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Background. Most information on bone-joint (BJ)-tuberculosis is based on data from high-incidence areas. We conducted a nationwide register-based analysis of BJ-tuberculosis in Denmark from 1994 to 2011. Methods. We linked data from the national tuberculosis surveillance system on BJ-tuberculosis, hospital records, the Danish Hospital and Civil Registration System. Results. We identified 282 patients with BJ-tuberculosis, 3.6% of all tuberculosis cases (n = 7936). Spinal tuberculosis was found in 153 of 282 patients (54.3%); 83.3% of all cases were immigrants. Danes were older and had higher Charlson comorbidity index scores than immigrants (P < .01). C-reactive protein and erythrocyte sedimentation rates were elevated in most cases. Median time to diagnosis after first hospital contact was 19.5 days for spinal tuberculosis and 28 days for other forms of BJ-tuberculosis (P = .01). Of patients with spinal tuberculosis, 54/133 (40.6%) had neurologic deficits at admission and 17.3% presented with cauda equina. Diagnosis was culture verified in 87%. (Resistance to any drug was found in 10.2%). Median time on antituberculous treatment for patients with spinal and other forms of BJ-tuberculosis was 9 months and 7 months, respectively (P < .01). Surgery was required in 44.4% patients with spinal tuberculosis and in 32.6% patients with other forms of BJ-tuberculosis (P = .04). Sequelae were reported in 57.5% of patients with spinal tuberculosis and 29.1% of patient with other forms of BJ-tuberculosis (P < .01). One-year mortality was 25.5% among Danes compared with 1.3% among immigrants (P < .01). Conclusions. BJ-tuberculosis was rare and seen mainly in younger immigrants in Denmark. More than half of cases were spinal tuberculosis, presenting with more severe symptoms and worse outcome, compared with other forms of BJ-tuberculosis.

Clinical data on bone and joint tuberculosis (BJTB) in developing countries remain limited. This study aims to investigate the clinical, epidemiological, and drug-resistance characteristics of BJTB patients in Central China and to optimize diagnostic strategies. This retrospective study analyzed data from patients diagnosed with BJTB at Henan Provincial Chest Hospital between 2016 and 2022. Among the 902 patients, 518 (57.4%) were male and 384 (42.6%) were female. The age groups of 21-30 years and 51-60 years, as well as the rural population, showed the highest prevalence of cases. Local pain was the most prevalent symptom, followed by fever, night sweats, and neurological dysfunction. On average, the time from symptom onset to diagnosis was 6.1 months, and the mean hospital stay was 64.2 days. Spinal tuberculosis was the most frequently affected site, accounting for 77.6% (700/902) of cases. Five diagnostic techniques were evaluated, with GeneXpert MTB/RIF demonstrating superior performance by achieving a sensitivity of 91.6% (95%CI: 86.3%-95.0%) and specificity of 90.1% (95%CI: 85.5%-93.6%). Unlike drug resistance patterns observed in other regions, streptomycin (29.6%) and rifabutin (18.2%) were the most frequently encountered first-line and second-line anti-tuberculosis drugs, respectively. The prevalence of multidrug-resistant tuberculosis (MDR-TB) was 8.3% (95% CI: 5.1%-13.2%), and extensively drug-resistant tuberculosis (XDR-TB) was identified in 1.6% (95% CI: 0.2%-5.6%) of cases. The application of GeneXpert MTB/RIF demonstrated significant diagnostic accuracy for BJTB. The control of MDR-TB remains a critical challenge in the management of BJTB in Central China.

Background Wrist joint tuberculosis(WJ-TB)is a rare manifestation of osteoarticular tuberculosis(OAT).Delayed diagnosis is common and often leads to postponed treatment, resulting in complications such as joint stiffness and persistent pain in the affected limb. Case presentation A 50-year-old man presented with symptoms in the wrist joint suggestive of WJ-TB.Initially, he was diagnosed with traumatic arthritis.However, following a series of diagnostic tests, the final diagnosis of tuberculous arthritis was confirmed.The patient underwent effective treatment, which led to a marked improvement in his condition. Conclusions WJ-TB is a treatable condition.Early diagnosis and prompt treatment are essential to prevent joint destruction and maintain function in patients with OAT.

Objective To establish a unified tuberculosis staging system for trunk and limbs joints (Osteoarticular tuberculosis At Qinghai Fourth People’s Hospital, QFOT), and verify the rationality and applicability of the classification system. Method Searching our hospital’s electronic medical record database from 2019 to 2022, including data of patients with bone and joint tuberculosis according to preset inclusion and exclusion criteria, and formulating a bone and joint tuberculosis staging system of the Fourth People’s Hospital of Qinghai Province based on imaging data related to bone collapse, abscess flow metastasis, mechanical axis deviations, stable bone structure, joint deformity and other characteristics. Then, gender distribution, age distribution, whether surgery, pre-operation anti-tuberculosis drug treatment courses, white blood cell count, RBC sedimentation rate, C-reactive protein and serum procalcitonin were analyzed statistically. Understand the characteristics of Osteoarticular tuberculosis cases in different stages and verify the rationality of the QFOT staging system. Results A total of 16,487 tuberculosis patients were admitted to our hospital from 2019 to 2022, and a total of 509 patients with Osteoarticular tuberculosis were finally included, aged 41.1 ± 16.39 years. According to the QFOT staging system, 202 patients with stage I tuberculosis, 164 patients with stage II tuberculosis, 107 patients with stage III tuberculosis, 29 patients with stage IV tuberculosis, and 1 patient with stage V tuberculosis were classified. There were no significant differences in gender and age distribution of patients in different stages. There is a significant difference in the distribution of whether or not anti-tuberculosis drugs were used before surgery. There was no significant difference in white blood cell count levels among patients with different stages of Osteoarticular tuberculosis, and there were significant differences in red blood cell sedimentation rate and C-reactive protein levels. There are significant differences in the distribution of serum procalcitonin in patients with different stages of Osteoarticular tuberculosis. Conclusion The QFOT staging system stages according to the pathological process of bone and joint tuberculosis. The verification results found that the QFOT staging system is scientific, but due to the small number of stage V patients included, further research is still needed to verify and improve this typing method. Clinical trial number Not applicable.

Extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide. Nevertheless, the diagnosis is often delayed or even missed due to insidious clinical presentation and poor performance of diagnostic tests. Culture, the classical gold standard for tuberculosis, suffers from increased technical and logistical constraints in EPTB cases. In this review the authors outline current diagnostic options for the main forms of EPTB. The authors also discuss the opportunities and challenges linked in particular to microbiological diagnostics and to the attempts to find a new gold standard test for EPTB. Finally, new biomarkers and tests currently under evaluation are hopefully on the way to introduce significant improvements in EPTB diagnosis, for which clinical suspicion will nevertheless be essential.

In the 1980s, after a steady decline during preceding decades, there was a resurgence in the rate of tuberculosis in the United States that coincided with the acquired immunodeficiency syndrome epidemic. Disease patterns since have changed, with a higher incidence of disseminated and extrapulmonary disease now found. Extrapulmonary sites of infection commonly include lymph nodes, pleura, and osteoarticular areas, although any organ can be involved. The diagnosis of extrapulmonary tuberculosis can be elusive, necessitating a high index of suspicion. Physicians should obtain a thorough history focusing on risk behaviors for human immunodeficiency virus (HIV) infection and tuberculosis. Antituberculous therapy can minimize morbidity and mortality but may need to be initiated empirically. A negative smear for acid-fast bacillus, a lack of granulomas on histopathology, and failure to culture Mycobacterium tuberculosis do not exclude the diagnosis. Novel diagnostic modalities such as adenosine deaminase levels and polymerase chain reaction can be useful in certain forms of extrapulmonary tuberculosis. In general, the same regimens are used to treat pulmonary and extrapulmonary tuberculosis, and responses to antituberculous therapy are similar in patients with HIV infection and in those without. Treatment duration may need to be extended for central nervous system and skeletal tuberculosis, depending on drug resistance, and in patients who have a delayed or incomplete response. Adjunctive corticosteroids may be beneficial in patients with tuberculous meningitis, tuberculous pericarditis, or miliary tuberculosis with refractory hypoxemia.

Multiple osteoarticular tuberculosis (MOT) represents an uncommon yet severe form of tuberculosis, characterized by a lack of systematic analysis and comprehension. Our objective was to delineate MOT’s epidemiological characteristics and establish a scientific foundation for prevention and treatment. We conducted searches across eight databases to identify relevant articles. Pearson’s chi-square test (Fisher’s exact test) and Bonferroni method were employed to assess osteoarticular involvement among patients of varying age and gender (α = 0.05). The study comprised 98 articles, encompassing 151 cases from 22 countries, with China and India collectively contributing 67.55% of cases. MOT predominantly affected individuals aged 0–30 years (58.94%). Pulmonary tuberculosis was evident in 16.55% of cases, with spinal involvement prevalent (57.62%). Significant differences were noted in trunk, spine, thoracic, and lumbar vertebrae involvement, as well as type I lesions across age groups, increasing with age. Moreover, significant differences were observed in upper limb bone involvement and type II lesions across age groups, decreasing with age. Gender differences were not significant. MOT primarily manifests in China and India, predominantly among younger individuals, indicating age-related variations in osteoarticular involvement. Enhanced clinical awareness is crucial for accurate MOT diagnosis, mitigating missed diagnoses and misdiagnoses.

Osteoarticular tuberculosis (TB) of long bones is an uncommon manifestation and a frequently challenging diagnosis due to the absence of typical symptoms. We report a case of an infant with tubercular osteomyelitis involving the distal radial metaphysis. He presented with a lytic lesion in the distal radius, which was treated with decompression, debridement and biopsy. The TB was diagnosed by detecting Mycobacterium tuberculosis (low) on cartridge-based nucleic acid amplification test, and histopathological analysis verified the diagnosis. Anti-tubercular medication treatment improved radiological and clinical outcomes. This case emphasises the importance of considering TB as a differential diagnosis for lytic bone lesions in infants, particularly in endemic areas. Early diagnosis through appropriate investigations and combined medical–surgical management can achieve excellent outcomes without growth disturbances or deformities.

Both osteoarticular tuberculosis (OA-TB) and inflammatory arthritis can lead to osteoarticular structural damage. These conditions exhibit similar symptoms, physical signs, and imaging features. Rapidly and accurately diagnosing OA-TB in patients with inflammatory arthritis presents a challenge to clinicians. Xpert MTB/RIF (Xpert) has been endorsed by the World Health Organization (WHO) as a rapid diagnostic tool for diagnosis of pulmonary and extrapulmonary TB. This study was designed to investigate diagnostic efficiency of Xpert for OA-TB in patients with inflammatory arthritis in China. A total of 83 consecutive patients with inflammatory arthritis and suspected OA-TB were enrolled prospectively from June 2014 to May 2018. Demographic, clinical, and biological data were recorded. Xpert assay, smear microscopy examination (smear), BACTEC MGIT 960 (MGIT 960), pathological examination, and T-SPOT.TB test were performed for each patient who received operations. Diagnostic efficiency of Xpert was evaluated based on a composite reference standard (CRS). A total of 49 out of 83 patients with inflammatory arthritis and suspected OA-TB received operations, and 49 specimens were obtained during operations. According to CRS, 36 out of 49 patients with inflammatory arthritis were diagnosed with OA-TB, and 13 were not affected by the condition. Sensitivity of Xpert assay, smear, MGIT 960, pathological examination, and T-SPOT.TB test reached 66.70% (24/36), 25.00% (9/36), 30.55% (11/36), 47.22% (17/36), and 80.55% (29/36), respectively. Specificity of Xpert assay, smear, MGIT 960, and pathological examination was all 100% (13/13). Specificity of T-SPOT.TB test was 53.84% (7/13). Sensitivity of Xpert was higher than that of smear, MGIT 960 and pathological examination, but the sensitivity of Xpert was lower than that of T-SPOT.TB. Sensitivity of Xpert was statistically different from that of smear and MGIT 960 (P<0.001, P = 0.002), but the sensitivity of Xpert was not significantly different from that of pathological examination and T-SPOT.TB (P = 0.096, P = 0.181). Specificity of T-SPOT.TB was less than that of Xpert, smear, MGIT 960, and pathological examination, and the difference between them was statistically significant (P = 0.015). Among the 27 OA-TB patients with smear negative results, Xpert had the highest sensitivity, but sensitivity of Xpert was not significantly different from that of pathological examination and T-SPOT.TB (P = 0.413, P = 0.783). 2 of 36 OA-TB patients exhibited RIF resistance. Xpert was concordant with MGIT 960-based drug susceptibility testing (DST) in detecting rifampin (RIF) resistance. Xpert is an efficient tool with high sensitivity and specificity for OA-TB diagnosis in patients with inflammatory arthritis in high-TB prevalence countries. Compared with conventional methods, Xpert has two advantages: one is fast, and the other is able to provide RIF resistance information simultaneously.

Background Even though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet. Case Presentation A one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery. Conclusion Tubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes.