Diagnosis Of Osteoarticular Tuberculosis Research Articles

Interferon gamma release assays for diagnosis of osteoarticular tuberculosis: A systematic review and meta-analysis.

BackgroundAlthough the Interferon Gamma Release Assays (IGRA) is often used to identify latent tuberculosis, it also plays a crucial role in diagnosing active extrapulmonary tuberculosis. Some studies have assessed the use of IGRA as a biomarker for osteoarticular tuberculosis (OATB), which is elevated following TB infection. Still, conclusive results about its effectiveness have not been reported.MethodWe searched PubMed, Embase, and Cochran databases. We obtained literature related to the diagnosis of OATB by IGRA, and the retrieval period was from the establishment of the database to June 2021. The bivariate random effect model was used to summarize the sensitivity, specificity, and accuracy of other indicators in diagnosing OATB by IGRA, and the forest plot and receiver operating characteristic (ROC) curve were used for testing.ResultsWe included seven studies involving 643 subjects in diagnosing OATB by IGRA. The comprehensive sensitivity and specificity were 0.84 (95% CI, 0.70–0.92) and 0.78 (95% CI, 0.66–0.87), respectively. The area under the curve (AUC) was 0.87.ConclusionIn blood samples, the diagnostic accuracy of IGRAS is poor in patients with suspected OAT. We conclude that IGRA may not be appropriate for patients with OATB.

Novel Potential Diagnostic Serum Biomarkers of Metabolomics in Osteoarticular Tuberculosis Patients: A Preliminary Study.

Osteoarticular tuberculosis is one of the extrapulmonary tuberculosis, which is mainly caused by direct infection of Mycobacterium tuberculosis or secondary infection of tuberculosis in other parts. Due to the low specificity of the current detection method, it is leading to a high misdiagnosis rate and subsequently affecting the follow-up treatment and prognosis. Metabolomics is mainly used to study the changes of the body’s metabolites in different states, so it can serve as an important means in the discovery of disease-related metabolic biomarkers and the corresponding mechanism research. Liquid chromatography tandem mass spectrometry (LC-MS/MS) was used to detect and analyze metabolites in the serum with osteoarticular tuberculosis patients, disease controls, and healthy controls to find novel metabolic biomarkers that could be used in the diagnosis of osteoarticular tuberculosis. Our results showed that 68 differential metabolites (p<0.05, fold change>1.0) were obtained in osteoarticular tuberculosis serum after statistical analysis. Then, through the evaluation of diagnostic efficacy, PC[o-16:1(9Z)/18:0], PC[20:4(8Z,11Z,14Z,17Z)/18:0], PC[18:0/22:5(4Z,7Z,10Z,13Z,16Z)], SM(d18:1/20:0), and SM[d18:1/18:1(11Z)] were found as potential biomarkers with high diagnostic efficacy. Using bioinformatics analysis, we further found that these metabolites share many lipid metabolic signaling pathways, such as choline metabolism, sphingolipid signaling, retrograde endocannabinoid signaling, and sphingolipid and glycerophospholipid metabolism; these results suggest that lipid metabolism plays an important role in the pathological process of tuberculosis. This study can provide certain reference value for the study of metabolic biomarkers of osteoarticular tuberculosis and the mechanism of lipid metabolism in osteoarticular tuberculosis and even other tuberculosis diseases.

Diagnosis of osteoarticular tuberculosis by immuno-PCR assay based on mycobacterial antigen 85 complex detection.

Diagnosis of osteoarticular tuberculosis (OATB) exhibits serious challenges owing to paucibacillary nature of specimens and localization of disease at sites that are difficult to access. We recently developed indirect immuno-PCR (I-PCR) and real-time I-PCR (RT-I-PCR) assays for the detection of mycobacterial antigen 85 complex (Ag85) in OATB patients. Detection limits for the purified Ag85 protein were found to be 1 and 41 fg ml-1 by I-PCR and RT-I-PCR, respectively, which were at least 105 -fold lower than respective ELISA. While spiking synovial fluids of non-TB control subjects with the purified Ag85 protein, LODs of 100 and 120 fg ml-1 were obtained by I-PCR and RT-I-PCR, respectively, thus demonstrating the sample matrix effect. Sensitivities of 87·5 and 70·5% were observed in bodily fluids of confirmed (n = 8) and clinically suspected (n = 51) OATB cases, respectively, by I-PCR, with a specificity of 93·9% (n = 33). Markedly, the sensitivities obtained by I-PCR/RT-I-PCR were significantly higher (P < 0·05-0·01) than ELISA and GeneXpert assay (n = 30). However, no substantial difference in sensitivity was observed between the I-PCR and RT-I-PCR assays. After further improving the accuracy of I-PCR, this test may lead to development of an attractive diagnostic kit.

Diagnosis of osteoarticular tuberculosis: multi-targeted loop-mediated isothermal amplification assay versus multiplex PCR.

Aim: Diagnosis of osteoarticular tuberculosis (OATB) is quite challenging and there is an urgent need to design a prompt and precise diagnostic test. Methods: We developed a multi-targeted loop-mediated isothermal amplification (LAMP) assay using mpt64 (Rv1980c) and pstS1 (Rv0934) targets for the detection of Mycobacterium tuberculosis in OATB patients. Results: The sensitivities of 100 and 82.4% were obtained in confirmed (n=10) and suspected (n=57) OATB cases, respectively by multi-targeted LAMP with a specificity of 96.9% (n=33). Moreover, the sensitivities attained by multi-targeted LAMP in total OATB cases were significantly higher (p<0.05-0.01) than multiplex PCR (mpt64 +pstS1) and GeneXpert assay. Conclusion: Our LAMP is simple, reliable and cost-effective method, which may develop into an attractive diagnostic kit for early detection of OATB cases.

A 20-year retrospective study of osteoarticular tuberculosis in a pediatric third level referral center

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.

The Role of Cartridge-Based Nucleic Acid Amplification Test (CBNAAT), Line Probe Assay (LPA), Liquid Culture, Acid-Fast Bacilli (AFB) Smear and Histopathology in the Diagnosis of Osteoarticular Tuberculosis.

There is a paucity of data on the role of molecular methods in the diagnosis of osteoarticular tuberculosis. The present study was conducted to define the role of molecular (CBNAAT, LPA), phenotypic (AFB smear and culture) and histopathological evaluation in the diagnosis of osteoarticular TB. Seventy-seven consecutive cases of osteoarticular tuberculosis were grouped into presumptive TB cases (group A) and presumptive drug-resistant cases (group B). Tissue samples obtained were submitted for CBNAAT, LPA, AFB smear, liquid culture and histological examinations. The diagnostic accuracy of each test was reported against histologically diagnosed cases and in all tests in tandem. Group A and group B had 65 and 12 cases, respectively. The diagnostic accuracy for tuberculosis was 84.62% by CBNAAT, 70.77% by LPA, 86.15% by molecular tests (combined), 47.69% by AFB smear, 50.77% by liquid culture and 87.69% by histology in group A, and 91.67% for CBNAAT, 83.33% for LPA, 91.67% for molecular tests (combined), 25% for AFB smear, 16.67% for liquid culture and 83.33% for histology in group B. The drug resistance detection rate was 4.62% on CBNAAT, 3.08% on LPA, 6.15% on molecular tests (combined) and 1.54% on DST in group A, while it was 33.33% on CBNAAT, 58.33% on LPA, 58.33% on molecular tests (combined) and 16.67% on DST among group B cases. Similar sensitivity rates for the various tests were obtained among both the groups on comparison with histology (taken as denominator). The addition of molecular methods increased the overall diagnostic accuracy (all tests in tandem) from 93.8 to 100% in group A and from 83.3 to 100% in group B cases. No single tests could diagnose tuberculosis in all cases; hence, samples should be evaluated by molecular tests (CBNAAT and LPA), AFB smear, culture and histological examinations simultaneously. The molecular tests have better demonstration of drug resistance from mycobacterial culture. The online version contains supplementary material available at 10.1007/s43465-020-00326-w.

Delays in diagnosis of osteoarticular tuberculosis

Background: Osteoarticular Mycobacterium tuberculosis infection is uncommon, accounting for 2–5% of tuberculosis (TB) cases worldwide. Presenting symptoms may be non-specific, leading to a delay in diagnosis and treatment. We reviewed data from a cohort of patients with osteoarticular TB in an ethnically diverse area of London with the highest TB endemicity in the UK. Methods and materials: Retrospective analysis of laboratory and medical records, radiology and microbiology results of patients with osteoarticular TB identified from the London TB register between January 2016 and October 2019 from London North West University Healthcare NHS Trust. Results: 74 patients were identified with median age 36 years (range 11–82). 59.5% were South Asian, 23% were from Sub-Saharan Africa. None were HIV positive; 16.2% had type 2 diabetes. The commonest site of infection was spine (46 patients), followed by sternum (8) and ankle (5). Twenty (27%) had multifocal disease with 14.9% having concurrent pulmonary TB. A 50% of patients with spinal TB had radiological evidence of multilevel disease. Patients with spinal TB were more likely to present with constitutional symptoms than patients with TB at other osteoarticular sites (48.8% vs. 10.7%, p < 0.001). Forty cases were culture-positive with 38 fully-sensitive, 1 MDR and 1 isoniazid-resistant. Twenty-nine patients had positive tissue or pus GeneXpert MTB/RIF®. A 42% of patients were treated empirically on a clinico-radiological basis. Mean number of days from symptom onset to initiation of treatment was 187.5 days. Patients with spinal TB had fewer days between onset of symptoms and commencing treatment compared to patients with TB at other sites (mean 99.8 days vs. 328.4 days, p < 0.01). Most patients (73%) received extended treatment between 9 and 12 months. Twenty-five required surgical intervention including abscess drainage (16), spinal fixation (1) and joint replacement (2). 32.8% of patients had residual symptoms after completing treatment including limb weakness, flaccid paralysis and pain. Two patients were lost to follow up and 3 died before completing treatment. Conclusion: This cohort review identifies a significant delay in diagnosing osteoarticular TB, resulting in disability and morbidity. Clinicians should therefore give early consideration to osteoarticular TB in patients presenting with bone or joint pain, even in the absence of constitutional symptoms.

Tuberculous Arthritis in the Ankle in an Immunocompetent Patient: a Case Report

Osteoarticular tuberculosis comprises 1–3% of tuberculosis (TB) patients. In 50% of cases of osteoarticular TB affects the spine. Other joints, such as the ankle, hip, and knee, are less affected. The diagnosis may be delayed for months due to an indolent course and absence of specific signs. Here we report the case of a 42-year-old immigrant immunocompetent male with tuberculosis osteoarthritis of the ankle. The patient experienced intermittent arthritis episodes affecting the left ankle following a fracture of the calcaneus 4 years prior. Initial therapy with anti-inflammatory drugs and empirical antibiotics did not produce improvement. A histological study following a surgical biopsy of the bone provided the diagnosis of tuberculosis. The patient had no respiratory symptomatology, and the chest X-ray was normal. The patient improves his symptoms by administering antitubercular chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The diagnosis of osteoarticular TB requires a high index of suspicion, mainly in immunocompetent patients and in low-incidence countries.

Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World-A WAIOT View.

There has been a major resurgence of tuberculosis (TB) and drug-resistant tuberculosis in the last few decades. Although it has been brought under control in most Western countries, it is still a major cause of death in endemic regions like India. Osteoarticular tuberculosis (OA TB) forms a small proportion of the total cases of tuberculosis. Perceptions and practices of orthopedic surgeons are entirely different in endemic and non-endemic regions around the world, due to the vast difference in exposure. Literature from endemic areas puts stress on clinico-radiological diagnosis and empirical anti-tubercular treatment (ATT). Such practices, although non-invasive, simple to implement, and economical, carry a significant risk of missing TB mimics and developing drug resistance. However, OA TB is still perceived as a “diagnostic enigma” in non-endemic regions, leading to a delay in diagnosis. Hence, a high index of suspicion, especially in a high-risk population, is needed to improve the diagnosis. Evolving drug resistance continues to thwart efforts to control the disease globally. This review article discusses the perceptions and practices in different parts of the world, with India as an example of the endemic world, and lays down priorities for overcoming the challenges of diagnosing osteoarticular TB.

Diagnostic value of Xpert MTB/RIF Ultra for osteoarticular tuberculosis

The diagnosis of osteoarticular tuberculosis (TB) remains challenging and results in under- or over-diagnosis. The aim of the present study was to evaluate performance of the novel next-generation Xpert MTB/RIF Ultra (Xpert Ultra) in comparison to culture and Xpert MTB/RIF (Xpert) for osteoarticular TB diagnosis in high burden settings. Osteoarticular TB suspected cases were enrolled consecutively during June 2017 to June 2018 at Beijing Chest Hospital and their pus specimens were subjected to smear, culture, Xpert and Xpert Ultra. Drug susceptibility testing (DST) was conducted for all of the recovered isolates. The performances of Xpert Ultra and Xpert were evaluated using composite reference standard (CRS) as gold standard, which included clinical, laboratory, histopathological, radiological and ≥6 months' follow-up data. In total, 186 patients were recruited, and 132 of them were diagnosed with osteoarticular TB according to CRS. The direct head-to-head performance comparison for M. tuberculosis detection showed that Xpert Ultra (90.91%, 120/132) produced a higher sensitivity than Xpert (78.79%, 104/132, P = 0.006) and culture (39.39%, 52/132, P<0.001). When Xpert Ultra outcomes were integrated, the percentage of confirmed osteoarticular TB case increased from 84.09% (111/132) to 93.94% (124/132). The specificities of Xpert and Xpert Ultra were 100% (34/34) and 97.06% (33/34), respectively. Both Xpert Ultra and Xpert accurately identified all of the 9 rifampicin (RIF)-resistant and 38 RIF-sensitive cases defined by phenotypic DST. Therefore, Xpert Ultra was 100% concordant with phenotypic DST for the detection of RIF resistance. Xpert Ultra detected significantly more osteoarticular TB cases than Xpert or culture, making it a useful tool for rapid diagnosis of osteoarticular TB.

Exploration of the serum differential biomarkers for osteoarticular tuberculosis based on matrix-assisted laser desorption/ionization time of flight mass spectrometry

Objective Toinvestigatestatistically significant peptide peaks as biomarkersto diagnose osteoarticular tuberculosis, matrix-assisted laser desorption/ ionization time of flight mass spectrometry (MALDI-TOF MS) was applied to identify the characteristic fingerprint among the serum of patients with osteoarticular tuberculosis, rheumatoid arthritis and healthy adults. Methods Clinical Study. Serum samples of untreatedpatients with osteoarticular tuberculosis and rheumatoid arthritis were collected from August 2018 to December 2018, and serum samples of healthy adults from physical examination were collected as control. After analysis with MALDI-TOF MS, the serum peptide fingerprint datawas imported into software, and protein polypeptide peaks with obvious differences were screened to establish diagnostic models. Results Established the diagnostic model of osteoarticular tuberculosis and healthy adults with m/z 2 943.9, 5 929.6, 7 615.4 and 9 033.8 as differential protein polypeptides, the diagnostic model of osteoarticular tuberculosis and rheumatoid arthritis with m/z 4 195.6, 5 847.6, 5 929.6 and 7 748.6 as differential protein polypeptides. To these two models, the sensitivity were 95.00% and 97.50%, respectively. The specificity were 85.71% and 88.46%, respectively. The accuracy rates were 89.58% and 92.39%, respectively. The AUC value of ROC curves were 0.885 9 and 0.870 9, respectively. Conclusions By mass spectrometry and software analysis, the serum protein polypeptides with statistical difference were found successfully. The related diagnostic modelsarealso established, which has certain reference value for auxiliary diagnosis of osteoarticular tuberculosis. Key words: Tuberculosis, osteoarticular; Arthritis, rheumatoid; Spectrometry, mass, matrix-assisted laser desorption-ionization; Peptide mapping; Biomarkers

Diagnosis of osteoarticular tuberculosis via metagenomic next-generation sequencing: A case report.

Osteoarticular tuberculosis (OAT) may cause severe complications and disability. Due to its indolent nature, OAT is difficult to diagnose in the early stages. Diagnosis by conventional culture is time-consuming and insensitive, and polymerase chain reaction-based molecular diagnostic methods are incapable of excluding co-infections. Metagenomic next-generation sequencing (mNGS) may identify a broad spectrum of microorganisms, including Mycobacterium, bacteria and fungi, in clinical specimens. Therefore, the diagnosis of OAT may be rapidly performed using mNGS. The present study reports on a case of OAT. The patient presented with right knee swelling and pain for 1 year; his C-reactive protein levels and erythrocyte sedimentation rate were markedly elevated. Although multiple pre-operative cultures were negative, mNGS was finally used to successfully detect the underlying pathogen. The result was confirmed by other molecular biology methods and Mycobacterium culture. Anti-tuberculosis therapy was administered accordingly and the patient finally recovered. In conclusion mNGS, with the ability to detect Mycobacterium and other microorganisms in a single assay, is an emerging approach for rapidly and accurately diagnosing OAT. This method may provide significant support to guide physicians in selecting the appropriate pharmacotherapy and surgical treatments.

Needle Aspiration and Cytology for Suspected Osteoarticular Tuberculosis in Children.

Introduction: Early diagnosis of osteoarticular tuberculosis (OATB) is essential to prevent significant functional disability. There is no single test for diagnosis. Despite an array of investigations available, definitive diagnosis at early stage before starting antitubercular drugs is still a challenge. Materials and Methods: A cross sectional study was carried out between February 2016 and October 2017. All children less than 18 years of age with suspected osteoarticular tuberculosis were included. The cases were subjected to simple needle aspiration from whichever site was accessible. Multiple sample aspirations were done at site of involvement. Smears were prepared from the aspirated material.Results: Ziehl-Neelsen staining for Acid Fast Bacilli (AFB) showed deep pink red rods under light microscopy. Features suggestive of tuberculosis can be seen by May-Grünwald-Giemsa (MGG) staining. Auramine-O staining method of detecting AFB under fluorescent microscope shows the bacilli as greenish yellow slender curved rods in dark background. Fluorescent microscopy has higher sensitivity and comparable specificity. In our study, microbiological confirmation of OATB could be done in 100% cases where the lesion could be accessed for aspiration. The molecular techniques are relatively more expensive and not available everywhere.Conclusion: Meticulous search for AFB in a well stained smear using three different staining methods provides a direct evidence of infection over costly imaging especially in poor patients seen in resource limited settings.

CB-NAAT MTB/RIF assay and histopathology correlation in diagnosis of osteoarticular tuberculosis using culture as reference standard

CB-NAAT MTB/RIF assay and histopathology correlation in diagnosis of osteoarticular tuberculosis using culture as reference standard

Evaluation of molecular tests in diagnosis of osteoarticular tuberculosis

Osteoarticular tuberculosis is a relatively uncommon type of extrapulmonary tuberculosis. It is an important cause of mortality and morbidity and accounts for approximately 10-15% of all extrapulmonary forms of tuberculosis. The diagnosis is difficult and hence often late. The disability resulting from osteoarticular tuberculosis is directly related to the time of detection of disease and initiation of treatment. A prospective study of 36 patients suspected with osteoarticular tuberculosis was done from August 2010 to December 2012 was done at St. stephens hospital Delhi. For the purpose of this study, a diagnosis of osteoarticular TB was based on a combination of suggestive clinical features, in conjunction with typical radiological findings associated with osteoarticular TB. The specimens were subjected to ZN staining, Real Time PCR, Bac-T alert culture & Accuprobe. The sensitivity of real time PCR was 100%, specificity was 58.8%, positive predictive value was 73%, negative predictive value was 100%, efficiency was 80.5% considering culture as gold standard. As shown by the study, each diagnostic test including Real time PCR has its own disadvantages and shortcomings and does not provide 100% accuracy in diagnosing osteoarticular tuberculosis, therefore, strong clinical suspicion and correlation along with radiological and laboratory evidence is a must in establishing a diagnosis.

Expression of Alpha Crystallin Protein in Osteoarticular Tuberculosis in Latent Phase: A Review of Evidences

Due to scarcity of bacilli, an accurate diagnosis of osteoarticular tuberculosis is always being a challenge. Though conventional methods lack sensitivity and are time consuming, molecular diagnostic modalities are very effective for early diagnosis with high sensitivity and specificity. Timely diagnosis even in latent period will improve the efficacy of the treatment of osteoarticular tuberculosis. Under some stress conditions like hypoxia, nitric oxide stress, long term viability of M. tuberculosis is favoured by alpha crystallin protein (acr), which is a dominant protein of latent phase. In this article we focuses on protein that shows significant expression in the latent phase of M. tuberculosis. It may be further used as a prognostic biomarker for differentiating latent and active tuberculosis.

A rare localization of tuberculosis of the wrist: The scapholunate joint

The tuberculosis of the hand and the wrist is a rare entity. Affecting the scapholunate joint is exceptional. It is usually diagnosed at an advanced stage of carpal destruction, due to slowly development of the symptoms. We report the case of a 58-year-old female, presenting as wrist pain for 3months. Clinical study showed a local swelling in the left wrist, the mobility of the wrist was normal but painful at the end of motion. The diagnosis of osteoarticular tuberculosis was suspected after radiological and biological study then confirmed after histological study. Antibacillary chemotherapy during 12months promoted healing and good outcome.

Clinical, radiological and molecular diagnosis correlation in serum samples from patients with osteoarticular tuberculosis

To assess the role of polymerase chain reaction (PCR) in serum samples, in the diagnosis of osteoarticular tuberculosis (OTB) in a setting where only clinical and imaging diagnoses determine the treatment. A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients, based on clinical and radiological [X-ray or magnetic resonance imaging/computed tomography] features. They were screened by in-house nested PCR. In addition, a few specimens were examined by Gram stain, acid-fast bacilli stain, histopathology and routine bacterial culture. A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls. Of the 44 clinically suspected OTB patients, in-house nested PCR was positive in 40 (91%) cases; PCR was negative in 38 (97%) negative controls. Sensitivity and specificity of our in-house nested PCR was 90.9% and 97.4%, respectively. The PCR report was available within 48 h. It was possible to standardize serum PCR technique and in positive cases, a good correlation was observed in terms of an adequate treatment response. Nested PCR in serum samples is a rapid, highly sensitive and specific modality for OTB detection. PCR should be performed in addition to clinical evaluation, imaging studies, acid-fast bacilli staining, culture and histopathology diagnosis, if possible.

Evaluation of interferon-γ release assay in the diagnosis of osteoarticular tuberculosis

The aim of this study was to assess the value of interferon-γ (IFN-γ) release assay (IGRA) (T-SPOT.TB) for patients with suspected osteoarticular tuberculosis (TB) in comparison with conventional and molecular methods. Of 145 patients with suspected osteoarticular TB, recruited from Beijing Chest Hospital between July 2011 and June 2012, 86 (59.3%)had osteoarticular TB (26 with culture-confirmed TB, 60 with probable TB), 24 (16.6%) were not having active TB. The remaining 17 (11.7%) inconclusive TB and 18 (12.4%) possible TB were excluded from final analysis. In addition to conventional tests and molecular method, T-SPOT.TB assay using peripheral blood mononuclear cells to examine IFN-γ response to early secretory antigenic target 6 and culture filtrate protein 10 was also performed. The sensitivity and specificity for T-SPOT.TB assay were 94.2% and 70.8%, respectively. A statistically significant difference in sensitivity was found between T-SPOT.TB assay (94.2%) and other tests (acid-fast bacilli smear (19.7%), culture (34.2%), real-time PCR (36.8%); P < 0.01, respectively). These results suggested that the IGRA assay could provide useful aids in the diagnosis of osteoarticular TB.

Tuberculous arthritis revisited as a forgotten cause of monoarticular arthritis

BACKGROUND AND OBJECTIVES:Tuberculosis (TB) continues to be a major concern for health care workers. The number of reported cases of extrapulmonary tuberculosis, particularly osteoarticular tuberculosis, is increasing. This fact is attributed to different factors such as underestimating the disease and difficulty in diagnosis, which requires tissue sampling and can lead to a delay in the diagnosis, and can result in significant morbidity and mortality. The aim of this study was to highlight the difficulties and delay in diagnosis of articular tuberculosis, raising the need to create awareness about the importance of early diagnosis to avoid major complications of joint destruction.DESIGN AND SETTING:Retrospective review of patients presenting to a tertiary care center between 2003 and 2009.PATIENTS AND METHODS:We reviewed cases who presented with monoarticular joint pain and swelling that failed to respond to treatment elsewhere and were eventually diagnosed as having articular tuberculosis. We collected the demographic data, history, data on clinical examination and the relevant laboratory investigations, in addition to the data on radiological studies. All patients were treated medically with antituberculosis chemotherapy and surgically according to the severity of joint destruction.RESULTS:Thirteen patients had a mean age was 40 years (range, 17-70 years). The average delay in diagnosis was 2 years. Only 1 patient had pulmonary TB. The hip, knee and elbow were the most common joints involved. Bacteriology was positive in 69% of the cases; and histopathology, in 92%. Fifteen percent of the patients had arthrodesis. None showed recurrence after follow-up of 4 years.CONCLUSION:A high level of clinical suspicion is essential for early diagnosis and treatment of osteoarticular TB to reduce its significant morbidity.