Osteoarticular Tuberculosis: Clinical and Therapeutic Feature

Abstract

Purpose: To review the diagnosis and treatment of osteoarticular tuberculosis (OAT) in 42 patients. Methods: Records of 23 men and 19 women aged 18 to 83 (mean, 52) years who presented with OAT were reviewed. Results: Tuberculous spondylodiscitis was diagnosed in 29 patients. An extra-spinal bone tuberculosis was observed in 13 cases touching knees in 5 cases, hip in 5 cases, wrist in one case, sacroiliac joint in one case and greater trochanter in one case. A multifocal osteoarticular tuberculosis was observed in 3 patients. Thirty four patients presented with inflammatory pain. Psoas abscess was noted in 3 cases, paravertebral abscess in 9 cases and multiple abscesses in one case. Radiographs objectified disc space narrowing in 18 cases and erosion of the vertebral endplates in 3 cases. CT was performed in 12 cases and MRI in 22 cases having confirmed bone disease in all cases. The search of koch bacillus in the sputum was positive in 4 cases, in the urine in 2 cases and in joint fluid in 11 cases. An histological confirmation was obtained in 11 cases. The tuberculous origin was retained in other cases based on clinical and radiological data. Surgical drainage of abscesses was performed in 5 cases. All patients responded to antituberculous therapy (ATT). Conclusion: OAT still common in Tunisia because of the endemicity of tuberculosis. There are still severe forms of the disease. Isolation of Mycobacterium tuberculosis is difficult. The diagnosis is often based on a beam of arguments.