Treatment Of Osteoarticular Tuberculosis Research Articles

Diagnosis and treatment of osteo-articular tuberculosis of the foot and ankle (a five case series)

IntroductionOsteo-articular tuberculosis is a rare manifestation of this disease, often posing diagnostic challenges that necessitate additional diagnostic imaging modalities such as radiography, CT, and MRI. This article presents a series of five cases involving tuberculosis affecting the bones of the foot and ankle, diagnosed at various stages. The patients received appropriate anti-tuberculosis medical treatment following national protocols, along with surgical interventions when necessary. Case studiesIn this series, we describe the clinical characteristics and management of five cases of foot and ankle bone tuberculosis. These cases were diagnosed at different stages, and all patients received standard anti-tuberculosis medical therapy according to national treatment guidelines. Surgical interventions were performed when deemed necessary to optimize patient outcomes. DiscussionThe diagnosis of bone tuberculosis should be considered in any clinical scenario that presents with uncertain features, persistent symptoms, or resistance to conventional treatment approaches. It is crucial to employ a multidisciplinary approach involving medical and surgical management to effectively address this challenging disease. However, it is important to note that surgical intervention cannot replace the necessity of proper medical treatment. ConclusionTuberculosis involving the bones of the foot and ankle remains an infrequent occurrence. However, considering the endemic context, prompt therapeutic interventions are essential to prevent significant osteoarticular damage. Early diagnosis, adherence to established treatment protocols, and a comprehensive approach encompassing both medical and surgical modalities are crucial for successful management of this rare entity.

Development of tetracycline-modified nanoparticles for bone-targeted delivery of anti-tubercular drug.

Background: Since the poor response to existing anti-tuberculosis drugs and low drug concentration in local bone tissues, the traditional drug therapy does not result in satisfactory treatment of osteoarticular tuberculosis. Thus, we report a rifapentine release system with imparted bone targeting potential using tetracycline (TC) -modified nanoparticles (NPs). Methods: TC was conjugated to PLGA-PEG copolymer via a DCC/NHS technique. Rifapentine-loaded NPs were prepared by premix membrane emulsification technique. The resulting NPs were characterized in terms of physicochemical characterization, hemolytic study, cytotoxicity, bone mineral binding ability, in vitro drug release, stability test and antitubercular activity. The pharmacokinetic and biodistribution studies were also performed in mice. Results: Rifapentine loaded TC-PLGA-PEG NPs were proved to be 48.8nm in size with encapsulation efficiency and drug loading of 83.3% ± 5.5% and 8.1% ± 0.4%, respectively. The release of rifapentine from NPs could be maintained for more than 60h. Most (68.0%) TC-PLGA-PEG NPs could bind to HAp powder in vitro. The cellular studies revealed that NPs were safe for intravenous administration. In vivo evaluations also revealed that the drug concentration of bone tissue in TC-PLGA-PEG group was significantly higher than that in other groups at all time (p < 0.05). Both NPs could improve pharmacokinetic parameters without evident organ toxicity. The minimal inhibitory concentration of NPs was 0.094μg/mL, whereas this of free rifapentine was 0.25μg/mL. Conclusion: Rifapentine loaded TC-PLGA-PEG NPs could increase the amount of rifapentine in bone tissue, prolong drug release in systemic circulation, enhance anti-tuberculosis activity, and thereby reducing dose and frequency of drug therapy for osteoarticular tuberculosis.

Применение бисфосфонатов при экспериментальном туберкулезном остите: КТ-визуализация

Introduction The complex treatment of osteoarticular tuberculosis is based on combination of anti-tuberculosis therapy, complete (radical) removal of involved bone and restoration of the supporting and motor function of the affected musculoskeletal segment. Inhibited activity of osteoclasts involved in osteoresorption as one of the mechanisms of reparative osteoregeneration can be involved in regulation of bone formation after radical reconstructive surgery. The objective was to explore CT signs of osteoregeneration due to multimodal treatment of experimental tuberculous osteitis with use of bisphosphonates as targeted inhibitors of osteoclasts. Material and methods An experimental study was carried out on 21 mature male Chinchilla rabbits. The first stage included bone tuberculosis simulated in the medial condyle of the right femur using invasive local infection with M. tuberculosis strains H37Rv, a virulent reference laboratory strain. Pathological focus was resected and bone graft used at the second stage. Animals receiving antituberculosis therapy (ATT), ATT and bisphosphonates (BP) and BP only were divided into three groups at the third stage. Animals were sacrificed at 3 and 6 months of surgical treatment at the fourth stage. Autopsy implantation zone, bone of the contralateral condyle and intact femur were quantitatively and qualitatively assessed using micro-CT imaging. Results Positive dynamics in bone restoration was seen in the groups. ATT group showed complete lysis of the implant with bone cavities identified and no bone restoration in half of the cases seen at 6 months. Rabbits treated with BP demonstrated absence of complete lysis of the implant and CT signs of ingrowth of bone trabeculae. CT signs of maximum osteoregeneration were noted in the group of isolated BP therapy. Discussion The use of bisphosphonates can prevent lysis of grafts preserving the osteoconductive properties and facilitating formation of new bone. Conclusion Targeted osteoclast inhibitors can be safety and efficaciously used in the complex treatment of focal infectious skeletal lesions and be recommended as a potential component of pathogenetic therapy in the postoperative treatment of infectious (tuberculous) skeletal lesions.

Knee tuberculosis: A misleading clinical entity (case report).

IntroductionBone and joint infections are rare localizations of tuberculosis, and its diagnosis is challenging. The atypical clinical presentation may lead to delayed diagnosis and severe complications.Case presentationWe report the case of a 72-year-old female diagnosed with tuberculosis of the knee. She was complaining of progressive right knee pain and swelling without systemic signs. She was misdiagnosed as having a flare-up of osteoarthritis, which led to a delayed diagnosis and a septic subluxation of the knee. We performed a knee arthrotomy, lavage, and stabilization with an external fixator. The microbiologic tests did not isolate any germs. However, a histological examination confirmed the diagnosis by revealing a caseating granuloma surrounded by epithelioid cells. The patient treated with anti-tuberculosis therapy had a good evolution. Three months post-surgery, the external fixator was replaced with a removable knee brace.DiscussionOsteoarticular tuberculosis is often caused by the hematogenous route. The lack of specificity in clinical and radiological signs makes the diagnosis difficult, especially at the early stage, leading to delays in diagnosis and complications.Nevertheless, the recognition of predisposing factors to tuberculosis, with persisting symptoms despite treatment, should draw the intention of further investigation.The treatment of osteoarticular tuberculosis is primary medical with antituberculosis chemotherapy. However, surgical treatment is reserved for specific indications and mostly to treat complications.ConclusionThe lack of specificity in clinical and radiological signs in osteoarticular tuberculosis may mislead the physician. Nevertheless, focusing on predisposing factors, especially in endemic areas, may guide diagnosis and avoid complications.

Surgical stabilization of appendicular joints in tuberculous arthritis: its place in treatment of osteoarticular tuberculosis

The objective: to analyze results of stabilizing techniques in the surgical treatment of tuberculous arthritis of appendicular joints, to define their place in treatment of tuberculous arthritis.Subjects and Methods. Data of 8 patients who underwent surgery for tuberculosis of appendicular joints were analyzed during the study. 7 patients suffered from tuberculosis of rare localization: ankle – 3 cases, foot – 1 case, wrist – 3 cases. And 1 patient suffers from tuberculosis of the knee joint, underwent arthrodesis, which eventually failed, had quadriceps fibrosis with no patella. At the time of the study, athroplasty couldn’t be performed in all 8 patients, so stabilizing surgery including arthrodesis was the method of choice. With the active tuberculosis disease and an extensive bone defect of the joint in 5 patients, static cement spacers loaded with anti-tuberculosis drugs were used. Spacers were used both for two-stage surgical treatment (2 cases) and one-stage (3 cases).Results: in all 8 cases, the stable eradication of tuberculosis infection was achieved with a follow-up period from 6 months to 7 years, average duration of follow-up made 2.2 Ѓ} 1.4 years. In 5 patients with tuberculosis of the ankle, foot and former knee joint, the support ability of the extremity was restored. With the stabilization of the wrist in a functionally advantageous position, all 3 patients showed a significant improvement in hand functions. After the spacer was installed, all patients were scheduled for the second stage of the operation but 3 of them achieved a good functional result, thus it was possible to avoid the next stage. The main criterion for stabilizing surgery of joints may be the impossibility of performing arthroplasty in cases of extensive bone defects as well as in case of persistent loss of anatomical structures.

3D-Printed Porous Tantalum Coated with Antitubercular Drugs Achieving Antibacterial Properties and Good Biocompatibility.

Treatment of bone and joint tuberculosis remains a challenge. The development of tissue-engineered drug-loaded biomaterials has increased the therapeutic options. However, for the treatment of osteoarticular tuberculosis with severe local infection risks and high weight-bearing requirements, it is still necessary to design materials consistent with bone biomechanics, cytocompatibility, and osteogenesis and to provide more effective antimicrobial functions. The antitubercular drugs isoniazid and rifampicin are loaded with gellan gum, and a 3D-printed porous tantalum surface is treated with polydopamine to increase adhesion. The osteogenic induction and differentiation are tested using alkaline phosphatase, alizarin red staining, sirius red staining, and polymerase chain reaction testing. Bone regeneration in vivo is measured by X-ray, micro-computerized tomography, hard tissue sections, and fluorescence staining. The drug is released slowly in vitro and in vivo, increasing the duration of antibacterial action. The composite bio-scaffolds inhibit Staphylococcus aureus growth, have good biocompatibility, and does not inhibit the induction of osteogenic differentiation of rat bone marrow mesenchymal stem cells. The composite bio-scaffold can simultaneously achieve localized long-term controlled drug release and bone regeneration and is a promising route for bone and joint tuberculosis treatment.

Comparative analysis of five inspection techniques for the application in the diagnosis and treatment of osteoarticular tuberculosis

ObjectiveTo evaluate five examination techniques in the diagnosis and treatment of osteoarticular tuberculosis (TB). MethodsMicrobiological samples were collected from a total of 284 patients during the period August 2017 to December 2019 in Wuhan Pulmonary Hospital. The specimens were examined by acid-fast bacillus (AFB) smear microscopy, mycobacterial culture, PCR, T-SPOT.TB, and X-pert MTB/RIF rapid molecular detection. ResultsThe diagnostic sensitivity of the Xpert technology was 96.8% (116/120), specificity was 96.8% (58/60), the Youden index was 0.936, and the area under the receiver operating characteristic (ROC) curve was 0.967. The sensitivity and specificity of PCR were 84.2% (104/128) and 95.2% (76/80), respectively; the area under the ROC curve was 0.881. T-SPOT.TB had a detection sensitivity of 75.0% (12/16) and specificity of 85.0% (17/20). AFB smear microscopy had a sensitivity of 60.0% (75/125) and specificity of 95.8% (152/159). TB culture sensitivity was 58.1% (72/124) and specificity was 96.2% (73/76). The sensitivity and specificity of Xpert MTB/RIF for detecting rifampicin resistance were 100% (2/2) and 97.3% (73/75), respectively. ConclusionsThe Xpert MTB/RIF technique was found to have a good diagnostic value. With an additional diagnosis of Rifampicin resistance, it was also useful in tuberculosis therapy.

A bioactive implant combining isoniazid with nanohydroxyapatite/polyamide 66 for the treatment of osteoarticular tuberculosis

Maintaining an effective drug concentration in the nidus during the early stage is essential for the surgical treatment of osteoarticular tuberculosis (TB) and the prevention of internal infection. In this study, an implantable composite scaffold, denoted as n-HP@ICG, was synthesized by attaching isoniazid (INH) to chitosan followed by crosslinking via glutaraldehyde to porous nanohydroxyapatite/polyamide 66 (n-HA/PA66). Drug release and biocompatibility experiments showed that INH could be effectively released from the composite scaffold for approximately 15 days in vitro and 28 days in vivo with no obvious cytotoxicity or harm to liver or kidney function. The anti-TB test indicated that n-HP@ICG had satisfactory anti-TB effects, including the inhibition of Mycobacterium tuberculosis activity, proliferation and adhesion. The rabbit femoral condyle defect repair experiment showed that the composite scaffold had satisfactory osteoconduction and osseointegration. These results demonstrate that the n-HP@ICG composite scaffold can simultaneously provide relatively long-term drug release, biosafety, and anti-TB and bone regeneration activity and is thus promising for treating osteoarticular TB.

Evaluation of pattern and treatment of osteoarticular tuberculosis in central India

Introduction: Tuberculosis the global epidemic continues to be a major health problem despite availability of effective chemotherapy. The main aim of the study was to analyse the pattern, clinical findings, diagnosis, and treatment options for osteoarticular tuberculosis at Tertiary care hospital so that proper treatment guidelines can be formulated for the patient. Materials and Methods: A prospective study was performed in the tertiary care. Patients clinically diagnosed as osteoarticular tuberculosis, all the patients who were regular on anti-tubercular treatment and follow-up and all the patients with radiological evidence matching with clinical profile were included in the study. All the patients who showed histopathological evidence in favor of osteoarticular tuberculosis were also included. The patients with only pulmonary tuberculosis, with extra pulmonary involvement, with no osteoarticular involvement were excluded from the study. Observation and Results: The age group of patient ranged from 1-80 years, mean age was 38.11 in males and 34.5 years in females with a total mean age of 36.96 years. Sex predominance was seen in males with 68%. The distribution of the patient according to occupation farmer category showed a maximum of 56%. Socio-economic class distribution according to modified kuppuswamy classification showed most patient belonged to Upper-Lower (IV) 82% and 18% belonged to lower-middle (III) category. Conclusion: Tuberculosis of the spine is still the most preferred site of osteoarticular tuberculosis. Spine patient usually require early surgical intervention especially those with neurological deficits. Outcomes may be maximized through early detection and treatment, although adequate results can still be achieved with salvage procedures in patients presenting with late stages of disease. Keywords: Tuberculosis, Spine, AKT, Pattern, Treatment.

Bone penetration of linezolid in osteoarticular tuberculosis patients of China

BackgroundLinezolid presents strong antimicrobial activity against multidrug-resistant (MDR) pulmonary tuberculosis (TB), but its application in osteoarticular tuberculosis treatment remains understudied. Our objective was to analyze the bone penetration efficiency of linezolid in osteoarticular TB patients. MethodsOsteoarticular TB patients, treated with 600 mg q 24 h linezolid-containing regimens and undergoing surgery, were prospectively and consecutively enrolled. One dose linezolid was administered before surgery. Blood and bone samples were collected simultaneously during operation, and their linezolid concentrations were then detected using high-performance liquid chromatography-tandem mass spectrometry. Pus samples were subjected to mycobacterial culture and GeneXpert MTB/RIF assay. The minimum inhibition concentrations (MICs) and drug susceptibility testing were performed with the recovered isolates. ResultsA total of 36 eligible osteoarticular TB patients were enrolled, including five MDR/rifampicin-resistant cases. All the 12 recovered isolates had MICs ≤0.5 μg/mL for linezolid. Mean concentrations in plasma, collected 100−510 min after the preoperative dosing, were 10.43 ± 4.83 μg/mL (range 3.29−22.26 μg/mL), and median concentrations in bone were 3.93 μg/mL (range 0.61−16.34 μg/mL). The median bone/plasma penetration ratio was 0.42 (range 0.14−0.95 μg/mL). Linezolid concentration in bone had a linear correlation with the drug concentration in plasma (r = 0.7873, p < 0.0001), while plasma concentration could explain 61.98% of the variation of concentration in bone (R2 = 0.6198). Notably, stratification analysis by sampling time demonstrated that samples collected 200−510 min after dosing had very good linear relationships between their bone and plasma concentrations (r = 0.9323). ConclusionsLinezolid penetrates from blood to bone efficiently, and the penetration further stabilizes ∼3 h after dosing.

Development and in vitro characterization of rifapentine microsphere-loaded bone implants: a sustained drug delivery system.

This study aimed to develop and evaluate a sustained drug delivery system for the treatment of osteoarticular tuberculosis (TB) to address the issues surrounding low drug concentration in lesions and bone defects or nonunion after debridement. The effects of rifapentine on the proliferation and cell cycle of bone marrow mesenchymal stem cells (BMSCs) were evaluated by Cell Counting Kit-8 (CCK-8) and flow cytometry. Rifapentine polylactic acid (PLA) sustained-release microspheres (RPSMs) were prepared through the double emulsion solvent evaporation method and investigated the antibacterial activity in vitro. In this study, two sustained drug delivery systems were prepared by integrating RPSMs and BMSCs into hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) or allogeneic bone. We evaluated these drug delivery systems for dynamics of drug release and osteogenic ability by in vitro release test, alkaline phosphatase (ALP) and alizarin red staining, and real-time PCR. The results showed that rifapentine concentrations up to 45.0 μg/mL had no effect on cell proliferation and cell cycle. The encapsulation and drug loading efficiency of the fabricated RPSMs were 78.11%±1.16% and 35.57%±0.85%, respectively. The RPSMs had uniform particle size distribution and a long-term anti-bacterium effect. The HA/β-TCP-implanted drug delivery system was found to be more effective in reducing the burst release and having a longer duration of sustained release and retention compared to allogeneic bone. The ALP and alizarin red staining and real-time PCR results showed that it had excellent osteoconductive and osteoinductive properties. In conclusion, the sustained drug delivery system with HA/β-TCP as scaffold material represents a potential new strategy for TB infections and bone defects.

A bioactive implant in situ and long-term releases combined drugs for treatment of osteoarticular tuberculosis

Anti-tuberculosis chemotherapy with a long duration and adequate dosing is the mainstay for treatment of osteoarticular tuberculosis (TB). However, it is difficult for systemic administration to reach adequate local drug concentrations and achieve effective treatment. Herein, a hydroxyapatite (HA) scaffold implant combined with a drug-releasing system was designed to achieve in situ and long-term anti-TB drug release and highly efficient therapeutic activity in vitro and in vivo. The clinical anti-TB drugs hydrophilic isoniazid (INH) and hydrophobic rifampicin (RFP) were molecularly dispersed into polyvinyl alcohol (PVA) through immersion-curing techniques and were steadily adhered onto the surfaces of HA scaffolds (HA-drug@PVA). The HA-drug@PVA scaffolds showed a long-term, sustained drug release profile and killed proliferating Mycobacterium in vitro. In vivo experimental results revealed that the HA-drug@PVA scaffolds provided over 10- and 100-fold higher concentrations in muscles and bones, respectively, as well as a much lower concentration (<0.025) in blood. Furthermore, the HA-drug@PVA scaffold implanted in an osteoarticular TB rabbit model showed obvious bone regeneration and fusion due to the inhibition of TB-associated inflammatory changes. The excellent therapeutic effects indicate that in situ implant materials combined with a long-term drug release system are promising for the treatment of osteoarticular TB and other osteoarticular infections.

Tuberculous osteoarthritis of the wrist about three observations and review of the literature

Objectives: To determine the therapeutic modalities and to specify the evolution of the treatment of osteo-articular tuberculosis of the wrist. Introduction: Osteoarticular tuberculosis is rare 3 to 5% of all localizations by BK. Their diagnosis is often late. Patients and methods: This was a retrospective study continued from January 2010 to November 2017. 3 patients, 2 men and 1 woman aged 39.66 years (range 19 to 65 years) were involved. The average consultation time was 17 months (range 3 to 24 months). For both patients, it was isolated osteoarthritis of the wrist and for the 3rd, it was associated with another location. Two patients presented a concept of tuberculous contagion and the other a pulmonary tuberculosis associated with Pott's disease. The function was evaluated according to the Mayo Wrist score and the winding of the fingers. Results: The treatment consisted of debridement in all cases. In all our patients the pathological examination found an epitio-gigantocellular granuloma with caseous necrosis. Anti-tuberculosis chemotherapy was instituted in all patients for a period of 6 months (n = 2, one of which is still in treatment), 9 months (n = 1). At the average follow-up of 5 years in the 2 (extremes 2 and 8 years), we did not observe a recurrence. The function was good the 2 cases that finished their treatment with a complete winding of the fingers. Conclusion: Treatment is based on debridement and antituberculous chemotherapy. Applied early, it provides excellent results.

Dr. Józef Aleksiewicz Activity in Support of the Development of Orthopedics and Rehabilitation in Iwonicz-Zdrój (1921-1957).

Based on source materials in the possession of Józef Aleksiewicz family (typescripts, manuscripts, photographs, other documents) and articles published in professional medical journals and newspapers, the authors present the contribution of Dr. J. Aleksiewicz to the development of orthopedics and rehabilitation in Iwonicz-Zdrój. In May 1921, he was appointed Surgeon General of the Spa Commission in Iwonicz-Zdrój. After holding several scholarly trips abroad in 1925 to sanatoriums treating cases of osteo-articular tuberculosis, he commenced the construction of "Sanato", a modern sanatorium. Opened in 1930, it was the only center in Poland treating osteo-articular tuberculosis in a spa setting. It was the first orthopedic rehabilitation center in what is now Podkarpackie Voivodship offering diagnostic work-up, surgery and conservative treatment of osteo-articular tuberculosis in children. Modelled on the best Western centers, Dr. Aleksiewicz widely employed physical methods, such as Swedish therapeutic gymnastics, mechanotherapy, massage, physical therapy and hydrotherapy.

An exceptional location of tuberculous arthritis: The metatarsal phalangeal joint

Osteoarticular tuberculosis is a rare type of tuberculosis. The spine is the most frequent location, while peripheral locations in the limbs are rare. We report a case of tuberculous osteoarthritis of the metatarsophalangeal joint of the first ray of the foot in a 48-year-old woman.The patient presented with painful swelling of the dorsum of the big toe, insidiously evolving for 6months. Diagnosis was obtained with histological study after surgical biopsy. Antitubercular chemotherapy for 12months promoted healing.Through this clinical case the authors describe the epidemiological, diagnostic features, and treatment of osteoarticular tuberculosis and discuss the causes of delayed diagnosis often encountered in these exceptional locations and differential diagnoses, gout in particular, for this particular case.

Osteoarticular Tuberculosis: Clinical and Therapeutic Feature

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.

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.

Development and in vitro characterization of drug delivery system of rifapentine for osteoarticular tuberculosis.

The study was to develop and evaluate the rifapentine-loaded poly(lactic acid-co-glycolic acid) (PLGA) microspheres (RPMs) for the treatment of osteoarticular tuberculosis to avoid critical side effects caused by oral regimens of antibiotics or intravenous antibiotics. The RPMs were spherical with rough surfaces, and elevated amounts of rifapentine in the formulation markedly increased the particle size and drug loading, while decreased the size distribution and entrapment efficiency. The highest drug loading and encapsulation efficiency of RPMs were 23.93%±3.93% and 88.49%±8.49%, respectively. After the initial rapid drug release, the release rate gradually decreased, and approximately 80% of the encapsulated rifapentine was released after 30 days of incubation. Moreover, RPMs could effectively inhibit the growth of Staphylococcus aureus. With increasing rifapentine content, the inhibition zones were continuously enlarged while the minimal inhibitory concentration values decreased. These results suggested that RPMs were bioactive and controlled release delivery systems for the treatment of osteoarticular tuberculosis.

3D-printed hierarchical scaffold for localized isoniazid/rifampin drug delivery and osteoarticular tuberculosis therapy

After surgical treatment of osteoarticular tuberculosis (TB), it is necessary to fill the surgical defect with an implant, which combines the merits of osseous regeneration and local multi-drug therapy so as to avoid drug resistance and side effects. In this study, a 3D-printed macro/meso-porous composite scaffold is fabricated. High dosages of isoniazid (INH)/rifampin (RFP) anti-TB drugs are loaded into chemically modified mesoporous bioactive ceramics in advance, which are then bound with poly (3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) through a 3D printing procedure. The composite scaffolds show greatly prolonged drug release time compared to commercial calcium phosphate scaffolds either in vitro or in vivo. In addition, the drug concentrations on the periphery tissues of defect are maintained above INH/RFP minimal inhibitory concentrations even up to 12weeks post-surgery, while they are extremely low in blood. Examinations of certain serum enzymes suggest no harm to hepatic or renal functions. Micro-CT evaluations and histology results also indicate partly degradation of the composite scaffolds and new bone growth in the cavity. These results suggest promising applications of our hierarchical composite scaffold in bone regeneration and local anti-TB therapy after osteoarticular TB debridement surgery.

Profile of Knee’s Bone and Joint Tuberculosis in Adults: About 33 Cases

The authors report toward a monocentric retrospective and descriptive study on a 08 year period, 33 cases of knee osteoarticular tuberculosis (OAT) of adult, certified by bacteriologic and/or histolological evidence proof of the sample (synovial biopsy) after a knee arthrotomy. There were 07 cases of arthritis and 26 cases of osteoarthritis. The treatment of knee OAT was medical (anti-tubercular poly-chemotherapy) on one year duration. The surgery was useful in front of some clinical presentations. After a minimum of 18 months, a functional evaluation was done following the Lequesne algo-functionnal index. None had signs of local recurrence testifying the adequacy of medical treatment, even if it is long and binding. The main of our case series is to establish an epidemiological, clinical and biological profile of the knee tuberculosis of adult and to research elements of prognosis through an analysis of results.