Home Archive Vol.43, No.3, 2017 Osteoraticular Tuberculosis - Brief Review of Clinical Morphological and Therapeutic Profile

Osteoraticular Tuberculosis - Brief Review of Clinical Morphological and Therapeutic Profile

I. PROCOPIE(1), ELENA LEOCADIA POPESCU(1), VERONICA HUPLEA(2), R.M. PLEȘEA(3), Ș.M. GHELASE(4), G.A. STOICA(5), R.F. MUREȘAN(6), V. ONȚICĂ(6), I.E. PLEȘEA(7), D.N. ANUȘCA(8)

(1)Doctoral School, University of Medicine and Pharmacy of Craiova, Romania, (2)Faculty of Medicine, University of Oradea, Romania, (3)Department of Cellular and Molecular Biology, University of Medicine and Pharmacy of Craiova, Romania, (4)Department of Public Health and Health Management, University of Medicine and Pharmacy of Craiova, Romania, (5)Department of Pediatric Surgery, University of Medicine and Pharmacy of Craiova, Romania, (6)Department of Orthopaedics and Traumatology, Emergency County Hospital of Craiova, Romania, (7)Department of Pathology, “Carol Davila” University of Medicine and Pharmacy of Bucharest, Romania “Victor Babeș” National Institute of Research and Development in Pathology and Biomedical Sciences, (8)Department of Orthopaedics and Traumatology, Emergency County Hospital of Craiova, Romania University of Medicine and Pharmacy of Craiova, Romania

    Abstract: Osteoarticular tuberculosis (OATB) is a rare form of tuberculosis (TB) whose incidence rose significantly nowadays especially in the underdeveloped countries. The main risk factors predisposing to this new challenge for the medical system are the Human Immunodeficiency Virus (HIV) epidemic, the migration from TB endemic areas and the development of drug and multidrug-resistant strains of Mycobacterium tuberculosis (Mt). The disease affects both genders and any age group although the distribution depending on gender is controversial and that depending on age has a bimodal pattern. In most cases the initial focus is elsewhere in the organism and the most frequent pathway of dissemination is lympho-haematogenous. The clinical picture includes local symptoms as pain, tenderness and limitation of motion, with some particularities depending on the segment of the osteoarticular system involved, sometimes accompanying systemic symptoms specific for TB and other specific clinical signs as cold abscesses and sinuses. The radiographic features are not specific, CT demonstrates abnormalities earlier than plain radiography and MRI is superior to plain radiographs in showing the extent of extraskeletal involvement. Both CT and MRI can be used in patient follow-up to evaluate responses to therapy. TBhas been reported in all bones of the body, the various sites including the spine (most often involved) and extraspinal sites (arthritis, osteomyelitis and tenosynovitis and bursitis). Two basic types of disease patterns could be present: the granular type (most often in adults) and the caseous exudative type (most often in children) one of which being predominant. The algorithm of diagnosis includes several steps of which detection of Mt is the gold standard. The actual treatment is primarily medical, consisting of antituberculosis chemotherapy (ATT), surgical interventions being warranted only for selected cases. It is essential that clinicians know and refresh their knowledge about manifestations of OATB.
    Keywords: extrapulmonary tuberculosis, osteoarticular system, bones, joints

DOI 10.12865/CHSJ.43.03.01 


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Volume 43 Issue 3 2017