Antitubercular Drug Therapy Research Articles

Cat Scratch Disease: A Diagnostic Challenge in Cervical Lymphadenopathy

Introduction: Cat scratch disease typically manifests as long standing regional lymphadenopathy, though clinical features may cover a wide spectrum. Lack of definite history of cat scratch, atypical presentation, non-availability of serological tests and misleading needle cytology may often lead to delay in diagnosis. Case report: A 44 years old diabetic female, presented with persistent fever for 15 days followed by 4x4cm, tender tense swelling in left parotid region extending into upper neck. Her blood sugar was deranged. Polymorphonuclear leucocytosis was noted. Radiological investigation showed lymph nodal conglomeration involving level II, III and IV with non-enhancing necrotic areas within it. Mass was abutting Internal Jugular Vein, which was attenuated cranially. Aggressive antibiotics treatment and optimal glycemic control failed to resolve fever and lymphadenopathy, hence excision of neck mass was done which was reported histopathologically as Cat Scratch Disease. Conclusion: While ruling out tuberculosis, Epstein Barr-Virus infection, acute bacterial lymphadenitis or malignant disease, Cat Scratch Disease should be included in the differential diagnosis of lymphadenopathies in head-neck region so that possibility of antibiotic abuse, an unnecessary biopsy, long term antitubercular drug therapy or even surgical treatment may be avoided. Keywords: Cat Scratch Disease; Bartonella henselae; lymphadenopathy; serological test

A Study of COVID-19 Infected Patients with Tuberculosis as Comorbidity and on Antitubercular Drug Therapy

A Study of COVID-19 Infected Patients with Tuberculosis as Comorbidity and on Antitubercular Drug Therapy

Female Genital Tuberculosis and Subfertility: Nobel Approaches for Successful Reproductive Outcome with Anti Tubercular Drug Therapy in Bangladesh Perspective

Background: Female Genital Tuberculosis is one of the important causes of infertility in Bangladesh. An early diagnosis and treatment with ATT (Anti Tubercular Therapy) is important to prevent adverse sequlae and can improve reproductive outcome. Aims and Objectives: The aim of the study is to evaluate the reproductive outcome of infertile patients with GTB. Methods: The present prospective observational study was conducted in Reproductive Endocrinology and Infertility Department of BSMMU from January 2018 to December 2021. Thirty (30) infertile women suspected of Genital Tuberculosis (GTB) who undergone hystero-laparoscopy as a part of infertility work up were included in our study. Results: GTB is the disease of young women with the mean age 27.5 ± 5.49 years in our study and most commonly present with primary infertility (63.33%). After completing antitubercular treatment, 90% of the study group had resumed normal menstrual cycles. A comparable proportion (16.67%) of GTB patients receiving ATT conceived, all without the aid of IVF. Among those who were conceived, 60% pregnancy remained uneventful, 20% had abortion, and 20% had ectopic pregnancy. The median length of time to conception after initiation of ATT was 4 months, stressing the role of ATT in conception in women with GTB. Conclusions: In low-income countries like Bangladesh where IVF is costly, Anti Tubercular Therapy may be started even on the basis of positive DNA PCR result or on the basis of laparoscopic and hysteroscopic findings. Effective anti- tubercular therapy can provide successful reproductive outcome in infertile patients with Genital TB.

VEGFR1 blockade reduces Mycobacterium tuberculosis-induced pathology in immunocompromised mice

Abstract Mycobacterium tuberculosis (Mtb) is a major public health concern that caused 1.6 million deaths in 2021. New treatments are needed, especially in immunocompromised individuals, such as patients with HIV coinfection, who are severely impacted by the disease. We have recently reported that blocking VEGFR1, a receptor that is present on monocytes and contributes to their recruitment to the sites of infection, limits Mtb-induced pathology in immunocompetent mice of both Mtb-resistant (C57BL/6J) and Mtb-supersusceptible (C3HeB/FeJ) strains (Harding et al., 2019). These results offer a way to reduce lung pathology without impeding host defense. Here, we extend this finding by showing that VEGFR1 blockade has similar effects in immunocompromised (RAG1KO) mice as well, measured by a reduction in the area of inflammation and without a change in bacterial burden. Following treatment with the VEGFR1 blocker SU5416, we have found an elevated ratio and an increase in the absolute number of neutrophil granulocytes in the Mtb-infected lungs in both immunosufficient and immunocompromised mice. Surprisingly however, this did not result in exacerbated pathology as the majority of the recruited neutrophils remained in the lung vasculature. Our results indicate that further evaluation of VEGFR1 blockers as an adjunctive treatment to antitubercular drug therapy for immunocompromised populations could be worthwhile. Supported by grants from NIH (R01 HL128778 and R01 NS123449)

A Case Study on Tubercular Cavernous Sinus Syndrome

Tubercular cavernous sinus syndrome is a rare condition of extra-pulmonary tuberculosis EPTB in which cavernous sinus involvement is observed. Cavernous sinus is a venous structure that holds and protects pituitary gland on one side and temporal lobe on other side. CSS is mainly characterized by multiple cranial neuropathies which is effected by various etiologies. This is a case report of tubercular cavernous sinus syndrome admitted to hospital with chief complaints of fever headache drooping of eyelids altered sensorium with disorientation and fever that reduced over next 3 to 4 days but headache was still persisting due to the damage to the cranial nerves. Based on these symptoms they underwent clinical examination which revealed hypotension elevated CRP levels and MRI suggestive of acute dural venous sinus thrombosis involving superior sagittal sinus and bilateral bulky cavernous sinus with transverse T2 hypo intensity in right transverse sagittal superior sagittal and internal jugular vein IJV. Granulomatous etiology indicated tubercular cavernous sinus syndrome. For this treatment was initiated with anti-tubercular drug therapy with vitamin supplements and anticoagulants. EPTB remains a significant health problem in developing countries. Prevalence of EPTB is increasing over the last several years globally.

Andrographis paniculata mitigates first-line anti-tubercular drugs-induced nephrotoxicity in Wistar rats

Context Anti-tubercular drugs (ATDs) mediated adverse drug reactions are major concerns for clinicians to treat tuberculosis infection. This study aimed to investigate Andrographis paniculata extract-based phytotherapy to combat the nephrotoxic effects caused by ATDs therapy. Methods Reno-protective effect of A. paniculata extract in ATDs-induced rats was evaluated through LPO, GSH, CAT, SOD, GST, urea, creatinine, uric acid, and histopathological studies. Standardization of the extract was performed using RP-HPLC and FTIR analysis. Whereas, the effect of A. paniculata extract on ATDs induced genetic perturbation was analyzed using micronucleus assay. Moreover, the expression level of the xenometabolic gene was investigated using RT-PCR to explore the therapeutic mechanism. Results The nephrotoxic effect of ATDs was indicated by elevated levels of LPO and renal function markers along with the reduced activity of renal antioxidants. An up-regulated expression profile of NAT gene and histological alterations were observed in renal tissue however, micronucleated PCEs were observed in bone marrow cells. Concomitant treatment with A. paniculata extract revealed a noticeable amelioration of elevated oxidative stress markers, gene expression levels, genotoxic perturbation, and histological alterations in a dose-dependent manner. Conclusion Hence, the present study using A. paniculata leaf extract confirmed to play effective phytotherapy against ATDs induced renal toxicity.

Pharmacovigilance of Antitubercular Therapy in Tuberculosis.

BackgroundAdverse drug reactions (ADRs) to tuberculosis (TB) drugs are a significant concern for medical professionals and health authorities. Adverse events due to drug-resistant TB (DRTB) treatment are among the most important reasons for treatment interruption.MethodsThis study was an observational study conducted among patients diagnosed with TB (pulmonary/extrapulmonary) receiving antitubercular therapy (ATT) (first line/second-line drugs) irrespective of their age and gender. The patients who consented to participate, registered under National Tuberculosis Elimination Program (NTEP), Puducherry, during the study period from March 2020 to December 2020, were included in the study. The demographic details were recorded from the treatment card, and the participants were provided a diary to note down the adverse events. They were asked to report over the phone or during their visits to treatment centers for the first two months. During the follow-up (irrespective of their treatment phase [intensive/continuation]), the patients were assessed for symptoms and signs of common adverse events. Any adverse events reported by the patient were also recorded and analyzed for causality and severity.ResultsDuring the study period, 219 patients were included, of which 92 patients (42%) presented with adverse events. Among the patients with ADRs, 56.5% were males and 43.5% were females. The females were found to be at more risk than males for adverse events with the OR 1.871 (95% CI: 1.066-3.284). GI system was the most common body system involved (39%), followed by musculoskeletal system and skin disorders (24% and 21%), respectively. Most of the adverse events were latent in nature (60.9%), followed by sub-acute onset (28.3%) and acute events (6.5%). Maximum adverse events reported were mild to moderate (71.8%), followed by severe (18.5%). Most of the events were probable in nature (41.3%), and the definite category was 25% as per Naranjo’s probability scale.ConclusionThe current study shows the frequency of adverse events in patients receiving antitubercular drug therapy. The females were found to be at more risk than males for adverse events. It was found that the GI system was most affected as a known reaction to TB therapy followed by the musculoskeletal system. With more effective pharmacovigilance measures implementation, the adverse events being one of the factors for treatment interruption can be overcome.

Diagnostic dilemma in a patient with chronic non–healing ulcer on leg: A case report

Rationale: Though cutaneous tuberculosis accounts for a small proportion of all tuberculosis cases, it becomes an important health issue considering its high prevalence in tropical countries. Due to its myriad clinical manifestations, it becomes difficult to diagnose and may pose a great diagnostic dilemma.Patient concerns: A 17-year-old male complaint of ulcerproliferative lesion on the left lower leg for 5 years. There was no history suggestive of tuberculosis. On cutaneous examination, single well-defined erosiocrustive plaque of size 14 cm × 13 cm with yellowish adherent crust presented over the left lower leg. The underlying surface shows ulceration after removing the crust.Diagnosis: Ulcerative Lupus vulgaris.Interventions: Anti-tubercular drug therapy (isoniazid, rifampicin, pyrazinamide and ethambutol).Outcomes: Lesion showed dramatic improvement after one month of anti-tubercular therapy.Lessons: Dermatologists should be aware of variable clinical presentations of cutaneous tuberculosis so as to diagnose it timely and correctly.

An Unusual Presentation of Tuberculosis at Atypical Anatomical Location: Rectus Abdominis Muscle

Unusual presentation of Tuberculosis (TB) in anatomical locations like skeletal muscle which are atypical and not favorable for survival and multiplication of Mycobacterium tuberculosis.Commonly, muscle involvement is secondary. A direct inoculation (abdominal lymph node) or extension from underlying tubercular synovitis and osteomyelitis may involve an abdominal muscle. The case report is about a 43-year-old female who presented with an abdominal lump for past one month. There was no history of cough, weight loss, pain abdomen, recurrent vomiting, breathlessness and no history of TB or close contact with TB patient. Ultrasound (USG) and Contrast Enhanced Computed Tomography (CECT) of the abdomen revealed loculated collection in right rectusabdominis muscle, and USG-guided aspiration for cytology, culture and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) confirmed tubercular abscess. The patient was managed as per National Tuberculosis Elimination Programme and responded well with antitubercular drug therapy for six months. This case throws light on to the possibility of tubercular infection in atypical anatomical locations as primary foci, especially in those areas where tuberculosis is endemic.

A prospective study of surgical management of Koch’s abdomen in a tertiary care hospital

Background: Tuberculosis is a communicable disease that is a major cause of morbidity and mortality worldwide. Abdominal tuberculosis is the sixth most common form and is associated with serious complications like perforation and stricture formation.Methods: Observational and prospective study conducted in Hamidia Hospital, Bhopal from September 2018 to September 2020 included 122 patients, between the age of 16 to 60 years who underwent surgical management of abdominal tuberculosis.Results: The incidence of abdominal tuberculosis was higher in young age groups mostly belonging to male sex. The most common presentation was of subacute intestinal obstruction. On surgical exploration ileocecal tuberculosis was the most common finding which was managed most commonly by segmental resection with anastomosis followed by adhesiolysis and strictureplasty. Post-operative wound infection was the most common complication followed by pulmonary complication which was the most common cause of death.Conclusions: Early diagnosis of abdominal tuberculosis with the help of newer diagnostic tools and early referral to higher centers is necessary to decrease the morbidity and mortality. Early start of anti-tubercular drug therapy along with surgical management can help us reduce the mortality and long-term complications associated with abdominal tuberculosis.

Tuberculosis of the spine and drug resistance: a review article.

Pott's spine is tuberculosis of spine caused due to hematogenous spread of mycobacterium from a primary focus. It constitutes about 50% of skeletal tuberculosis cases. Paradiscal type is the most common type of spinal tuberculosis. Untreated cases can lead to complications like a cold abscess, paraplegia, and deformity which may require surgical intervention. Rapid molecular methods have made the diagnosis of spinal tuberculosis and drug resistance faster and easier but it still remains a problem due to difficulties in sample collection and the paucibacillary nature of the Pott spine. Antitubercular drug therapy forms the mainstay of management. The emergence of MDR TB and XDR TB has posed a big challenge in the management of spinal tuberculosis. The literature regarding drug resistance in spinal tuberculosis and its management is lacking. We conducted a literature review of 29 studies and presented information on pathogenesis, diagnosis, and management of spinal tuberculosis and drug resistance. New shorter regimens for MDR and XDR TB are under trial in different parts of the world. We believe this article will provide information on spinal tuberculosis and drug resistance and help clinicians outline important research areas.

SURGICAL MANAGEMENT OF INTRAMEDULLARY TUBERCULOMA: A CASE REPORT AND REVIEW OF LITERATURE

Tuberculosis (TB) is a common disease of developing countries especially in immunocompromised population. Most of the Central Nervous System (CNS) lesions in tuberculosis are intracranial with the ratio of cranial and spinal lesions averaging 42:1. Medical therapy with antitubercular drugs is the mainstay of the treatment modality for a conrmed lesion. We report a case of intramedullary spinal tuberculoma managed surgically, which did not respond to the medical management with radiological expansion and clinical deterioration. Surgical excision denitely has role in management of intramedullary tuberculoma. Early surgical intervention may provide better outcome if neurological symptoms appear or lesion size increases despite on antitubercular drug therapy.

Presentation, management and outcomes of pediatric urogenital tuberculosis: 20 years’ experience from a tertiary center

Urogenital tuberculosis (UGTB) has traditionally being a diagnosis of adulthood and is supposed to be rare in children, as it is believed that the symptoms of renal tuberculosis do not appear for 10 or more years after the primary infection. While this may be true in developed countries, where childhood pulmonary tuberculosis is a rarity nowadays. In developing countries, childhood pulmonary tuberculosis is still a major issue and hence, UGTB is not an uncommon diagnosis in younger children and adolescents in these countries. Considering this dearth of data on childhood UGTB, we retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery. To analyze the clinical presentation, management strategies and outcomes of pediatric UGTB managed in a tertiary care center. Case records of children and adolescents ≤18 years diagnosed with UGTB during the period July 1998 to June 2018at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied. There were 41 children and adolescents (M: F=22:19) identified, with a mean age of 14.8±3.9 years who fulfilled the inclusion criteria. The most common presentation was flank pain and irritative storage symptoms. Mycobacterium tuberculosis was identified on urinary examination in only 17 (41.5%) cases. Six patients were lost to follow up after initial diagnosis. A total of 45 procedures (35 primary and 10 secondary) were performed in 35 children. Initial diversion in the form of PCN and DJS were done in 11 and 12 patients respectively, of which 8 were managed with stenting alone. Surgical management was done mostly in the form of nephrectomy (15), nephrectomy along with reconstruction (5) and reconstruction only (6). On univariate analysis, factors associated with nephrectomy were poor initial function and nephrostomy as initial diversion. Overall median follow-up was 25 (IQR 15.5-74.25) months. During follow up, chronic renal failure developed in nearly 53.8% of patients who underwent major reconstruction. Urogenital tuberculosis presents with a wide spectrum of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of minimally invasive diversions and surgery (both ablative and reconstructive) achieve satisfactory results in the majority of cases. Children undergoing major surgical reconstruction in particular need to be followed up rigorously and counselled about possibility of development of renal failure.

Decreased Serum Cholinesterase Activity- A Reliable Diagnostic Aid for Tuberculosis

Introduction: Siderophore, the low molecular weight ferric iron chelator, is secreted extracellularly by Mycobacterium tuberculosis, an obligate aerobe. The pathogenic mycobacteria need iron as co-factor for the extracellularly secreted enzyme Superoxide Dismutase (SOD) for its pathogenicity as well as it requires iron for its metabolic functions like reduction of oxygen for synthesis of Adenosine Triphosphate (ATP), etc. The termination of impulse conduction is endorsed by the rapid hydrolysis of Acetylcholine (ACh) by Acetylcholinesterase (AChE) in the central as well as peripheral nervous system (cholinergic pathway). The inhibitors to Cholinesterase (ChE) might lead to accumulation of ACh, hyper stimulation of nicotinic and muscarinic receptors and also disruption of neurotransmission. Possibility of an inhibitor substance for AChE in Tuberculosis (TB) patients interestingly correlates with the symptom of night sweating in those subjects. Aim: To assay the level of serum ChE in normal control, lung disease control and tubercular subjects;circumvent the serum ChE level as a diagnostic potential in TB at an early stage. Materials and Methods: The study was conducted on total 124 subjects, and were divided into three groups: Group 1: normal control (n=31), Group 2: lung disease control (n=31) and Group 3: patients suffering from TB {3A: pulmonary TB (n=31) and 3B: extrapulmonary TB (n=31)}. Serum ChE activity for all the subjects were measured according to the method of Hestrin S. Serum ChE level was assayed for group 3 subjects after additional one month’s anti-TB drug treatment and also for group 2 subjects after one month with usual treatment. The level of significance was assessed using Student’s t-test. Results: There was a significant inhibition of serum ChE activity in both pulmonary and extrapulmonary TB patients in comparison to that of in normal control as well as lung disease control subjects (p<0.01). With the anti-tubercular drug therapy for one month, there was significant recovery in the serum ChE activity in pulmonary as well as extrapulmonary tubercular subjects (p<0.01). Conclusion: It appears that the high level of hydroxamate type of siderophores (secreted by Mycobacterium tuberculosis for acquiring iron) might form ACh ferric hydroxamate complex binding more strongly with serum ChE resulting in inhibition of serum ChE activity in tubercular subjects. With anti-tubercular drug therapy, there was decrease in serum ACh ferric hydroxamate complex level resulting in recovery of serum ChE activity.

Clinical Profile, Drug Utilization Pattern and Adverse Drug Reactions of Anti-tubercular Drugs at DOTS Center in a Tertiary Hospital

Most of anti-tubercular drugs (ATD) cause various adverse drug reactions (ADRs) leading to significant morbidity which may have negative consequences on drug adherence and treatment outcome. The objectives of the study were to know the clinical profile of patients receiving ATD, to identify the pattern of ADRs caused by ATD and to know the drug utilization pattern (DUP) in different types of tuberculosis (TB). A prospective observational study was conducted among patients diagnosed with TB at DOTS center in BPKIHS from June 2017 to May 2018 and occurrence of any ADRs were detected during their monthly visit. Descriptive statistics were used to analyze the data. A total of 126 tuberculosis patients were on ATD therapy during the study period. Seventy five patients (59.5%) were male. Most of the patients (44.4%) belonged to age group 21-40 year. Pulmonary TB (66.7%) was more common than extra-pulmonary TB. Multi-drug resistant TB was detected in 4 patients (3.2%). Seventy one patients (56.3%) were found to be smear positive for acid fast bacilli. First line ATD was given to 122 patients (96.8%). Out of 126 patients, 116 (92.1%) reported occurrence of at least one ADR. A higher number of ADRs were observed in male (68.3%). Change in urine color was the most common ADR (92.9%) followed by nausea and vomiting (39.7%). Further studies covering different regions of Nepal are needed to generalize the findings.

Hepatotoxicity Induced by Anti-Tubercular Drugs Therapy: A Case Report

Anti-tubercular therapy induced liver injury (ATTILI) is the most important risk for the past many years. Many pre-existing factors and conditions like persisting liver injury, female gender, alcohol abuse etc. are important risk factors for the ATT induce liver injury. I read many case reports and literature review for the drugs induce liver injury, and concluded the results, ATT drugs are the most responsible for the liver injury during the therapy periods. The present case was 42-year-old male patient and known case of pulmonary tuberculosis, patients were on the ATT drugs therapy in the last 14 days. After few days of therapy, he produced signs of vomiting (multiple episode), fever (high grade), abdomen pain, coughing, loss of appetite, epigastric discomforts & generalized weakness. On general examination the patient was found to produce signs of Jaundice with yellowish appearance of the sclera. Pulmonologist had firstly withdrawal the anti-tubercular drugs therapy and started the modified anti-tubercular drugs therapy. As a Clinical pharmacist we advise the patients & patients relatives, proper monitoring of liver and renal function test should also be carried out by the health care professional specialist from time to time in order to avoid critical situations.
 Keywords: Anti-tubercular therapy, Anti-tubercular therapy induced liver injury, Pulmonologist, Hepatotoxicity.

CLINICAL PROFILE, DRUG RESISTANCE PATTERN AND TREATMENT OUTCOMES OF ABDOMINAL TUBERCULOSIS PATIENTS IN WESTERN INDIA.

Abdominal tuberculosis is an increasing problem in developing world. The objective of the study was to describe the clinical presentations, drug resistance pattern and treatment outcomes of abdominal tuberculosis in Western India. All the cases of abdominal tuberculosis from May 2014 to April 2017, diagnosed on the basis of clinical profile and gross morphological findings at endoscopy, imaging, followed by histology and/or GeneXpert and MGIT culture were included. All patients received antitubercular drug (AKT) therapy according to national protocol. Patients were followed from diagnoses till completion of treatment and various parameters were studied. Out of the 176 patients, 48% were males. Abdominal pain was most common complaint in 83.5%. On colonoscopy terminal ileum and ileocaecal valve were most commonly involved segments. Upper gastrointestinal tract was involved in four patients. Overall ulceronodular lesions were most common followed by ulcerative/nodular lesion. Strictures in bowel were seen in 28 (15.9%) patients with ileocaecal valve being most commonly involved, of which 23 had symptomatic relief with AKT and only three required dilatation. Histopathology showed granuloma in 80.8% cases. MGIT was positive in 43 (35.80%) cases and GeneXpert was positive in 35 (26.1%) cases. Eight patients had multi drug resistant tuberculosis. Only two patients required surgical management. Abdominal tuberculosis with wide spectrum of presentation, can still be managed with early diagnosis and treatment even in patients with sub acute intestinal obstruction. Weight gain or resolving symptoms were considered early markers of treatment response. Patients with stricture can become asymptomatic with medical treatment alone.

Nanoemulsion for the Effective Treatment and Management of Anti-tubercular Drug Therapy.

Tuberculosis is considered as one of the deadliest diseases of human existence. Since ancient age the treatment of tuberculosis has been highly challenging primarily owing to the pathogenic nature of the Mycobacterium and its diverse spots of localization in human body including lungs, liver, spleen, eye, meninges and lymph nodes. The conventional drug therapy employed for the treatment of tuberculosis is not highly satisfactorily owing to low oral bioavailability of the drugs. The evolution of nano-technology recently in few decades has completely revolutionized the treatment of diverse diseases and so is the tuberculosis. Nanotechnology not only possesses enormous potential for improving the biopharmaceutical performance, but also allows the delivery of therapeutic molecules to the desired site of action. Diverse types of nanocarriers have been employed for the treatment of tuberculosis infections. In this regard, nanoemulsions are considered as one of the promising alternatives for augmenting the bioavailability of the antitubercular drugs through oral route for improving their therapeutic efficacy. The nanoemulsion loaded with antitubercular drugs can easily cross the biological barriers to reach the systemic circulation and consequently in the target for reducing the load of Mycobacterium tuberculosis. Besides, the lipidic nature of such systems facilitates targeting of the drugs to the lymph nodes, thus improves drug bioavailability and reduction of the dosing frequency. In lieu of this, the present article compiles the basics of nanoemulsions in brief along with an updated account on their applications in delivering antitubercular drugs for enhanced immunization. Moreover, overview of patent literature published in this area has also been included in the manuscript.

Hip Surgery in Quiescent or Active Tubercular Hip Arthritis; Is Reactivation Risk Really a Matter.

About 15 % of all musculoskeletal tuberculosis (TB) have hip involvement. Early anti-tubercular drug therapy and other conservative treatment including short-term traction and mobilization programs could prevent hip joint destruction. Reactivation of TB accounts for a significant of active TB incidence, especially in the developed countries with a low TB prevalence. The risk of TB activation for population with the latent form of disease is about 5-10%. According to the existing literature surgery in tubercular hip arthritis would be safe once sufficient debridement and precise anti tubercular chemotherapy has been done.

Isolated Iliac Crest Tuberculosis

Following an insidious onset of symptoms, a 29-year-old man who had no risk factors for tuberculosis was diagnosed with tuberculosis of the iliac crest. The red flag in this case was the patient's progressive deterioration despite a variety of antibiotic regimens. Histopathologic demonstration of necrotic granulomatous inflammation and a positive culture led to the diagnosis. A combination of surgery and antitubercular-drug therapy resulted in clinical recovery. Iliac crest tuberculosis represents <1% of all skeletal tuberculosis cases. Even in the absence of classic symptoms and risk factors, orthopaedic surgeons should maintain a low threshold for tuberculosis in the differential diagnosis.