Asian Spine J.  2017 Jun;11(3):405-411. 10.4184/asj.2017.11.3.405.

Epidemiology of Musculoskeletal Tuberculosis in an Area with High Disease Prevalence

• Held MF
• Hoppe S
• Laubscher
• Mears S
• Dix-Peek S
• Zar HJ
• Dunn RN

• KMID: 2382558
• DOI: http://doi.org/10.4184/asj.2017.11.3.405

Abstract

STUDY DESIGN: Retrospective observational study. PURPOSE: The aim of this study was to assess the distribution of age and site of infection in patients with musculoskeletal tuberculosis (TB) and determine the number of TB/human immunodeficiency virus (HIV) coinfections as well as the incidence of multidrugresistant (MDR) TB. OVERVIEW OF LITERATURE: Of all TB cases, 1%-3% show skeletal system involvement and 30% are HIV coinfected. Although the reported distribution of skeletal TB is majorly in the spine, followed by the hip, knee, and foot/ankle, the epidemiology of extrapulmonary TB and especially musculoskeletal TB remains largely unknown, particularly in areas with a high prevalence of the disease.
METHODS
This is a retrospective study of a consecutive series of patients admitted to a tertiary care facility in an area with the highest prevalence of TB worldwide. TB was confirmed on tissue biopsy with polymerase chain reaction testing (Xpert for Mycobacterium tuberculosis and rifampicin resistance), culturing, or histological analysis. Data were analyzed regarding demographic information, location of the disease, HIV coinfections, and drug resistance.
RESULTS
In all, 125 patients (44 children; 35%) with a mean age of 27 years (range, 1-78 years) were included. Age peaks were observed at 5, 25, and 65 years. Spinal disease was evident in 98 patients (78%). There were 66 HIV-negative (53%) and 29 (23%) HIVpositive patients, and in 30 (24%), the HIV status was unknown. Five patients (4%) showed MDR TB.
CONCLUSIONS
The age distribution was trimodal, spinal disease was predominant, MDR TB rate in our cohort was high, and a large portion of TB patients in our hospital were HIV coinfected. Hence, spinal services with sufficient access to operating facilities are required for tertiary care facilities in areas with a high TB prevalence.

Keyword

Spine; Bone and joint; Tuberculosis; HIV; Epidemiology

MeSH Terms

Age Distribution
Biopsy
Child
Cohort Studies
Coinfection
Drug Resistance
Epidemiology*
Hip
HIV
Humans
Incidence
Knee
Mycobacterium tuberculosis
Observational Study
Polymerase Chain Reaction
Prevalence*
Retrospective Studies
Rifampin
Spinal Diseases
Spine
Tertiary Healthcare
Tuberculosis*
Rifampin