Abstract
PurposeThe objective of the present study is to describe the clinical, diagnostic, radiological and therapeutic aspects of osteoarticular tuberculosis (OATB) in patients in a tertiary pediatric hospital, to know if the diagnosis of OATB in pediatrics is a challenge due to its insidious clinical presentation.MethodsA retrospective, descriptive study of the cases of Tuberculosis (TB) in children was carried out. A total of 159 cases met the condition for the analysis.ResultsThe most frequent TB modality was extrapulmonary in 85%. Out of this, only 29% was OATB. The mean age was 4.9 years (range 8 months–16 years). Eighty-six per cent of cases received Bacille Calmette-Guérin (BCG) vaccination at birth. Median time of symptoms prior to diagnosis was 8 months. Microbiological confirmation was achieved only in five cases, with a high sensitivity to the antimicrobial treatment. Mycobacterium bovis BCG strain Tokio 172 was confirmed in three cases. Mortality rate was 0% during the time of studyConclusionOur study describes the epidemiological characteristics of OATB cases in Mexican children. This data revealed a high prevalence of bone and joint TB infection. Pediatric OATB should be considered in cases with lytic bone lesions, fever and local pain. In countries with BCG immunization program, M. bovis should not be forgotten as an etiological agent. The low detection rate with one technique approach highlights the urgent need for more sensitive test to diagnose OATB in children.
Highlights
Tuberculosis is a disease that has been in existence for centuries, with report of skeletal lesions in early Neolithic population [1]
The age range was from 8 months to 18 years with an average of 4.9 years. 35 (81.3%) of the cases occurred in children < 6 years old, 4 (9.3%) in those between 7 and years and 5 (11.6%) in the patients between and 16 years
All patients were assessed in search of primary immunodeficiencies such as chronic granulomatous disease (CGD), interleukin 12-interferon gamma axis
Summary
Tuberculosis is a disease that has been in existence for centuries, with report of skeletal lesions in early Neolithic population [1]. The causative agent is the bacillus Mycobacterium tuberculosis, a strict aerobic microorganism, TB has been a persistent global health problem with annual incidence rate of approximately 10 million cases, and one of the 10 leading causes of death in the world. The latest global report indicated that a total of 10.4 million peoples are infected and that out of these, 6% corresponds to children under 18 years of age. Of the total cases of TB infection, osteoarticular involvement represents 4% to 5% with reports in the pediatric population of up to 7%. The diagnosis of extrapulmonary tuberculosis in the pediatric age is a challenge, since it presents with insidious onset without constitutional signs and symptoms in up to 72% m [4]. The objective of the present study is to describe the clinical, diagnostic, radiological and therapeutic aspects of OATB in patients in a tertiary pediatric hospital
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