Osteoarticular Tuberculosis in an Inner City University Medical Center: Epidemiology and Outcomes
Methods: We retrospectively reviewed the records of patients treated for osteoarticular TB at University Hospital in Newark, NJ from 2000-2012. Microbiology laboratory records were used to identify patients with positive bone/joint cultures for Mycobacterium tuberculosis (MTB). Specimen source, organisms isolated, MTB PCR results, and susceptibilities were recorded. The following data was extracted from the electronic medical record of case patients: demographics, comorbid conditions, history of active or latent TB, site of infection, symptoms and duration, surgical procedures, imaging studies, ESR, CRP, histopathology, anti-TB regimen, duration of therapy and outcomes.
Results: There were 24 patients with musculoskeletal specimens positive for MTB representing 4.2% of all positive MTB specimens. 20 infections were extra-spinal (83%) with foot/ankle most frequent (21%); 8 were spinal. Osteomyelitis was present in 17; 9 had joint involvement; 10 abscess formation. Pain (92%), swelling (50%) and weight loss (21%) were the most frequent presenting symptoms; fever occurred in only 8%. Mean duration of symptoms was 5.9 mos; mean age 38 yrs. 71% of patients were men. The majority of patients were immigrants (75%). Prior history of pulmonary TB was present in 5 patients; 7 were diagnosed with pulmonary TB concomitantly; 8 had bacterial infection. Comorbid conditions included HIV, IVDU, and HCV. Mean ESR was 55; CRP 55. Mean time to culture diagnosis was 45 days. 19 MTB isolates were fully susceptible; 4 had 1-drug resistance; 2 had 3-drug resistance; 1 had multidrug resistance. All patients initially received 4 anti-TB drugs. 75% of patients required surgery; 2 patients amputation. 9 patients were cured, 6 improved, 2 failed, 1 died, 6 were lost to follow up.
Conclusion: Osteoarticular TB in our patient population is uncommon and occurs most frequently in immigrant men. The spine and foot/ankle are the most common sites of infection. Diagnosis is often delayed and outcomes variable. A high index of suspicion is needed to establish a timely diagnosis and provide appropriate therapy.
L. Dever, None