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Resumen La incidencia de Tb osteoarticular es mucho menor que la pulmonar, representando 1-2% de los casos de Tuberculosis (Tb) y el 10% de los casos de Tb extrapulmonar, por lo que usualmente no es considerada para el diagnóstico diferencial de pacientes con enfermedad articular. Su diagnóstico es difícil y se basa en hallazgos clínicos, radiológicos, bacteriológicos e histológicos. Las lesiones extrapulmonares son paucibacilares y las muestras, en la mayoría de los casos, difíciles de obtener, por lo que el diagnóstico a menudo es simplemente presuntivo. La tuberculosis articular en etapas tempranas, presenta manifestaciones clínicas e imagenológicas inespecíficas. Esto puede facilitar la progresión de la enfermedad local, generando lesiones osteoarticulares graves y, finalmente, la destrucción articular. Se presenta el caso de una paciente de 60 años, intervenida quirúrgicamente por presentar manifestaciones clínicas e imagenológicas compatibles con una ruptura del manguito rotador, y cuya evolución tórpida posoperatoria, llevó al diagnóstico bacteriológico de tuberculosis de húmero proximal.
Abstract The incidence of osteoarticular TB is much lower than that of the lung, representing 1-2% of TB cases and 10% of extrapulmonary TB cases, so it is often not considered for the differential diagnosis of patients with joint disease. Its diagnosis is difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and specimens, in most cases, difficult to obtain, so the diagnosis is often simply presumptive. Joint tuberculosis in early stages presents nonspecific clinical and imaging manifestations. This can lead to the progression of the local disease, generating severe osteoarticular lesions and, finally, joint destruction. We present the case of a 60-year-old patient who underwent surgery due to clinical and imaging manifestations compatible with a rotator cuff tear, and whose torpid postoperative evolution led to the bacteriological diagnosis of proximal humerus tuberculosis.
Subject(s)
Humans , Middle Aged , Tuberculosis , Humerus , Diagnostic Imaging , Rotator CuffABSTRACT
Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .
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Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .
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Objective To analyze and discuss the clinical value of tuberculosis infection T cell ELISPOT test and tuberculosis antibody test used in bone and joint tuberculosis.Methods The patients with suspected bone and joint TB diagnosed and treated in Xishan people's Hospital of Wuxi City from 2012 to 2014 were selected as the objects of this study.They were taken randomly,which divided into T-SPOT.TB test group and tuberculosis antibody test groups.Each group had 162 per-sons.The patients of T-SPOT.TB test group were tested by tuberculosis infection T cell enzyme-linked immunosorbent spot test,tuberculosis antibody test group were taken tuberculosis antibody test,comparative analysis of the sensitivity and speci-ficity of two diagnostic methods were contrastively analyzed.Results The sensitivity and specificity of T-SPOT.TB test group were 93.43% and 84.00%.The sensitivity and specificity of tuberculosis antibody in the experimental group were 40.44% and 53.85%.There was statistical difference between two groups (χ2 =184.62,7.86,all P <0.05).The false posi-tive rate and the false negative rate of T-SPOT.TB test group were 16.00% and 6.57%.The false positive rate and the false negative rate of tuberculosis antibodies in the experimental group were 26.92% and 59.56%,respectively.There was statis-tical difference between two groups (χ2 =7.86,156.18,all P <0.05).In addition,the positive and negative predictive values of T-SPOT.TB test group were 96.97% and 70.00%.Positive and negative predictive values of tuberculosis antibody in the experimental group were 88.71% and 14.74%.There was statistical difference between two groups (χ2 = 20.27,73.06,all P <0.01).Conclusion Compared to experimental tuberculosis antibody,TB infection of T cells ELISPOT test had high sen-sitivity and specificity in the diagnosis of bone and joint tuberculosis.It’s worthy of spreading.
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Objective To discuss the significance of the detection of interferon-γin the diagnosis of active joint tuberculosis. Methods 5 kinds of specific proteins of mycobacterium tuberculosis were used as stimulating protein, the chemiluminescence enzyme immunoassay was used to test the content of interferon-γ. The interferon-γof 35 cases of patients with active joint tuberculosis and 35 cases of healthy people were detected. The difference of the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ra-tio and negative likelihood ratio of 5 kinds of proteins to the diagnostic of active joint tuberculosis were compared. Results CFP10/ESAT6 fusion protein, Rv2041c protein, Rv0057/1352 fusion proteins, Rv1419 protein and Rv1656 protein were used as stimulating protein, the sensitivities of active joint tuberculosis by the whole blood interferon-γassay were 77.1%, 68.6%, 71.4%, 74.3%and 65.7%. The specifici-ties were 65.7%, 54.3%, 57.1%, 60.0%and 62.9%. The positive predictive values were 62.9%, 60%, 62.5%, 65%and 63.9%. The negative predictive values were 74.2%, 63.3%, 66.7%, 70%and 64.7%. The positive likelihood ratios were 2.25, 1.5, 1.67, 1.86 and 1.77. The nega-tive likelihood ratios were 0.348, 0.579, 0.5, 0.429 and 0.545. Conclusion The detection of interferon-γhas certain significance to joint tu-berculosis. But it is not as an index of diagnosing joint tuberculosis.
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Objective To study the effect of surface physical properties of different materials for the artificial joint pros -thesis interface on Mycobacterium tuberculosis adhesion .Methods The surface polishing coating , titanium coating and hydroxyapatite coating were chosen as the experimental materials to analyze the surface topography and measure the surface roughness, contact angle and surface energy .The M.tuberculosis strains were used by in vitro cultivation method and ob-served by scanning electron microscopy (SEM) to study the morphology of M.tuberculosis and the material surface adhe-sion.The influence of surface physical properties of the interface of the artificial joint prostheses on the proliferation and ad -hesion of bacteria was evaluatd .Results The titanium coating and hydroxyapatite coating materials were hydrophobic , while the surface polishing coating was hydrophilic .The contact angle and surface energy were significantly different ( P0.05)in the OD value of bacterial solution .The titanium coating had the largest amount of interface adhesion for M.tuberculosis, fol-lowed by the hydroxyapatite coating and the polishing coating .The difference between various materials was statistically sig-nificant (P<0.05).Conclusion The adhesion of M.tuberculosis in the surface of artificial joint prosthesis materials is closely related to the surface physical properties .A adhesiveness improves with surface roughness .
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Objective To explore therapy effect of different operational strategy on tuberculosis of cacroiliac joint with anterior-posterior giant abscess.Methods Fifteen cases were selected as our subject,who suffered with tuberculosis of cacroiliac joint with anterior-pesterior giant abscess from Apr.2005 to Oct.2009.Seven cases underwent focus clearance merely through posterior approach whereas the other 8 cases received focus clearance through anterior-posterior combined approach.We followed-up the cases postoperatively and compared the status of ambi-operation period and tuberculosis' turnover.Results In the posterior approach group,operational periods was (1.9 ± 1.3) h,hemorrhage volume was (487 ± 225) ml,of which 3 cases suffered from abscess relapse postoperatively.In the combined approach group,operational periods was (3.6 ± 1.8) h,hemorrhage volume was (765 ± 538) ml,of which I cases suffered from sinus tract formation postoperatively.Conclusion For patient with tuberculosis of cacroiliac joint with anterior-posterior giant abscess,it has the less relapse rate of the anterior-posterior combined approach than posterior approach.
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[Objective] To investigate X-ray and CT manifestations of tobereulosis of ankle joint and to discuss the differentiation with other diseases.[Method]The X-ray and CT findings in 5 cases with pathalogically proved tuberculosis of ankle joint were retrospectively analyzed.The differentiation with other diseases was discussed.[Result]The lesions involved entire right ankle joint in all 5 cases,The typical signs were as follows:(1)indistlnct and erosive joint surface,insect bitten-like of bony destruction ofjotht surface,digging-like shape of cancellous bone's destruction;(2)narrowed or irregular widened joint space;(3)ostooporosis of diseased region and surrounding;(4)extensive periostoal reaction of distal fibia and fibula;(5)to form cold abscess and sinus tract.[Conclusion]The tuberculosis of ankle joint earyies certain characteristic X-ray and CT signs,CT is better than X-ray in diagnosis.Highly alert of ankle joint tuberculosis is the key of early correct diagnosis.
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For confirmative diagnosis of bone and joint tuberculosis, it is made by culture method, inoculation to guinea pig, or histological examination of the specimen obtained from a lesion site. But plain reontgenogram is not valuable for early detection of the disease because specific, abnormal finding is not found in early stage and only found in late stage as progressive destruction of bone and joint. Many reports were made thst whole body bone scan, as diagnostic tool, was valuable in other orthopedic disease, but report for its diagnostic value in bone and joint tuberculosis is very rare. The study was carried out on 35 patients of bone and joint tuberculosis who whole body bone scan was performed before operation from Janusry, 1978 to December, 1987 in Depaartment of Orthopedic Surgery, Yonsei University college of Medicine. The following results were obtained. 1. Value of early detection of tuberculosis is not much as pyogenic infection. Intensity of uptake was decreased in tuberculosis than acute pyogenic osteomyelitis and arthritis, but increased than chronic osteomyelitis. 2. Intensity of uptake was decreased in female than male, and also increased in age. group under 10 and over 60 than other age group. 3. The longer duration of the disease, the more decreased intensity of uptake. 4. Intensity of uptake is increased in joint tuberculosis than bone, snd also increased in tuberculosis of spine than long bone. 5. Multifocal disease was detected in 14.3% by whole body bone scan.