RESUMEN

Objective: Osteoarticular tuberculosis (OATB) is one of the most common forms of extrapulmonary tuberculosis; however, limited epidemiological data are available on this public health concern worldwide, especially in developing countries. This study aimed to analyze the clinical epidemiology and drug resistance characteristics of OATB cases in Hunan province which located in South-central China. Methods: We retrospectively enrolled OATB patients with Mycobacterium tuberculosis culture positive at Hunan Chest Hospital from January 2013 through March 31, 2022. The multiple demographic, clinical variables and drug susceptibility data of the patients were collected from the hospital's electronic patient records. Descriptive statistical methods, Chi-square test and logistic regression analysis were employed as statistical methods. Results: Of the 269 OATB cases, 197 (73.23%) were males, 206 (76.85%) were farmers; patients' ages ranged from 5 to 85 years, 57 (21.19%) aged at 20-29 years old and 52 (19.33%) aged at 60-69 years old. In terms of the disease, 177 (65.80%) had spinal TB with most occurrence in lumbar vertebrae (26.02%, 70/269), multiple spinal sites (18.96%, 51/269) and thoracic vertebrae (15.24%, 41/269). Outside of the spine, OATB mainly occurred in the lower limb (13.38%, 36/269). In terms of drug resistance, 40 (14.87%) and 72 (26.77%) were resistant to rifampicin (RFP) and isoniazid (INH) respectively; 38 (14.13%) were multi-drug resistant (MDR), and a total of 78 (29.00%) isolates were drug resistant. OATB patients aged 40-49 years old (compared to those aged ≥70 years) and from the west of Hunan province, China (compared to those from the center of Hunan) were at risk for developing RR/MDR (ORs were 5.057 and 4.942, respectively; 95% CIs were 1.009-25.342 and 1.458-16.750, respectively). Conclusion: In South-central China, OATB mainly affected males, farmers and those aged 20-29 and 60-69 years old. Spinal TB is prone to occur in the lumbar and multiple spinal sites. The resistance situation of OATB was serious, and people aged 40-49 years old and patients from the west of Hunan were risk factors of RR/MDR. All these findings will help to improve the prevention, diagnosis and treatment strategies of OATB.

Asunto(s)

RESUMEN

The clinical data of a child with disseminated tuberculosis with osteomyelitis of the right little finger as the first manifestation who was admitted to Tianjin Children's Hospital on April 8, 2023 were retrospectively analyzed. The child, a 14-year-old female, presented with osteomyelitis of the right little finger as the first manifestation. She still had recurrent fever after focal incision and drainage. She was referred to our hospital. The samples from multiple sites were positive for molecular biology detection of Mycobacterium tuberculosis. She was considered as disseminated tuberculosis and was given anti-tuberculosis treatment. The child has recovered well. Pediatric disseminated tuberculosis has variable clinical manifestations and lacks specificity. It is often misdiagnosed and has a high mortality rate. Clinicians should improve their understanding of the disease and ensure early diagnosis and treatment.

Asunto(s)

RESUMEN

BACKGROUND: Even though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet. CASE PRESENTATION: A one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery. CONCLUSION: Tubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes.

Asunto(s)

RESUMEN

INTRODUCTION: Extrapulmonary tuberculosis (EPTB) accounts for 16 % of tuberculosis cases globally, with knee joint tuberculosis more prevalent in underdeveloped nations. Total knee arthroplasty (TKA) is commonly used to treat tubercular arthritis of knee, however, there is a marked paucity of research on the outcomes after an incidental diagnosis. The aim of the study is to investigate the outcomes of total knee arthroplasty after an incidental diagnosis of tuberculosis and its management. METHODS: A prospective-observational study was conducted in NCR-Delhi from May 2019 to June 2023, wherein 533 patients had synovial tissue abnormalities and 11 patients reported with positive histopathological examination (HPE) for knee tuberculosis. All the patients whose informed consent was obtained were put on a twelve-month standard treatment (2HRZE or S/10HR) according to World Health Organization (WHO) guidelines for extrapulmonary TB after TKA and were monitored for the outcome of treatment, any postoperative complication, or implant failure. RESULT: The mean age of the patients was 63 ± 13 years and 72.7 % of patients were female. The mean hemoglobin, Body Mass Index (BMI), and Erythrocyte Sedimentation Rate (ESR) values were 10.29 ± 1.36 mg/dl, 29.78 ± 6.1 kg/m2, and 37.37 mm/h respectively and the median of the C-reactive protein (CRP) value was 11 mg/dl at the time of operative procedure. All patients presented with knee-joint pain and swelling and were operated for knee-joint replacement surgery. After one year of standard treatment (2HRZE or S/10HR), no relapses, pain, or progressive radiolucency around the component, or postoperative neurologic or vascular complications were observed. The median range of motion (ROM) was improved from 10 - to 100 to 0-115, the average knee score improved from 44.9 ± 8.9 to 84.9 ± 7.73 points and the average function score improved from 28.82 ± 15.56 to 94.0 ± 7.68 points which were statistically significant at 95 % CI (p < 0.0001). CONCLUSION: We concluded from this study that any abnormalities in ESR, CRP level prior to, and bone tissue or synovial tissue during operative procedure should be considered for articular tuberculosis and managed according to guidelines. This will make replacement procedures more sustainable and effective by lowering the risk of post-operative infection or implant-related complications and improving patients' quality of life.

Asunto(s)

RESUMEN

BACKGROUND: Cell subsets differentially modulate host immune responses to Mycobacterium tuberculosis (MTB) infection. However, the nature and functions of these subsets against osteoarticular tuberculosis (OTB) are unclear. Here, we aimed to understand the phenotypes and functions of immune cell subsets in patients with OTB using single-cell RNA sequencing (scRNA-Seq). METHODS: Pathological and healthy adjacent tissues were isolated from patients with OTB and subjected to scRNA-Seq. Unsupervised clustering of cells was performed based on gene expression profiles, and uniform manifold approximation and projection was used for clustering visualization. RESULTS: Thirteen cell subsets were identified in OTB tissues. scRNA-seq datasets of patients and healthy controls (HCs) showed that infection changed the frequency of immune cell subsets in OTB tissues. Myeloid cell examination revealed nine subsets. The frequency of macrophage-RGS1high subsets decreased in OTB tissues; this increased MTB susceptibility in an SLC7A11/ferroptosis-dependent manner. Immunohistochemistry assays and flow cytometry for patients with OTB and osteoarticular bacterial infection (OBI) and HCs verified that the frequency of macrophage-RGS1high subset decreased in OTB tissues and blood samples, thereby distinguishing patients with OTB from HCs and patients with OBI. CONCLUSION: The macrophage-RGS1high subset levels were decreased in patients with OTB, and would be up-regulated after effective treatment. Therefore, the clinical significance of this study is to discover that macrophage-RGS1high subset may serve as a potential biomarker for OTB diagnosis and treatment efficacy monitoring.

Asunto(s)

RESUMEN

Patellar tuberculosis (TB) is a rare manifestation of musculoskeletal tuberculosis, accounting for a small proportion of cases. This case report presents a detailed analysis of a female patient in her early 30s who presented with isolated TB of the patella without concurrent pulmonary involvement. The patient received antitubercular chemotherapy, consisting of a 4-month intensive phase followed by an 8-month continuation phase. This case report underscores the rarity and diagnostic complexities associated with patellar TB. The condition often presents with non-specific symptoms, often mimicking prepatellar bursitis, necessitating a high level of clinical suspicion, particularly in patients from the endemic areas. Radiographic imaging and histopathological examination play crucial roles in establishing an accurate diagnosis. Antitubercular chemotherapy forms the cornerstone of treatment while surgical intervention is reserved for cases of extensive bone destruction or treatment failure.

Asunto(s)

RESUMEN

PURPOSE: Bone and joint tuberculosis (BJTB) is a distinct variant of tuberculosis in which clinical diagnosis often leads to relative misdiagnosis and missed diagnoses. This study aimed to evaluate the diagnostic accuracy of the targeted nanopore sequencing (TNPseq) assay for BJTB patients in China. METHOD: The study enrolled a cohort of 163 patients with suspected BJTB. Diagnostic testing was performed using the TNPseq assay on samples including punctured tissue, pus, and blood. The diagnostic accuracy of the TNPseq assay was then compared with that of the T-SPOT and Xpert MTB/RIF assays. RESULT: TNPseq exhibited superior performance in terms of accuracy, demonstrating a sensitivity of 76.3% (95% CI: 71.0-81.6%) and a specificity of 98.8% (95% CI: 93.5-100%) in clinical diagnosis. When evaluated against a composite reference standard, TNPseq demonstrated a sensitivity of 74.4% (95% CI: 69.3-79.5%) and a specificity of 98.8% (95% CI: 93.7-100%). These results exceed the performance of both the T-SPOT and Xpert MTB/RIF tests. Notably, TNPseq demonstrated high specificity and accuracy in puncture specimens, with a sensitivity of 75.0% (95% CI: 70.2-79.8%) and a specificity of 98.3% (95% CI: 92.7-100%), as well as in pus samples, with a sensitivity of 83.3% (95% CI: 78.6-88.1%) and a specificity of 100% (95% CI: 100-100%). Additionally, TNPseq facilitated the detection of mixed infection scenarios, identifying 20 cases of bacterial-fungal co-infection, 17 cases of bacterial-viral co-infection, and two cases of simultaneous bacterial-fungal-viral co-infection. CONCLUSION: TNPseq demonstrated great potential in the diagnosis of BJTB due to its high sensitivity and specificity. The ability of TNPseq to diagnose pathogens and detect drug resistance genes can also guide subsequent treatment. Expanding the application scenarios and scope of TNPseq will enable it to benefit more clinical treatments.

Asunto(s)

Asunto(s)

RESUMEN

Tuberculosis (TB) arthritis remains a diagnostic challenge. In addition to clinical presentation, the use of imaging techniques and confirmation of Mycobacterium tuberculosis are essential. We present the case of a 69-year-old female in whom the diagnosis of knee TB arthritis was simultaneously established with the diagnosis of MALT lymphoma. This case report aims to highlight the role of multimodal ultrasound (US) in both diagnosis and its utility in interventional procedures, such as aspiration and synovial biopsy.

Asunto(s)

RESUMEN

Tuberculosis is one of the oldest known diseases and it remains one of the main causes of morbidity and mortality, especially in developing countries. It is associated with social inequalities and affects different age groups. Tuberculosis in children and adolescents should be considered a sentinel event, since it is linked to a recent infection through contact with bacilliferous adults. We report an immunocompetent 15-year-old adolescent with tuberculosis, exhibiting pulmonary, osteoarticular, and cutaneous involvement. Conventional treatment with tuberculostatic drugs for a year had satisfactory results without sequelae.

Asunto(s)

RESUMEN

CONTEXT AND AIMS: Tuberculosis (TB) is a leading cause of infectious disease deaths in India. It is also one of the most challenging diseases to diagnose and treat effectively. TB can occur both in the lungs and in extrapulmonary locations through hematogenous spread. Osteoarticular TB is a type of extrapulmonary characterized by atypical presentation. If diagnosed early, it can be treated effectively with reduced risk of mortality. SUBJECTS AND METHODS: At Nalanda medical college and hospital, an 18-month prospective research was undertaken. The study included a total of 120 patients with osteoarticular TB. Serum electrophoresis of blood samples was performed at baseline, 2 months, and 4 months following antitubercular medication administration. The fractions of albumin, α1, α2, ß, and γ globulins were estimated and compared with the baseline value. RESULTS: It was observed that as the disease progressed and became more chronic, there was a decrease in albumin and an increase in α1, α2, ß, and γ globulin percentages of serum proteins. Upon follow-up, the serum electrophoresis revealed that these values observed during baseline could be reversed by the administration of antitubercular drugs. CONCLUSIONS: This study suggests that analyzing serum protein fractions could be a cost-effective strategy to determine the presence of osteoarticular TB and also aid in initiating antitubercular treatment.

RésuméContexte et objectifs: La tuberculose (TB) est l'une des principales causes de décès par maladies infectieuses en Inde. C'est également l'une des maladies les plus difficiles à diagnostiquer et à traiter efficacement. La tuberculose peut survenir à la fois dans les poumons et dans des localisations extrapulmonaires par propagation hématogène. La tuberculose ostéoarticulaire est un type de tuberculose extrapulmonaire caractérisée par une présentation atypique. Si elle est diagnostiquée tôt, elle peut être traitée efficacement avec un risque de mortalité réduit. Sujets et méthodes: À la faculté de médecine et à l'hôpital de Nalanda, une recherche prospective de 18 mois a été entreprise. L'étude a inclus un total de 120 patients atteints de tuberculose ostéoarticulaire. L'électrophorèse sérique des échantillons de sang a été réalisée au départ, 2 mois et 4 mois après l'administration de médicaments antituberculeux. Les fractions d'albumine, a1, a2, b et g globulines ont été estimées et comparées à la valeur de base. Résultats: Il a été observé qu'à mesure que la maladie progressait et devenait plus chronique, il y avait une diminution de l'albumine et une augmentation des pourcentages de globulines a1, a2, b et g des protéines sériques. Lors du suivi, l'électrophorèse sérique a révélé que ces valeurs observées au départ pouvaient être inversées par l'administration de médicaments antituberculeux. Conclusions : Cette étude suggère que l'analyse des fractions protéiques sériques pourrait constituer une stratégie rentable pour déterminer la présence d'une tuberculose ostéoarticulaire et également faciliter l'initiation d'un traitement antituberculeux.

Asunto(s)

RESUMEN

Tuberculosis is a preventable and generally curable infectious disease caused by Mycobacterium tuberculosis. It mostly affects the lungs causing pulmonary tuberculosis; however, it may also involve non-pulmonary organs resulting in extrapulmonary tuberculosis (EPTB). Diagnosis of tuberculosis was based on the constitutional symptoms, organ-specific radiographs, and biological specimen examination. However, diagnosis of extrapulmonary tuberculosis can be difficult when the lungs are not affected and constitutional signs and symptoms of tuberculosis that can help to identify the disease are absent. Although multi-drug-resistant extrapulmonary tuberculosis is not uncommon, primary drug-resistant extrapulmonary tuberculosis in certain areas such as the extraspinal osteoarticular joint, tympanic membrane, and central nervous system is still rare. In this piece, we present three cases of primary multidrug-resistant extrapulmonary tuberculosis with an unusual presentation.

Asunto(s)

RESUMEN

BACKGROUND: Extrapulmonary tuberculosis (EPTB) without symptomatic pulmonary involvement has been thought to be non-transmissible, but EPTB with asymptomatic pulmonary tuberculosis (PTB) could transmit tuberculosis (TB). Genomic investigation of Mycobacterium tuberculosis (Mtb) isolates from EPTB may provide insight into its epidemiological role in TB transmission. METHODS: Between January 2017 and May 2020, 107 Mtb isolates were obtained from surgical drainage of bone TB patients at the Beijing Chest Hospital, and 218 Mtb strains were isolated from PTB cases. These 325 Mtb isolates were whole-genome sequenced to reconstruct a phylogenetic tree, identify transmission clusters, and infer transmission links using a Bayesian approach. Possible subclinical PTB in the bone TB patients was investigated with chest imaging by two independent experts. RESULTS: Among 107 bone TB patients, 10 were in genomic clusters (≤12 SNPs). Phylogenetic analysis suggested that three bone TB patients transmitted the infection to secondary cases, supported by epidemiological investigations. Pulmonary imaging of 44 bone TB patients revealed that 79.5 % (35/44) had radiological abnormalities suggestive of subclinical PTB. CONCLUSIONS: This study provides genomic evidence that bone TB patients without clinically diagnosed PTB can be sources of TB transmission, underscoring the importance of screening for subclinical, transmissible PTB among EPTB cases.

Asunto(s)

RESUMEN

RATIONALE: Tuberculosis of the long tubular bones in children's extremities is infrequent, particularly in the ulna. Early diagnosis poses significant challenges. This report presents a case involving a 2-year-old child with tuberculosis of the ulnar bone, accompanied by a comprehensive review of pertinent literature. The purpose of this study is to share diagnostic and therapeutic experiences and provide potentially valuable insights. PATIENT CONCERNS: In this case, the patient exhibited complete destruction and expansion of the ulnar bone, resulting in a forearm size considerably greater than normal. Concerns were raised about the irreversible deformation of the ulna, the potential for a malignant bone tumor, and its impact on forearm function, potentially endangering the patient's life. DIAGNOSES: The diagnosis was confirmed as tuberculosis of the ulnar bone. INTERVENTIONS: The patient underwent surgery to remove the affected ulnar tissue and received anti-tuberculosis medication. OUTCOMES: Subsequent to treatment, the destruction and expansion of the ulnar bone resolved, with the return of normal ulnar morphology and bone structure. LESSONS: Even in the absence of typical symptoms like fever, weight loss, and loss of appetite, extensive destruction and expansion of a long tubular bone should prompt vigilant consideration of bone tuberculosis.

Asunto(s)

RESUMEN

CASE: A 65-year-old female patient presented with complaints of diffuse pain and swelling in her right wrist with paresthesia in her right hand with thenar wasting. Her magnetic resonance imaging scan was suggestive of flexor tenosynovitis of the wrist with compression of the median nerve with multiple rice bodies. She underwent excisional biopsy along with median nerve decompression. Mycobacterium tuberculosis was detected by polymerase chain reaction (GeneXpert), and histopathology identified caseous granulomas. The patient was started on antitubercular chemotherapy postoperatively. CONCLUSION: In endemic countries such as India, tuberculous flexor tenosynovitis must always be a differential diagnosis in cases of wrist swelling with rice bodies.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

In the United States, rates of Mycobacterium tuberculosis infection have been declining for decades. Osteoarticular tuberculosis of the ankle is rarely observed. We present the case of a 65-year-old man who immigrated to the United States from India 24 years before the onset of symptoms. The patient initially reported atraumatic swelling and pain of the left ankle and foot and was treated for venous insufficiency. Later, the patient was referred to a nonsurgical orthopaedic clinic for additional workup and was found to have elevated inflammatory markers. MRI showed septic arthritis and osteomyelitis of the talus, distal tibia, and calcaneus. Joint aspiration revealed elevated white blood cell counts with predominately PMNs. The patient was then referred to an orthopaedic foot and ankle surgeon and underwent extensive irrigation and débridement. The patient was discharged on empiric antibiotics. Culture results from the original joint aspirate returned 14 days after surgery as positive for acid-fast bacillus, later identified as M tuberculosis by sequencing. Empiric antibiotics were discontinued, and the patient was started on appropriate antituberculotic therapy. This case report illustrates the challenge in the diagnosis of skeletal tuberculosis and the importance of including this condition on the differential for patients with atypical foot and ankle presentations.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVES: Adenosine deaminase (ADA) activity has shown good performance in diagnosing pleural, peritoneal, and meningeal tuberculosis. This meta-analysis aimed to evaluate the performance of measuring ADA activity in synovial fluid for the early diagnosis of joint tuberculosis. METHODS: We searched published information in MEDLINE, Embase, Cochrane Library, Web of Science, and MedRxiv databases, as well as unpublished information in the American College of Rheumatology and European League Against Rheumatism for conference abstracts (2012-2021). We also scanned the reference lists of articles. Two reviewers independently applied the criteria for selection, assessed quality, and extracted data (PROSPERO number CRD42021284472). RESULTS: Seven independent studies (N=305 subjects) that compared ADA activity in synovial fluid with a composite reference diagnostic method for tuberculosis were included. Overall, the risk of bias was judged low. Studies were classified as high quality (n=3; 148 subjects) and low quality (n=4; 157 subjects). Pooled sensitivity and specificity of ADA activity was 94% (95% confidence interval [CI], 0.89-98; I2=23%) and 88% (95% CI, 83-92; I2=83%), respectively. The random-effects model for pooled diagnostic Odds ratio was 67.1 (95%CI, 20.3-222.2; I2=30%). The receiver operating characteristic curve area was 0.96 (95% CI, 0.92-0.99). Meta-regression did not identify the quality of the study, country of publication, or the type of assay as a source of heterogeneity. CONCLUSIONS: Measuring ADA activity in synovial fluid demonstrates good performance for the early diagnosis of joint tuberculosis.

Asunto(s)