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Background: The delayed identification and management of musculoskeletal tuberculosis (MSTB) poses substantial health challenges and leads to significant morbidity. This study aimed to collate ten years of hospital data and provide valuable insights into the clinical, diagnostics, and outcomes of the patients diagnosed with MSTB. Methods: A retrospective study was undertaken to review clinic records from 2013 to 2022 for all individuals diagnosed with MSTB in a tertiary care hospital in South India. Results: Over a decade, 400 cases of MSTB were diagnosed, revealing 57 % males and 43 % females with a mean age of 43.2 ± 18.9 years. Spinal TB constituted 72 % of cases, with the most common involvement of thoracic vertebrae (50.9 %). Extra-spinal MSTB accounted for 28 %, prevalent more in the pediatric age group (p < 0.05). Surgical intervention was required for 80 % of spinal TB cases and 58 % of extra-spinal MSTB cases. The average follow-up duration was two years, with 73 % completing treatment. Unfortunately, seven patients died, and three experienced relapse. Conclusion: Spinal TB is the most common type of MSTB and is predominant in young and middle-aged adults, while extra-spinal MSTB is more frequently observed in children. Where use of MRI facilitates early detection of spinal TB; histopathological and microbiological examination confirm the diagnosis. Combining anti-tubercular drugs with modern surgical approaches is essential for obtaining favorable outcomes and improving the quality of life of such patients. It is crucial to have advanced and affordable diagnostic facilities, along with increased public awareness, to reinforce tuberculosis control strategies.

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OBJECTIVES: To evaluate the diagnostic accuracy of tuberculosis RNA (TB-RNA) for the rapid diagnosis of bone and joint tuberculosis (BJTB). METHODS: We conducted a retrospective study to evaluate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of TB-RNA and acid-fast bacillus (AFB) smear against the final clinical diagnosis. RESULTS: A total of 268 patients were included. The overall sensitivity, specificity, PPV, NPV, and AUC of AFB smear for BJTB were 0.7%, 100.0%, 100.0%, 49.3%, and 0.50, respectively, whereas those of TB-RNA were 59.6%, 100.0%, 100.0%, 70.6%, and 0.80, respectively; for cases of confirmed (culture-positive) BJTB, these values were 82.8%, 99.4%, 99.7%, 89.2%, and 0.91, respectively. CONCLUSIONS: The diagnostic accuracy of TB-RNA in the rapid diagnosis of BJTB was relatively good, especially in culture-positive BJTB. The use of TB-RNA could be an effective technique for the rapid diagnosis of BJTB.

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OBJECTIVES: To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis (BJTB) using tissue specimens, and to compare the diagnostic accuracy of different types of tissue specimens. METHODS: This study involved 242 patients admitted with suspected BJTB between May 2018 and March 2020. The Xpert MTB/RIF assay was performed on surgically excised tissue. Diagnostic accuracy of the Xpert MTB/RIF assay was evaluated by culture, histopathology and a composite reference standard (CRS). RESULTS: One hundred and seventy-five patients were excluded (91 based on the exclusion criteria, and 84 as pus specimens were used instead of tissue specimens). Of the 67 patients enrolled, 14 were confirmed as BJTB, 20 as probable BJTB, 11 as possible BJTB, and 22 as non-BJTB. Using culture as the reference standard, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) of the Xpert MTB/RIF assay were 92.9% (88.2-97.6%), 62.3% (56.1-68.5%), 39.4% (33.2-45.6%), 97.1% (92.3-100.0%), 2.464 (1.077-3.851), 0.114 (0.025-0.203) and 0.776 (0.654-0.897), respectively. When histopathology was used as the reference standard, the Xpert MTB/RIF assay had sensitivity, specificity, PPV, NPV, PLR, NLR and AUC of 79.3% (73.5-85.1%), 73.7% (67.8-79.6%), 69.7% (63.8-75.6%), 82.4% (76.5-88.3%), 3.015 (1.184-4.846), 0.281 (0.141-0.421) and 0.765 (0.646-0.884), respectively. Sensitivity, specificity, PPV, NPV, PLR, NLR and AUC obtained when using CRS as the reference were 73.3% (67.9-78.7%), 100.0% (100.0-100.0%), 100.0% (100.0-100.0%), 64.7% (58.5-70.9%), +∞, 0.267 (0.129-0.405) and 0.867 (0.781-0.952), respectively. Tissue samples were classified, and the positive rate of the Xpert MTB/RIF assay for BJTB using granulation tissue specimens was found to be significantly higher than that for caseous necrotic tissue, sequestrum and other necrotic connective tissues (P < 0.05). CONCLUSION: The Xpert MTB/RIF assay showed high sensitivity and specificity for the diagnosis of BJTB from tissue specimens.

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BACKGROUND: Musculoskeletal tuberculosis (TB) continues to share the major burden of extrapulmonary TB. This burden up to some extent may be attributed to the implementation gap which is reasonably broadest at the level of the immediate point of care. As an orthopedic physician is an important stakeholder at this juncture, it is imperative to recognize their experiences, perceptions, and anticipations to fill this gap. This qualitative inquiry tries to explore these attributes in the context of the recent development at the policy level in Revised National Tuberculosis Control Program. METHODOLOGY: Type of Study Qualitative inquiry with framework approach. SETTINGS: Orthopedic surgeons working in different work settings. SAMPLING METHOD: Purposive sampling. An iterative topic guide for an in-depth interview was prepared by reviewing the literature and expert opinions. The questions were contextual, diagnostic, evaluative, and strategic. This study adopted a framework approach as the issue was near to evaluative and strategic policy research. The recorded interviews were transcribed and coded into axial and serial codes. A framework matrix was created and thematic mapping was done to understand the phenomena and to offer the solution framework. RESULTS: The investigators detected an element of unawareness of the current context coupled with the perceived previous stringency of the program. This is in conjunction with already multifaceted diagnostic and prognostic complexity. This leads to mutual dissociation and skepticism. CONCLUSION: This qualitative inquiry explored an element of dissociation between programmatic objectives and individualistic concerns of the caregivers. An integrated ecosystem which may take care of synergistic reciprocation among the two is imperative for successful implementation.

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BACKGROUND: Nine percent of all cases of tuberculosis are bone and joint tuberculosis (BJTB). BJTB occurs in two main forms: spinal (STB) and extraspinal (ESTB). The aim of this study was to compare STB with ESTB in terms of diagnosis, treatment and outcomes. METHODS: We collected demographic, clinical, microbiological, treatment duration and outcome data for patients with BJTB in a retrospective multicentre study over a 17-year period. RESULTS: Of the 116 patients included in the study, 69 (59.5%) had STB and 47 (40.5%) had ESTB. The median age was higher in the ESTB group. There were significantly more foreign-born patients in the STB group. The median time for diagnosis was longer for ESTB (6 months) than STB (4 months) (p = 0.017). Magnetic resonance imaging was highly reliable for the diagnosis. Direct examination and histology allowed the diagnosis to be made in more than 80% of cases. The median treatment duration of 12 months, regardless of the type of BJTB, was longer than recommended. A favourable outcome was achieved in 91.9% of cases. CONCLUSION: The management of BJTB remains challenging. An earlier diagnosis should be more effective, reducing the total duration of treatment and leading to better tolerance.

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BACKGROUND: We evaluated the application value of Xpert MTB/RIF and T-SPOT.TB in the diagnosis of bone and joint tuberculosis. METHODS: One hundred two patients with suspected bone and joint tuberculosis (BJTB) were admitted to Zhengzhou Orthopaedics Hospital, Henan, China from April 2018 to February 2019. The Xpert MTB/RIF and T-SPOT.TB tests were performed using pus specimens and peripheral blood, respectively. The diagnostic performance of Xpert MTB/RIF and T-SPOT.TB tests was evaluated on the basis of the composite reference standard (CRS). RESULT: A Total of 73 suspected BJTB were enrolled and categorized, including 12 confirmed BJTB, 27 probable BJTB and 34 non-BJTB. When CRS was used as the reference, the specificity, PPV and NLR values of the Xpert MTB/RIF assay were significantly higher than those of the T-SPOT.TB assay (97.1% vs. 82.4%, p < 0.05; 96.7% vs. 85.4%, p < 0.05; 0.26 vs. 0.12, p < 0.05). However, the sensitivity, NPV and PLR values of the T-SPOT. TB assay were significantly higher than those of the Xpert MTB/RIF assay (89.7% vs. 74.4%, p < 0.05; 87.5% vs. 76.7%, p < 0.05; 5.08 vs. 2.52, p < 0.05). The AUCs from Xpert MTB/RIF and T-SPOT. TB tests were 0.857 and 0.860, respectively. However, the difference was not statistically significant. The Xpert MTB/RIF and T-SPOT. TB tests demonstrated medium concordance in diagnosing BJTB. CONCLUSION: The sensitivity of T-SPOT.TB test combined with the specificity of Xpert MTB/RIF not only shorten the time of diagnosis but also improve the accuracy of diagnosis of BJTB and reduce the misdiagnosis rate. Therefore, they are useful for early diagnosis of BJTB.

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BACKGROUND: China had the third highest burden of tuberculosis population in the world. Bone and joint tuberculosis was a major part and its characteristics were rarely discussed before. This study was designed to review the characteristics and management of bone and joint tuberculosis among native and migrant population in Shanghai, China during 2011-2015. METHODS: A retrospective analysis of the patient clinical records on their demographic information, clinical features and treatment was conducted from three tertiary referral hospitals. Analysis of continuous variables included calculation of the median value with interquartile range. Categorical variables were displayed as percentages and compared using the Fisher's exact test and chi-square test. All continuous variables were compared using Student's unpaired t-test and Mann Whitney U test. RESULTS: One hundred fifteen patients with bone and joint tuberculosis were involved in this study. Native people were generally older (p = 0.003) and had more comorbidities like hypertension (40.74% vs. 16.39%, p = 0.004), diabetes mellitus (38.89% vs. 13.11%, p = 0.001), and cancer (31.48% vs. 14.75%, p = 0.032) than migrants. Migrant patients generally experienced a longer period of uncomfortable feelings before going to doctor than native people (p = 0.007). Spine was a major infection site in comparison with other peripheral joints. Radiological evaluation displayed increased osteolytic reaction in migrant patients compared with native people (p = 0.031). The mean time for anti-tuberculosis treatment was significantly longer in native Shanghai patients (8.96 months vs. 7.94 months, p = 0.003). The curative ratio displayed a significant difference between native and migrant patients (88.24%vs.75.93%, p = 0.009). CONCLUSION: Bone and joint tuberculosis exhibited a poorer outcome in migrant people, who also had longer period of manifestation, more severe osteolytic reaction from CT scan and higher recurrent rate than native people. The surgical treatment in addition to anti-tuberculosis drug therapy had great implications for bone and joint tuberculosis recovery.

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PURPOSE: Peterborough has one of the highest rates of tuberculosis (TB) in the east of England. We reviewed the epidemiology, management and outcome of all cases of bone and joint TB (BJTB) diagnosed since 2000. METHODOLOGY: Retrospective review of all adult cases of BJTB between 1 January 2000 and 31 December 2015. Patients' notes were reviewed with regard to their presentation, investigation, management and outcomes. RESULTS: In total, 21 patients diagnosed with BJTB were reviewed. Thoracic and lumbar spine were the most common sites affected (62 %). The most common clinical manifestations included localized pain (76 %), fever (53 %) and weight loss (48 %). Fourteen (67 %) patients had a bone biopsy or aspirate sent for microbiological investigation; none were smear-positive, but 11 were culture-positive. Eleven patients (77 %) were fully susceptible to anti-tuberculous drugs, one was isoniazid-resistant and one was pyrazinamide-resistant. Anti-tuberculous therapy was given for 6-16 months. Nineteen (90 %) patients completed therapy. CONCLUSIONS: BJTB requires a high index of clinical suspicion. BJTB should be considered in any patient with unexplained pain, fever and weight loss. The diagnosis is proven by aspiration and biopsy and should be undertaken as soon as possible for culture purposes, as microscopy alone can be negative.

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BACKGROUND: To evaluate the application of interferon gamma release assay (IGRA), rifampicin resistant real-time fluorescence quantitative PCR technique Xpert Mycobacterium tuberculosis/rifampicin (Xpert MTB/RIF), and the levels of TNF-α and TGF-ß in the diagnosis of bone and joint tuberculosis. METHODS: Eighty-six patients with bone and joint tuberculosis, diagnosed by pathology or microbiology, were examined by Xpert MTB/RIF and IGRA (T-SPOT. TB) for Mycobacterium tuberculosis infection, and the TNF-α and TGF-ß levels of the patients were measured. RESULTS: The sensitivity of IGRA in diagnosing bone and joint tuberculosis was 81.4%; Xpert MTB/RIF's sensitivity was 70.9%. The combined sensitivity of the two methods was 91.9%. The combined detection sensitivity of the two methods was higher than individual IGRA or Xpert MTB/RIF detection sensitivity. The TNF-α and TGF-ß levels in bone and joint tuberculosis patients were higher than those in the control group. CONCLUSION: Xpert MTB/RIF, IGRA, TNF-α, and TGF-ßs expression have value in the rapid diagnosis of bone and joint tuberculosis, and the sensitivity and accuracy of bone and joint tuberculosis diagnosis by combining them can improve it.

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Rifapentine-loaded poly(lactic-co-glycolic acid) microspheres (RPMs)-loaded bone-like hydroxyapatite/poly amino acid (BHA/PAA) is effective in curing Staphylococcus aureus-induced chronic osteomyelitis. This study continues to investigate the effect of RPM-loaded BHA/PAA on the bacterial growth of Mycobacterium tuberculosis (MTB), cell proliferation and differentiation in MTB H37Rv-infected MG63 cells. Furthermore, whether Wnt/ß-catenin signaling pathway was activated by RPM-loaded BHA/PAA was explored. We found the bactec growth index of H37Rv was significantly inhibited by RPM-loaded BHA/PAA. The MTT assay showed that RPM-loaded BHA/PAA could promote the cell proliferation of H37Rv-infected MG63 cells, as determined by MTT assay. The alkaline phosphatase (ALP) activity and the expression of runt-related transcription factor 2 (Runx2) and osteocalcin (OCN) was examined by commercial kit and Western blot analysis to determine the effect of RPM-loaded BHA/PAA on MTB H37Rv-infected MG63 cell differentiation. It was revealed that RPM-loaded BHA/PAA could promote cell differentiation of H37Rv-infected MG63 cells. Furthermore, we found the expression of Wnt1, LDL receptor related protein 6 (Lrp6) and ß-catenin was significantly increased in H37Rv-infected MG63 cells following treatment with RPM-loaded BHA/PAA, as determined by Western blot analysis. In conclusion, this study demonstrated that RPM-loaded BHA/PAA has an effective activity against MTB. RPM-loaded BHA/PAA promoted cell proliferation and cell differentiation of H37Rv-infected MG63 cells. Wnt/ß-catenin signaling could be activated by RPM-loaded BHA/PAA in MG63 cells infected with H37Rv. This study demonstrated the potential value of RPM-loaded BHA/PAA in treating bone and joint TB, and suggested Wnt/ß-catenin signaling may be an important pathway underlying its function.

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Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .

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Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .

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BACKGROUND: Bone and joint tuberculosis (BJTB) constitutes about 10-20% of the extrapulmonary tuberculosis (EPTB) cases in China. The GenoType MTBDRplus assay (MTBDR) has been endorsed by the World Health Organization (WHO) for the diagnosis of pulmonary TB (PTB), while the Xpert MTB/RIF assay (Xpert) has also been endorsed by the WHO for the diagnosis of both PTB and EPTB. The diagnostic utility of these two techniques for BJTB was investigated prospectively. METHODS: Sixty pus specimens were obtained from orthopedic patients. Smear, culture, Xpert, and MTBDR assays were performed for each specimen, and MGIT 960-based drug susceptibility testing (DST) was conducted for all of the isolates recovered. The diagnostic efficiency of Xpert and MTBDR was evaluated on the basis of bacteriological examination and the composite reference standard (CRS). RESULTS: Fifty of the 60 patients were considered to have BJTB according to the CRS. The sensitivities of smear, culture, Xpert, and MTBDR were 26% (13/50), 48% (24/50), 82% (41/50), and 72% (36/50) respectively, while the specificities of all of the tests were 100% (10/10). Xpert was 100% concordant with MGIT 960-based DST for the detection of rifampicin resistance. MTBDR had a sensitivity of 83.3% and a specificity of 100% for the detection of rifampicin resistance and a sensitivity of 85.7% and specificity of 100% for the detection of isoniazid resistance. CONCLUSION: With their high sensitivities, short turnaround times, and ability to diagnose TB and detect drug resistance simultaneously, both Xpert and MTBDR are feasible as diagnostic tools for BJTB in clinical practice.

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Objective To analyze and discuss the clinical value of tuberculosis infection T cell ELISPOT test and tuberculosis antibody test used in bone and joint tuberculosis.Methods The patients with suspected bone and joint TB diagnosed and treated in Xishan people's Hospital of Wuxi City from 2012 to 2014 were selected as the objects of this study.They were taken randomly,which divided into T-SPOT.TB test group and tuberculosis antibody test groups.Each group had 162 per-sons.The patients of T-SPOT.TB test group were tested by tuberculosis infection T cell enzyme-linked immunosorbent spot test,tuberculosis antibody test group were taken tuberculosis antibody test,comparative analysis of the sensitivity and speci-ficity of two diagnostic methods were contrastively analyzed.Results The sensitivity and specificity of T-SPOT.TB test group were 93.43% and 84.00%.The sensitivity and specificity of tuberculosis antibody in the experimental group were 40.44% and 53.85%.There was statistical difference between two groups (χ2 =184.62,7.86,all P <0.05).The false posi-tive rate and the false negative rate of T-SPOT.TB test group were 16.00% and 6.57%.The false positive rate and the false negative rate of tuberculosis antibodies in the experimental group were 26.92% and 59.56%,respectively.There was statis-tical difference between two groups (χ2 =7.86,156.18,all P <0.05).In addition,the positive and negative predictive values of T-SPOT.TB test group were 96.97% and 70.00%.Positive and negative predictive values of tuberculosis antibody in the experimental group were 88.71% and 14.74%.There was statistical difference between two groups (χ2 = 20.27,73.06,all P <0.01).Conclusion Compared to experimental tuberculosis antibody,TB infection of T cells ELISPOT test had high sen-sitivity and specificity in the diagnosis of bone and joint tuberculosis.It’s worthy of spreading.

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Musculoskeletal tuberculosis (TB) is a severe extrapulmonary manifestation of chronic Mycobacterium (M.) tuberculosis infection. Considering increasing incidence, multi-drug resistance and associated treatment difficulties, more preclinical research is needed. In this study we developed a murine model for musculoskeletal TB. Mice, intranasally infected with M. tuberculosis, were sacrificed after ten months. Mycobacterial growth was detected in lung and femur homogenates. Ziehl-Neelsen staining of paraffin-embedded femurs showed acid-fast rods in the myelum and Magnetic Resonance Imaging demonstrated osteomyelitis and macronodular tuberculomas. This new murine model of musculoskeletal TB might be of value to further investigate immunologic and radiologic responses.

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For confirmative diagnosis of bone and joint tuberculosis, it is made by culture method, inoculation to guinea pig, or histological examination of the specimen obtained from a lesion site. But plain reontgenogram is not valuable for early detection of the disease because specific, abnormal finding is not found in early stage and only found in late stage as progressive destruction of bone and joint. Many reports were made thst whole body bone scan, as diagnostic tool, was valuable in other orthopedic disease, but report for its diagnostic value in bone and joint tuberculosis is very rare. The study was carried out on 35 patients of bone and joint tuberculosis who whole body bone scan was performed before operation from Janusry, 1978 to December, 1987 in Depaartment of Orthopedic Surgery, Yonsei University college of Medicine. The following results were obtained. 1. Value of early detection of tuberculosis is not much as pyogenic infection. Intensity of uptake was decreased in tuberculosis than acute pyogenic osteomyelitis and arthritis, but increased than chronic osteomyelitis. 2. Intensity of uptake was decreased in female than male, and also increased in age. group under 10 and over 60 than other age group. 3. The longer duration of the disease, the more decreased intensity of uptake. 4. Intensity of uptake is increased in joint tuberculosis than bone, snd also increased in tuberculosis of spine than long bone. 5. Multifocal disease was detected in 14.3% by whole body bone scan.

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