Tuberculosis (musculoskeletal manifestations)
Musculoskeletal tuberculosis is always secondary to a primary lesion in the lung.
The prevalence of the disease is around 30 million globally and 1-3% of the 30 million have involvement of bones and joints. Mycobacterium tuberculosis is responsible for almost all the cases of osteoarticular tuberculosis. Although atypical mycobacteria have been reported in lesions of the synovial sheath.
The predisposing factors are protein energy malnutrition, environmental conditions and living standards such as poor sanitation, overcrowded housing and slum dwelling. Trauma as a causative factor is debatable has been reported. Acquired immunodeficiency syndrome and other causes of immunocompromised status and repeated pregnancies and lactation in women is also a factor.
Osteo-articular tuberculosis can occur in the spine, hip, knee, foot, elbow, wrist, hand, shoulder and as diaphysial foci. It has not been reported to affect mandible and temporomandibular joint. The major method of spread is haematogenous. The most common method of spread to the vertebral body is through Batson's prevertebral venous plexus.
Osteoarticular tuberculosis is reported in various sites which includes
- tuberculosis of the spine
- tuberculous arthropathy
- tuberculosis of tendon sheath and bursae
- tuberculous osteomyelitis
- tuberculous dactylitis
- causative agent
- tuberculoma (tuberculous granuloma)
- tuberculous abscess
- miliary tuberculosis
- pulmonary tuberculosis
- cardiac tuberculosis
- intracranial tuberculosis
- tuberculous otomastoiditis
- gastrointestinal tuberculosis
- genitourinary tuberculosis
- skeletal tuberculosis
- tuberculous mastitis
- tuberculous lymphadenopathy
- tuberculous adrenalitis
- 1. Tuli SM. Tuberculosis of the Skeletal System. Anshan Publishers. (2004) ISBN:8180612708. Read it at Google Books - Find it at Amazon
- 2. Ridley N, Shaikh MI, Remedios D et-al. Radiology of skeletal tuberculosis. Orthopedics. 1999;21 (11): 1213-20. Pubmed citation
- 3. Halsey JP, Reeback JS, Barnes CG. A decade of skeletal tuberculosis. Ann. Rheum. Dis. 1982;41 (1): 7-10. doi:10.1136/ard.41.1.7 - Free text at pubmed - Pubmed citation