic area, especially when the thoracic vertebrae are affected and a pattern of bone destruction with relative disc preservation and paravertebral and epidural soft tissue masses are observed. Atypical tuberculous osteoarticular manifestations involving the extraspinal skeleton, a prosthetic joint, or the trochanteric area, and nontuberculous mycobacterial infections should be considered in favorable epidemiological contexts. Surgery combined with prolonged specific antituberculous chemotherapy is mainly indicated in patients with neurological manifestations or deformities, and provides satisfactory results in most cases. CONCLUSIONS Spinal tuberculosis is still a relative common extra spinal manifestation of spinal tuberculosis that requires a high degree of suspicion in order to avoid neurological complications and need of surgery.
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Affiliation(s)
- Carlos Pigrau-Serrallach
- Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona REIPI (Spanish Network for Research in Infectious Disease), Passeig Vall d'Hebron 119-129, Barcelona, Spain.
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Capuani C, Accadbled F, Delisle MB, Gomez-Brouchet A. Multifocal skeletal tuberculosis in 2 immunocompetent children. J Rheumatol 2010; 37:2441-2. [PMID: 21041269 DOI: 10.3899/jrheum.100562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Guillou-Debuisson C, Salanne S, Maréchal C, Laporte E, Claudet I, Grouteau E. Oligo-arthrite tuberculeuse : un diagnostic différentiel de l’arthrite juvénile idiopathique. Arch Pediatr 2010; 17:1553-8. [PMID: 20932725 DOI: 10.1016/j.arcped.2010.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 09/16/2009] [Accepted: 08/09/2010] [Indexed: 11/29/2022]
Affiliation(s)
- C Guillou-Debuisson
- POSU pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 09, France.
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Puche AM, Montesinos BL, Penadés IC, Lletí MS, Puig LG. [Tuberculous osteomyelitis and Poncet disease]. An Pediatr (Barc) 2009; 71:365-6. [PMID: 19647500 DOI: 10.1016/j.anpedi.2009.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 06/06/2009] [Accepted: 06/08/2009] [Indexed: 11/29/2022] Open
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Hamouda S, Opsomer H, Delattre A, Thumerelle C, Flammarion S, Santos C, Deschildre A. [Tuberculous otitis media]. Med Mal Infect 2008; 38:608-11. [PMID: 18954947 DOI: 10.1016/j.medmal.2008.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 04/02/2008] [Accepted: 09/11/2008] [Indexed: 11/30/2022]
Abstract
Tuberculous otitis media is a rare disease. Its diagnosis is often made late. We report the case of a 13-year-old girl presenting with a right chronic otitis media and a massive and painful cervical adenitis. High resolution CT-scan revealed cervical and mediastinal adenitis associated with extensive lesions involving the middle ear, mastoid air cells, and sphenoidal bone. The diagnosis of tuberculous otitis media was made on a positive tuberculin skin test and on the identification of Mycobacterium tuberculosis in gastric juices. The young girl progressed well after 9 months of antituberculous chemotherapy.
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Affiliation(s)
- S Hamouda
- Unité de pneumologie et allergologie pédiatrique, département de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
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Mercier A, Pouessel G, Dos Remedios J, Dewatre F, Ganga-Zandzou S, Ythier H. Abcès de la fesse et toux chronique chez une adolescente. Arch Pediatr 2007; 14:43-4, 73-6. [PMID: 17011757 DOI: 10.1016/j.arcped.2006.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2006] [Accepted: 08/08/2006] [Indexed: 11/24/2022]
Affiliation(s)
- A Mercier
- Service de pédiatrie, pavillon de pédiatrie médicochirurgical, centre hospitalier Victor-Provo, 59056 Roubaix cedex 01, France
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