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Musculoskeletal Tuberculosis

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  • Authors: Michael K. Leonard Jr.1, Henry M. Blumberg2
  • Editor: David Schlossberg3
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Division of Infectious Diseases, Carolinas HealthCare System, Charlotte, NC 28209; 2: Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30303; 3: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
  • Received 17 January 2017 Accepted 13 February 2017 Published 14 April 2017
  • Michael K. Leonard, Michael.Leonard@carolinashealthcare.org
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  • Abstract:

    Musculoskeletal tuberculosis (TB) accounts for approximately 10% of all extrapulmonary TB cases in the United States and is the third most common site of extrapulmonary TB after pleural and lymphatic disease. Vertebral involvement (tuberculous spondylitis, or Pott’s disease) is the most common type of skeletal TB, accounting for about half of all cases of musculoskeletal TB. The presentation of musculoskeletal TB may be insidious over a long period and the diagnosis may be elusive and delayed, as TB may not be the initial consideration in the differential diagnosis. Concomitant pulmonary involvement may not be present, thus confusing the diagnosis even further. Early diagnosis of bone and joint disease is important to minimize the risk of deformity and enhance outcome. The introduction of newer imaging modalities, including MRI (imaging procedure of choice) and CT, has enhanced the diagnostic evaluation of patients with musculoskeletal TB and for directed biopsies of affected areas of the musculoskeletal system. Obtaining appropriate specimens for culture and other diagnostic tests is essential to establish a definitive diagnosis and recover for susceptibility testing. A total of 6 to 9 months of a rifampin-based regimen, like treatment of pulmonary TB, is recommended for the treatment of drug susceptible musculoskeletal disease. Randomized trials of tuberculous spondylitis have demonstrated that such regimens are efficacious. These data and those from the treatment of pulmonary TB have been extrapolated to form the basis of treatment regimen recommendations for other forms of musculoskeletal TB.

  • Citation: Leonard M, Blumberg H. 2017. Musculoskeletal Tuberculosis. Microbiol Spectrum 5(2):TNMI7-0046-2017. doi:10.1128/microbiolspec.TNMI7-0046-2017.

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Central Nervous System Diseases
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References

1. Zink A, Haas CJ, Reischl U, Szeimies U, Nerlich AG. 2001. Molecular analysis of skeletal tuberculosis in an ancient Egyptian population. J Med Microbiol 50:355–366. [PubMed]
2. Crubézy E, Ludes B, Poveda JD, Clayton J, Crouau-Roy B, Montagnon D. 1998. Identification of Mycobacterium DNA in an Egyptian Pott’s disease of 5,400 years old. C R Acad Sci III 321:941–951.[PubMed]
3. Konomi N, Lebwohl E, Mowbray K, Tattersall I, Zhang D. 2002. Detection of mycobacterial DNA in Andean mummies. J Clin Microbiol 40:4738–4740. [PubMed]
4. Donoghue HD, Spigelman M, Greenblatt CL, Lev-Maor G, Bar-Gal GK, Matheson C, Vernon K, Nerlich AG, Zink AR. 2004. Tuberculosis: from prehistory to Robert Koch, as revealed by ancient DNA. Lancet Infect Dis 4:584–592. [PubMed]
5. Salo WL, Aufderheide AC, Buikstra J, Holcomb TA. 1994. Identification of Mycobacterium tuberculosis DNA in a pre-Columbian Peruvian mummy. Proc Natl Acad Sci U S A 91:2091–2094. [PubMed]
6. Fang HS, Ong GB, Hodgson AR. 1964. Anterior spinal fusion: the operative approaches. Clin Orthop Relat Res 35:16–33. [PubMed]
7. Centers for Disease Control and Prevention. 2016. Reported Tuberculosis in the United States, 2015. CDC, Atlanta, GA. [PubMed]
8. Hodgson SP, Ormerod LP. 1990. Ten-year experience of bone and joint tuberculosis in Blackburn 1978–1987. J R Coll Surg Edinb 35:259–262. [PubMed]
9. Lafond EM. 1958. An analysis of adult skeletal tuberculosis. J Bone Joint Surg Am 40-A:346–364. [PubMed]
10. Talbot JC, Bismil Q, Saralaya D, Newton DA, Frizzel RM, Shaw DL. 2007. Musculoskeletal tuberculosis in Bradford—a 6-year review. Ann R Coll Surg Engl 89:405–409. [PubMed]
11. Colmenero JD, Jiménez-Mejías ME, Reguera JM, Palomino-Nicás J, Ruiz-Mesa JD, Márquez-Rivas J, Lozano A, Pachón J. 2004. Tuberculous vertebral osteomyelitis in the new millennium: still a diagnostic and therapeutic challenge. Eur J Clin Microbiol Infect Dis 23:477–483. [PubMed]
12. Leibert E, Schluger NW, Bonk S, Rom WN. 1996. Spinal tuberculosis in patients with human immunodeficiency virus infection: clinical presentation, therapy and outcome. Tuber Lung Dis 77:329–334.
13. Franco-Paredes C, Díaz-Borjon A, Senger MA, Barragan L, Leonard M. 2006. The ever-expanding association between rheumatologic diseases and tuberculosis. Am J Med 119:470–477. [PubMed]
14. Ludwig B, Lazarus AA. 2007. Musculoskeletal tuberculosis. Dis Mon 53:39–45. [PubMed]
15. Davidson PT, Horowitz I. 1970. Skeletal tuberculosis. A review with patient presentations and discussion. Am J Med 48:77–84. [PubMed]
16. Agarwal RP, Mohan N, Garg RK, Bajpai SK, Verma SK, Mohindra Y. 1990. Clinicosocial aspect of osteo-articular tuberculosis. J Indian Med Assoc 88:307–309. [PubMed]
17. Evanchick CC, Davis DE, Harrington TM. 1986. Tuberculosis of peripheral joints: an often missed diagnosis. J Rheumatol 13:187–189. [PubMed]
18. Belzunegui J, Plazaola I, Uriarte E, Pego JM. 1995. Primary tuberculous muscle abscess in a patient with systemic lupus erythematosus. Br J Rheumatol 34:1177–1178. [PubMed]
19. De Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper AM. 2003. Imaging features of musculoskeletal tuberculosis. Eur Radiol 13:1809–1819. [PubMed]
20. Moore SL, Rafii M. 2001. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am 39:329–342. [PubMed]
21. Compere EL, Garrison M. 1936. Correlation of pathologic and roentgenologic findings in tuberculosis and pyogenic infections of the vertebrae: the fate of the intervertebral disk. Ann Surg 104:1038–1067.
22. Palmer PES. 2001. The Imaging of Tuberculosis: With Epidemiological, Pathological, and Clinical Correlation. Springer-Verlag, New York, NY.
23. Naim-ur-Rahman. 1980. Atypical forms of spinal tuberculosis. J Bone Joint Surg Br 62-B:162–165. [PubMed]
24. Calderone RR, Larsen JM. 1996. Overview and classification of spinal infections. Orthop Clin North Am 27:1–8. [PubMed]
25. Boachie-Adjei O, Squillante RG. 1996. Tuberculosis of the spine. Orthop Clin North Am 27:95–103. [PubMed]
26. Watts HG, Lifeso RM. 1996. Tuberculosis of bones and joints. J Bone Joint Surg Am 78:288–298. [PubMed]
27. Al Soub H. 1996. Retropharyngeal abscess associated with tuberculosis of the cervical spine. Tuber Lung Dis 77:563–565. [PubMed]
28. Wurtz R, Quader Z, Simon D, Langer B. 1993. Cervical tuberculous vertebral osteomyelitis: case report and discussion of the literature. Clin Infect Dis 16:806–808. [PubMed]
29. Burke HE. 1950. The pathogenesis of certain forms of extrapulmonary tuberculosis; spontaneous cold abscesses of the chest wall and Pott’s disease. Am Rev Tuberc 62(1-B):48–67. [PubMed]
30. Colmenero JD, Jiménez-Mejías ME, Sánchez-Lora FJ, Reguera JM, Palomino-Nicás J, Martos F, García de las Heras J, Pachón J. 1997. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56:709–715. [PubMed]
31. LeRoux PD, Griffin GE, Marsh HT, Winn HR. 1990. Tuberculosis of the skull—a rare condition: case report and review of the literature. Neurosurgery 26:851–855; discussion, 855–856. [PubMed]
32. Strauss DC. 1933. Tuberculosis of the flat bones of the vault of the skull. Surg Gynecol Obstet 57:384–398.
33. Asnis DS, Niegowska A. 1997. Tuberculosis of the rib. Clin Infect Dis 24:1018–1019. [PubMed]
34. González Herranz J, Farrington DM, Angulo Gutiérrez J, Rodriguez Ferrol P. 1997. Peripheral osteoarticular tuberculosis in children: tumor-like bone lesions. J Pediatr Orthop B 6:274–282. [PubMed]
35. Zahraa J, Johnson D, Lim-Dunham JE, Herold BC. 1996. Unusual features of osteoarticular tuberculosis in children. J Pediatr 129:597–602. [PubMed]
36. Isaacs AJ, Sturrock RD. 1974. Poncet’s disease—fact or fiction? A re-appraisal of tuberculous rheumatism. Tubercle 55:135–142. [PubMed]
37. Kroot EJ, Hazes JM, Colin EM, Dolhain RJ. 2007. Poncet’s disease: reactive arthritis accompanying tuberculosis. Two case reports and a review of the literature. Rheumatology (Oxford) 46:484–489. [PubMed]
38. Huang DY. 1990. Tuberculous muscle abscess: an unusual presentation of tuberculosis. Am J Med 88:57N–59N. [PubMed]
39. Plummer WW, Sanes S, Smith WS. 1934. Hematogenous tuberculosis of skeletal muscle; report of the case with involvement of gastrocnemius muscle. J Bone Joint Surg Am 16:631–639.
40. Ahmed J, Homans J. 2002. Tuberculosis pyomyositis of the soleus muscle in a fifteen-year-old boy. Pediatr Infect Dis J 21:1169–1171. [PubMed]
41. Kobayashi H, Kotoura Y, Hosono M, Tsuboyama T, Sakahara H, Konishi J. 1995. Solitary muscular involvement by tuberculosis: CT, MRI, and scintigraphic features. Comput Med Imaging Graph 19:237–240. [PubMed]
42. Lupatkin H, Bräu N, Flomenberg P, Simberkoff MS. 1992. Tuberculous abscesses in patients with AIDS. Clin Infect Dis 14:1040–1044. [PubMed]
43. Martini M, Ouahes M. 1988. Bone and joint tuberculosis: a review of 652 cases. Orthopedics 11:861–866. [PubMed]
44. Pertuiset E, Beaudreuil J, Lioté F, Horusitzky A, Kemiche F, Richette P, Clerc-Wyel D, Cerf-Payrastre I, Dorfmann H, Glowinski J, Crouzet J, Bardin T, Meyer O, Dryll A, Ziza JM, Kahn MF, Kuntz D. 1999. Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980–1994. Medicine (Baltimore) 78:309–320.
45. McLain RF, Isada C. 2004. Spinal tuberculosis deserves a place on the radar screen. Cleve Clin J Med 71:537–539, 543–549. [PubMed]
46. García S, Combalía A, Serra A, Segur JM, Ramón R. 1997. Unusual locations of osteoarticular tuberculosis. Arch Orthop Trauma Surg 116:321–323. [PubMed]
47. Neumann JL, Schlueter DP. 1974. Retropharyngeal abscess as the presenting feature of tuberculosis of the cervical spine. Am Rev Respir Dis 110:508–511. [PubMed]
48. Lukhele M. 1996. Tuberculosis of the cervical spine. S Afr Med J 86:553–556. [PubMed]
49. Al-Matar MJ, Cabral DA, Petty RE. 2001. Isolated tuberculous monoarthritis mimicking oligoarticular juvenile rheumatoid arthritis. J Rheumatol 28:204–206. [PubMed]
50. Valdazo JP, Perez-Ruiz F, Albarracin A, Sanchez-Nievas G, Perez-Benegas J, Gonzalez-Lanza M, Beltran J. 1990. Tuberculous arthritis. Report of a case with multiple joint involvement and periarticular tuberculous abscesses. J Rheumatol 17:399–401. [PubMed]
51. Gros T, Soriano V, Gabarre E, Tor J, Sabriá M. 1992. Multifocal tubercular osteitis in a female patient infected with the human immunodeficiency virus. Rev Clin Esp 191:35–37. (In Spanish.) [PubMed]
52. Babhulkar SS, Pande SK. 2002. Unusual manifestations of osteoarticular tuberculosis. Clin Orthop Relat Res 398:114–120. [PubMed]
53. Franco-Paredes C, Blumberg HM. 2001. Psoas muscle abscess caused by Mycobacterium tuberculosis and Staphylococcus aureus: case report and review. Am J Med Sci 321:415–417. [PubMed]
54. Chernoff WG, Parnes LS. 1992. Tuberculous mastoiditis. J Otolaryngol 21:290–292. [PubMed]
55. Wu H, Wang QZ, Jin Y. 1998. Tuberculosis of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:243. [PubMed]
56. McLellan DG, Philips KB, Corbett CE, Bronze MS. 2000. Sternal osteomyelitis caused by Mycobacterium tuberculosis: case report and review of the literature. Am J Med Sci 319:250–254. [PubMed]
57. Jaovisidha S, Chen C, Ryu KN, Siriwongpairat P, Pekanan P, Sartoris DJ, Resnick D. 1996. Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases. Radiology 201:507–513. [PubMed]
58. Klofkorn RW, Steigerwald JC. 1976. Carpal tunnel syndrome as the initial manifestation of tuberculosis. Am J Med 60:583–586. [PubMed]
59. Rashid M, Sarwar SU, Haq EU, Islam MZ, Rizvi TA, Ahmad M, Shah K. 2006. Tuberculous tenosynovitis: a cause of carpal tunnel syndrome. J Pak Med Assoc 56:116–118. [PubMed]
60. Hoffman KL, Bergman AG, Hoffman DK, Harris DP. 1996. Tuberculous tenosynovitis of the flexor tendons of the wrist: MR imaging with pathologic correlation. Skeletal Radiol 25:186–188. [PubMed]
61. Cramer K, Seiler JG III, Milek MA. 1991. Tuberculous tenosynovitis of the wrist. Two case reports. Clin Orthop Relat Res 262:137–140. [PubMed]
62. Tuli SM. 2002. General principles of osteoarticular tuberculosis. Clin Orthop Relat Res 398:11–19. [PubMed]
63. De Backer AI, Mortelé KJ, Vanhoenacker FM, Parizel PM. 2006. Imaging of extraspinal musculoskeletal tuberculosis. Eur J Radiol 57:119–130. [PubMed]
64. De Backer AI, Vanhoenacker FM, Sanghvi DA. 2009. Imaging features of extraaxial musculoskeletal tuberculosis. Indian J Radiol Imaging 19:176–186. [PubMed]
65. Handa U, Garg S, Mohan H, Garg SK. 2010. Role of fine-needle aspiration cytology in tuberculosis of bone. Diagn Cytopathol 38:1–4. [PubMed]
66. Pai M, Ling DI. 2008. Rapid diagnosis of extrapulmonary tuberculosis using nucleic acid amplification tests: what is the evidence? Future Microbiol 3:1–4. [PubMed]
67. Held M, Laubscher M, Zar HJ, Dunn RN. 2014. GeneXpert polymerase chain reaction for spinal tuberculosis: an accurate and rapid diagnostic test. Bone Joint J 96-B:1366–1369. [PubMed]
68. Held M, Laubscher M, Mears S, Dix-Peek S, Workman L, Zar H, Dunn R. 2016. Diagnostic accuracy of the Xpert MTB/RIF assay for extrapulmonary tuberculosis in children with musculoskeletal infections. Pediatr Infect Dis J 35:1165–1168. [PubMed]
69. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, Keane J, Lewinsohn DA, Loeffler AM, Mazurek GH, O’Brien RJ, Pai M, Richeldi L, Salfinger M, Shinnick TM, Sterling TR, Warshauer DM, Woods GL. 2017. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis 64:111–115. [PubMed]
70. Raut AA, Naphade PS, Ramakantan R. 2016. Imaging spectrum of extrathoracic tuberculosis. Radiol Clin North Am 54:475–501. [PubMed]
71. Griffith JF, Kumta SM, Leung PC, Cheng JC, Chow LT, Metreweli C. 2002. Imaging of musculoskeletal tuberculosis: a new look at an old disease. Clin Orthop Relat Res 398:32–39. [PubMed]
72. Clementsen P, Hansen M, Conrad C, Myhre O. 1988. Percutaneous drainage of tuberculous abscess of the psoas muscle. Tubercle 69:63–65. [PubMed]
73. Hoffman EB, Crosier JH, Cremin BJ. 1993. Imaging in children with spinal tuberculosis. A comparison of radiography, computed tomography and magnetic resonance imaging. J Bone Joint Surg Br 75:233–239. [PubMed]
74. De Backer AI, Mortelé KJ, Vanschoubroeck IJ, Deeren D, Vanhoenacker FM, De Keulenaer BL, Bomans P, Kockx MM. 2005. Tuberculosis of the spine: CT and MR imaging features. JBR-BTR 88:92–97. [PubMed]
75. Phemister DB, Hatcher CH. 1933. Correlation of the pathological findings in the diagnostic of tuberculous arthritis. Am J Roentgenol Radium Ther Nucl Med 29:736–740.
76. Hong SH, Kim SM, Ahn JM, Chung HW, Shin MJ, Kang HS. 2001. Tuberculous versus pyogenic arthritis: MR imaging evaluation. Radiology 218:848–853. [PubMed]
77. Moore SL, Rafii M. 2003. Advanced imaging of tuberculosis arthritis. Semin Musculoskelet Radiol 7:143–153. [PubMed]
78. Morris BS, Varma R, Garg A, Awasthi M, Maheshwari M. 2002. Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography. Skeletal Radiol 31:1–8. [PubMed]
79. Tiwari A, Sud A, Mehta S, Kanojia RK, Kapoor SK. 2007. Multifocal skeletal tuberculosis presenting as multiple bone cysts. Ann Acad Med Singapore 36:1038–1039. [PubMed]
80. Abdelwahab IF, Bianchi S, Martinoli C, Klein M, Hermann G. 2006. Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients: part II, tuberculous myositis, tuberculous bursitis, and tuberculous tenosynovites. Can Assoc Radiol J 57:278–286. [PubMed]
81. Graves VB, Schreiber MH. 1973. Tuberculous psoas muscle abscess. J Can Assoc Radiol 24:268–271. [PubMed]
82. Wallace R, Cohen AS. 1976. Tuberculous arthritis: a report of two cases with review of biopsy and synovial fluid findings. Am J Med 61:277–282.
83. Mondal A. 1994. Cytological diagnosis of vertebral tuberculosis with fine-needle aspiration biopsy. J Bone Joint Surg Am 76:181–184. [PubMed]
84. Masood S. 1992. Diagnosis of tuberculosis of bone and soft tissue by fine-needle aspiration biopsy. Diagn Cytopathol 8:451–455. [PubMed]
85. Debeaumont A. 1966. Bacteriology of osteoarticular tuberculosis under chemotherapy. Bibl Tuberc 22:125–188. (In French.) [PubMed]
86. Mousa HA. 1998. Tuberculosis of bones and joints: diagnostic approaches. Int Orthop 22:245–246. [PubMed]
87. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka V, Menzies RI, O’Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA, American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America. 2003. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 167:603–662. [PubMed]
88. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, Chaisson LH, Chaisson RE, Daley CL, Grzemska M, Higashi JM, Ho CS, Hopewell PC, Keshavjee SA, Lienhardt C, Menzies R, Merrifield C, Narita M, O’Brien R, Peloquin CA, Raftery A, Saukkonen J, Schaaf HS, Sotgiu G, Starke JR, Migliori GB, Vernon A. 2016. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 63:e147–e195. [PubMed]
89. Medical Research Council Working Party on Tuberculosis of the Spine. 1993. Controlled trial of short-course regimens of chemotherapy in the ambulatory treatment of spinal tuberculosis. Results at three years of a study in Korea. Twelfth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 75:240–248. [PubMed]
90. Medical Research Council Working Party on Tuberculosis of the Spine. 1986. A controlled trial of six-month and nine-month regimens of chemotherapy in patients undergoing radical surgery for tuberculosis of the spine in Hong Kong. Tenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Tubercle 67:243–259.
91. Darbyshire J, Medical Research Council Working Party on Tuberculosis of the Spine. 1999. Five-year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months’ duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery. Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Int Orthop 23:73–81.
92. Dobson J. 1951. Tuberculosis of the spine; an analysis of the results of conservative treatment and of the factors influencing the prognosis. J Bone Joint Surg Br 33-B:517–531. [PubMed]
93. Canetti G, Debeyre J, Seze SD. 1957. Sterilization of lesions in osteo-articular tuberculosis by antibacillary chemotherapy. Rev Tuberc (Paris) 21:1337–1344. (In French.)
94. Hodgson AR, Stock FE, Fang HS, Ong GB. 1960. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 48:172–178. [PubMed]
95. Konstam PG, Blesovsky A. 1962. The ambulant treatment of spinal tuberculosis. Br J Surg 50:26–38.
96. Medical Research Council Working Party on Tuberculosis of the Spine. 1982. A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong. Eighth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 64:393–398. [PubMed]
97. Medical Research Council Working Party on Tuberculosis of the Spine. 1985. A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 67:103–110. [PubMed]
98. Medical Research Council Working Party on Tuberculosis of the Spine. 1973. A controlled trial of ambulant out-patient treatment and in-patient rest in bed in the management of tuberculosis of the spine in young Korean patients on standard chemotherapy a study in Masan, Korea. First report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 55:678–697. [PubMed]
99. Medical Research Council Working Party on Tuberculosis of the Spine. 1974. A controlled trial of anterior spinal fusion and débridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: a study in Hong Kong. Br J Surg 61:853–866. [PubMed]
100. Medical Research Council Working Party on Tuberculosis of the Spine. 1978. A controlled trial of anterior spinal fusion and débridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: a study in two centres in South Africa. Seventh Report of the Medical Research Council Working Party on tuberculosis of the spine. Tubercle 59:79–105. [PubMed]
101. Medical Research Council Working Party on Tuberculosis of the Spine. 1973. A controlled trial of plaster-of-Paris jackets in the management of ambulant outpatient treatment of tuberculosis of the spine in children on standard chemotherapy. A study in Pusan, Korea. Second report of the Medical Research Council Working Party on Tuberculosis of the Spine. Tubercle 54:261–282.
102. Medical Research Council Working Party on Tuberculosis of the Spine. 1976. A five-year assessment of controlled trials of in-patient and out-patient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Fifth report of the Medical Research Council Working Party on tuberculosis of the spine. J Bone Joint Surg Br 58-B:399–411. [PubMed]
103. Medical Research Council Working Party on Tuberculosis of the Spine. 1978. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 60-B:163–177. [PubMed]
104. Pattisson PR, Chir B. 1986. Pott’s paraplegia: an account of the treatment of 89 consecutive patients. Paraplegia 24:77–91. [PubMed]
105. Jutte PC, Van Loenhout-Rooyackers JH. 2006. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev 2006(1):CD004532.
106. Fang D, Leong JC, Fang HS. 1983. Tuberculosis of the upper cervical spine. J Bone Joint Surg Br 65:47–50. [PubMed]
107. Hsu LC, Leong JC. 1984. Tuberculosis of the lower cervical spine (C2 to C7). A report on 40 cases. J Bone Joint Surg Br 66:1–5. [PubMed]
108. Jain AK, Kumar S, Tuli SM. 1999. Tuberculosis of spine (C1 to D4). Spinal Cord 37:362–369. [PubMed]
109. Aguirre M, Bago J, Martin N. 1989. Tuberculosis of the knee. Surgical or conservative treatment? Acta Orthop Belg 55:22–25. [PubMed]
110. Eskola A, Santavirta S, Konttinen YT, Tallroth K, Lindholm ST. 1988. Arthroplasty for old tuberculosis of the knee. J Bone Joint Surg Br 70:767–769. [PubMed]
111. Laforgia R, Murphy JC, Redfern TR. 1988. Low friction arthroplasty for old quiescent infection of the hip. J Bone Joint Surg Br 70:373–376. [PubMed]
112. Su JY, Huang TL, Lin SY. 1996. Total knee arthroplasty in tuberculous arthritis. Clin Orthop Relat Res 323:181–187.
113. Kramer SB, Lee SHS, Abramson SB. 2004. Nonvertebral infections of the musculoskeletal system by Mycobacterium tuberculosis, p 577–586. In Rom WN, Garay SM (ed), Tuberculosis, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA.
114. Harwin SF, Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA. 2013. Tubercular prosthetic knee joint infection. Orthopedics 36:e1464–e1469. [PubMed]
115. Spinner RJ, Sexton DJ, Goldner RD, Levin LS. 1996. Periprosthetic infections due to Mycobacterium tuberculosis in patients with no prior history of tuberculosis. J Arthroplasty 11:217–222.
116. Tokumoto JI, Follansbee SE, Jacobs RA. 1995. Prosthetic joint infection due to Mycobacterium tuberculosis: report of three cases. Clin Infect Dis 21:134–136. [PubMed]
117. Johnson R, Barnes KL, Owen R. 1979. Reactivation of tuberculosis after total hip replacement. J Bone Joint Surg Br 61-B:148–150. [PubMed]
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/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0046-2017
2017-04-14
2017-09-26

Abstract:

Musculoskeletal tuberculosis (TB) accounts for approximately 10% of all extrapulmonary TB cases in the United States and is the third most common site of extrapulmonary TB after pleural and lymphatic disease. Vertebral involvement (tuberculous spondylitis, or Pott’s disease) is the most common type of skeletal TB, accounting for about half of all cases of musculoskeletal TB. The presentation of musculoskeletal TB may be insidious over a long period and the diagnosis may be elusive and delayed, as TB may not be the initial consideration in the differential diagnosis. Concomitant pulmonary involvement may not be present, thus confusing the diagnosis even further. Early diagnosis of bone and joint disease is important to minimize the risk of deformity and enhance outcome. The introduction of newer imaging modalities, including MRI (imaging procedure of choice) and CT, has enhanced the diagnostic evaluation of patients with musculoskeletal TB and for directed biopsies of affected areas of the musculoskeletal system. Obtaining appropriate specimens for culture and other diagnostic tests is essential to establish a definitive diagnosis and recover for susceptibility testing. A total of 6 to 9 months of a rifampin-based regimen, like treatment of pulmonary TB, is recommended for the treatment of drug susceptible musculoskeletal disease. Randomized trials of tuberculous spondylitis have demonstrated that such regimens are efficacious. These data and those from the treatment of pulmonary TB have been extrapolated to form the basis of treatment regimen recommendations for other forms of musculoskeletal TB.

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Figures

Image of FIGURE 1
FIGURE 1

TB of the rib. Shown is a postero-anterior radiographic view of the chest of a man after 3 months of successful anti-TB chemotherapy. Note the mass in the left chest with destruction of a portion of the adjacent rib. A biopsy and culture confirmed TB. The mass resolved with continued therapy.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 2

This photograph demonstrates a cold abscess of the chest wall in a patient with TB. Aspiration of this mass yielded material that was AFB smear positive, and the culture yielded .

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 3

Swollen knee of a patient with tuberculous arthritis. An HIV-infected patient presented with a painful, swollen knee. He had a recent history of trauma to the knee. On examination the knee was warm and an effusion was present. Culture of the synovial fluid following arthrocentesis grew .

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 4

Plain film radiograph of the lumbar spine of a patient with tuberculous spondylitis demonstrating anterior end plate destruction, sclerosis, loss of disk space, and evidence of bony debris. These findings are suggestive of tuberculous spondylitis. A CT-directed biopsy was performed to obtain material for cultures, which yielded .

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 5

CT evaluation of patients with tuberculous spondylitis. CT demonstrated a large right psoas abscess in an HIV-infected patient with tuberculous spondylitis of the lumbar spine. A percutaneous drain was placed into the psoas abscess, and the fluid culture yielded .

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 6

MRI of a patient with multifocal tuberculous spondylitis who has both thoracic and lumbar spine involvement which is not contiguous (i.e., skip lesions). The thoracic lesion reveals anterior collapse of adjacent vertebrae and a Gibbus formation leading to kyphosis. There is also evidence of lumbar disease in this patient.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 7

Radiographs of the knee of a patient with tuberculous arthritis. Plain radiograph of the knee shown in Fig. 3 . Marginal erosions are visible, along with soft tissue swelling.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 8

TB of the knee. The radiograph shows findings of TB (left) and the normal knee (right). Note the narrowed joint space, lytic bone destruction in the distal femur and proximal tibia, and soft tissue swelling in the abnormal knee, which had shown clinical evidence of TB for more than 10 years (but the patient had not undergone treatment).

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 9

TB of the hip. Plain radiograph of a 12-year-old girl who presented with an abnormal gait for several months. The left femoral head is completely destroyed. Operative specimen of the destroyed femoral head.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 10

CT imaging of the knee of a patient with tuberculous arthritis, showing extensive marginal destruction as well as erosions.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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FIGURE 11

CT imaging of a psoas muscle abscess. The CT shows the lower extremities in a patient with lumbar tuberculous spondylitis who has a psoas abscess that extends into the right thigh.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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Tables

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TABLE 1

Numbers and proportions of musculoskeletal TB cases in the United States, 1993 to 2015

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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TABLE 2

Anatomic sites of musculoskeletal TB reported in Los Angeles County from 1990 to 1995

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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TABLE 3

Radiographic characteristics of tuberculous spondylitis

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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TABLE 4

Imaging features associated with tuberculous spondylitis

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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TABLE 5

Radiologic characteristics in the differential diagnosis of tuberculous arthritis

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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TABLE 6

Differential diagnosis of cystic bone lesions

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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TABLE 7

Differential diagnosis of primary myositis

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017
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TABLE 8

Etiologies of a psoas muscle abscess

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0046-2017

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