Osteoarticular Tuberculosis: Osteoarticular Tuberculosis: Challenges in Diagnosis Challenges in Diagnosis G. Omondi Oyoo FRCP(Edin), FACR G. Omondi Oyoo FRCP(Edin), FACR CONSULTANT PHYSICIAN AND RHEUMATOLOGIST, CONSULTANT PHYSICIAN AND RHEUMATOLOGIST, SENIOR LECTURER ,DEPARTMENT OF CLINICAL MEDICINE SENIOR LECTURER ,DEPARTMENT OF CLINICAL MEDICINE AND THERAPEUTICS, AND THERAPEUTICS, SCHOOL OF MEDICINE;UNIVERSITY OF NAIROBI, SCHOOL OF MEDICINE;UNIVERSITY OF NAIROBI, NAIROBI, KENYA.. NAIROBI, KENYA.. Chairman AARD Chairman AARD (Association for Arthritis and Rheumatic Diseases of Kenya ), (Association for Arthritis and Rheumatic Diseases of Kenya ), President-elect, AFLAR (African League of Associations for Rheumatology). Country coordinator, Bone and Joint Decade (BJD), Kenya.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Osteoarticular Tuberculosis:Osteoarticular Tuberculosis:Challenges in DiagnosisChallenges in Diagnosis
G. Omondi Oyoo FRCP(Edin), FACRG. Omondi Oyoo FRCP(Edin), FACRCONSULTANT PHYSICIAN AND RHEUMATOLOGIST,CONSULTANT PHYSICIAN AND RHEUMATOLOGIST,
SENIOR LECTURER ,DEPARTMENT OF CLINICAL MEDICINESENIOR LECTURER ,DEPARTMENT OF CLINICAL MEDICINEAND THERAPEUTICS, AND THERAPEUTICS,
SCHOOL OF MEDICINE;UNIVERSITY OF NAIROBI,SCHOOL OF MEDICINE;UNIVERSITY OF NAIROBI,NAIROBI, KENYA..NAIROBI, KENYA..
Chairman AARDChairman AARD(Association for Arthritis and Rheumatic Diseases of Kenya ),(Association for Arthritis and Rheumatic Diseases of Kenya ),
President-elect, AFLAR(African League of Associations for Rheumatology).
Country coordinator, Bone and Joint Decade (BJD), Kenya.
ASSUMPTIONS ASSUMPTIONS IN PREPARING THE TALKIN PREPARING THE TALK
ll AUDIENCE IS PREDOMINANTLY PHYSICIANSAUDIENCE IS PREDOMINANTLY PHYSICIANS
ll SINCE THE TALK IS IN THE MORNING, THE SINCE THE TALK IS IN THE MORNING, THE AUDIENCE IS PHYSICALLY STRONG AND AUDIENCE IS PHYSICALLY STRONG AND MENTALLY ALLERTMENTALLY ALLERT
ll TALK WILL BE MORE QUALITATIVE AND WILL TALK WILL BE MORE QUALITATIVE AND WILL STRESS KEY CONCEPTSSTRESS KEY CONCEPTS
Incidence of TBIncidence of TB
llWorld populationWorld population 6 billion6 billion
ll Latent TBLatent TB 2 billion2 billion
ll Incidence of TBIncidence of TB 144 / 100 000 144 / 100 000 GlobalGlobal
205 / 100 000 205 / 100 000 AfricaAfrica
introductionintroduction
ll TB cases have risen due to HIV infectionTB cases have risen due to HIV infection
ll Extra pulmonary TB on the rise ( now 16Extra pulmonary TB on the rise ( now 16--18% compared to 7.8% in 1964)18% compared to 7.8% in 1964)
ll Osteoarticular involvement is 1Osteoarticular involvement is 1--3 %3 %
Who is at Risk factorsWho is at Risk factors
ll AlcoholicsAlcoholics
ll HIV HIV ––positive patientspositive patients
ll Immigrants from endemic countriesImmigrants from endemic countries
ll Hand / wrist: carpal tunnel syndrome, Hand / wrist: carpal tunnel syndrome, swelling, painswelling, pain
OsteomyelitisOsteomyelitis
ll pain,pain,
ll Lytic lesions on radiographLytic lesions on radiograph
ll DactylitisDactylitis
Constitutional symptoms often are not Constitutional symptoms often are not presentpresent
PoncetPoncet’’s diseases disease
ll Acute polyarthritis( ? Reactive) in patients Acute polyarthritis( ? Reactive) in patients with visceral or pulmonary tuberculosiswith visceral or pulmonary tuberculosis
ll Tuberculous organisms are not cultured Tuberculous organisms are not cultured from involved jointsfrom involved joints
ll Commonly involves knees, ankles and Commonly involves knees, ankles and elbowselbows
ll Extensive vertebral destruction with relative Extensive vertebral destruction with relative preservation of disc spacepreservation of disc space
Osteoarticular tuberculosis: Osteoarticular tuberculosis: Radiographic featuresRadiographic features
ll Peripheral jointPeripheral joint
ll Destructive lessions near joints with little Destructive lessions near joints with little periosteal reactionperiosteal reaction
ll SoftSoft--tissue swelling and osteopeniatissue swelling and osteopenia
ll Subchondral erosionsSubchondral erosions
ll Joint destruction ( late finding)Joint destruction ( late finding)
““AtypicalAtypical”” mycobacteriamycobacteria
ll Propensity to involve tendons and joints of Propensity to involve tendons and joints of the handsthe hands
ll 50% affect hands50% affect hands
ll 20% affect knees20% affect knees
ll Polyarticular disease much lessPolyarticular disease much less
““AtypicalAtypical”” mycobacteriamycobacteria
ll Mycobacterium aviumMycobacterium avium--intracellulare (MAI)intracellulare (MAI)ll sytemic mycobacterial infection in 25% of sytemic mycobacterial infection in 25% of
AIDS patientsAIDS patients
ll Tenosynovitis,bursitis, and osteomyelitis Tenosynovitis,bursitis, and osteomyelitis
ll Mycobacterium kansasiiMycobacterium kansasiill Tenosynovitis,bursitis, and osteomyelitisTenosynovitis,bursitis, and osteomyelitis
ll Mycobacterium marinumMycobacterium marinumll Tenosynovitisof hands and wrists (typical )Tenosynovitisof hands and wrists (typical )
ll bursitis, and osteomyelitisbursitis, and osteomyelitis
ll Open wounds in the hands or fingersOpen wounds in the hands or fingers
ll immunosuppressionimmunosuppression
Treatment of Osteoarticular TBTreatment of Osteoarticular TB
ll Derived from therapy of pulmonary Derived from therapy of pulmonary diseasedisease
ll Most therapy as in pulmonary diseaseMost therapy as in pulmonary disease
ll Some authors recommend long term Some authors recommend long term therapy (1therapy (1--2 years)2 years)
ll Surgery to debried abscess in extensive Surgery to debried abscess in extensive bone involvement to hasten recoverybone involvement to hasten recovery
ll Resistant to isoniazid and Rifampin, any fluroquinolone Resistant to isoniazid and Rifampin, any fluroquinolone and at least one of the 3 injectable 2nd line drugs:and at least one of the 3 injectable 2nd line drugs:
ll AmikacinAmikacin
ll Kenamicyn Kenamicyn
ll CapreomycinCapreomycin
XTR TB + HIV = XTR TB + HIV = LETALLETAL
CDC ATLANTA Ga. March 2006CDC ATLANTA Ga. March 2006
You have reached the pinnacle You have reached the pinnacle of success as soon as you of success as soon as you
become uninterested in money, become uninterested in money, compliments , or publicitycompliments , or publicity
ll O . A. BattistaO . A. Battista
AFLAR: African League of AFLAR: African League of Associations for RheumatologyAssociations for Rheumatology
ll 44thth regional regional Rheumatology Rheumatology symposium and symposium and workshops :workshops :
ll October 11October 11--15, 2010 15, 2010 Nairobi, Kenya.Nairobi, Kenya.
ll 66thth AFLAR Congress, AFLAR Congress, Algiers, Algeria; May Algiers, Algeria; May 20112011
((Details to be announced soon)Details to be announced soon)