Diagnostic Challenges in Patients with Osteoarticular Tuberculosis in Mexico: Case Series
Main Article Content
Abstract
Introduction: Osteoarticular tuberculosis poses a significant diagnostic and therapeutic challenge in developing countries, where the absence of molecular tools demands reliance on clinical suspicion and histopathological findings for diagnoses. Here, we present a compilation of case studies on osteoarticular tuberculosis for academic reference and support to aid primary care physicians in providing the best possible patient care.
Methods: Retrospective analysis of cases diagnosed with osteoarticular tuberculosis through biopsy from 2010 to 2020 at a Mexican Traumatology and Orthopedics Hospital, examined using descriptive statistics.
Results: Thirty-three patients were registered: 23 men (70%) and 10 women (30%). The most affected regions included the spine in 28 cases (84%), the hip in 3 (9%), and the elbow and sternoclavicular joints in 1 case each. The main clinical manifestations were paravertebral abscesses in 16 patients (48%), discitis in 12 (36%) and arthritis in 5 (15%), while the primary associated diseases were immunosuppression in 8 cases (24%), 2 cases with hepatitis (6%) and 3 with hypertension (9%).
Discussion: Tuberculosis is endemic in Mexico, similar to other developing countries, with numerous reported cases of osteoarticular tuberculosis. This study highlights the importance of using alternative diagnostic tools when molecular tests and cultures are not accessible to general practitioners and orthopedic physicians who treat patients with clinical suspicion of osteoarticular tuberculosis.
Article Details
How to Cite
ZARDAIN MEDLICH DUCOULOMBIER, Omar et al.
Diagnostic Challenges in Patients with Osteoarticular Tuberculosis in Mexico: Case Series.
Medical Research Archives, [S.l.], v. 11, n. 12, jan. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4815>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i12.4815.
Section
Case Series
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Panico CT, de Oliveira PRD, de Carvalho VC, Dos Anjos AM, de Melo VFA, Lima ALLM. Clinical-epidemiological profile of confirmed cases of osteoarticular tuberculosis. J Bone Jt Infect. 2023;8(1):11-17. doi:10.5194/jbji-8-11-2023
2. Centro Nacional de Programas Preventivos y Control de Enfermedades. Morbilidad tuberculosis 1990-2015. (CENAPRECE). 2015. Accessed December 08, 2023. http://www.cenaprece.salud.gob.mx/programas/interior/micobacteriosis/tuberculosis/cifras_oficiales.html
3. World Health Organisation. TB in the US-Mexico border region. 2014. Accessed January 16, 2017. http://search.who.int/search?q=Tb+in+the+USMexico+Border+Region+2014&ie=utf8&site=who&client=_es_r&hl=lang_es&lr=lang_es&proxystylesheet=_es_r&output=xml_no_dtd&oe=utf8
4. Pan American Health Organization. The situation of tuberculosis on the United States-Mexico border. 2011. Accessed January 16, 2017. http://iris.paho.org/xmlui/bitstream/handle/123456789/3491/fep003175.pdf?sequence=1
5. World Health Organisation. Global tuberculosis report. 2016. Accessed January 16, 2017. http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1
6. García-Elorriaga G, Martínez-Elizondo O, del Rey-Pineda G, González-Bonilla C. Clinical, radiological, and molecular diagnosis correlation in serum samples from patients with osteoarticular tuberculosis. Asian Pac J Trop Biomed. 2014;4(7):581-585. doi:10.12980/APJTB.4.201414B112
7. Agashe, Vikas M et al. “Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World-A WAIOT View.” Microorganisms vol. 8,9 1312. 28 Aug. 2020, doi:10.3390/microorganisms8091312
8. World Health Organisation. Definiciones y marco de trabajo para la notificación de tuberculosis. 2013. Accessed January 16, 2017. http://www.who.int/tb/publications/definitions/es/
9. Malaviya AN, Kotwal PP. Arthritis associated with tuberculosis. Best Pract Res Clin Rheumatol. 2003;17(2):319-343. doi:10.1016/s1521-6942(02)00126-2
10. Ramírez-Lapausa M, Menéndez-Saldaña A, Noguerado-Asensio A. Extrapulmonary tuberculosis. Rev Esp Sanid Penit. 2015;17(1):3-11.
doi:10.4321/S1575-06202015000100002
11. Espinosa Gimeno A, Martínez-Sanz J, Asong Engonga Obono L, Rodríguez Zapata M. Protocolo diagnóstico y terapéutico de las tuberculosis extrapulmonares. Medicine. 2014;11(52):3091-3097. doi:10.1016/S0304-5412(14)70745-0
12. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis. 2009;49(9):1350-1357. doi:10.1086/605559
13. Mousa A-L. H. Bones and joints tuberculosis. Bahrain Med Bull. 2007;29(1):1-9. Accessed January 17, 2017. https://bahrainmedicalbulletin.com/march_2007/Bones_Joints_Tuberculosis.pdf
14. Tuli SM. General principles of osteoarticular tuberculosis. Clin Orthop Relat Res. 2002;398(398):11-19. doi:10.1097/00003086-200205000-00003
15. Pedro Carlos PC. Spectrum of skeletal tuberculosis in children. J Exer Sports Orthop. 2014;1(2):1-10.
doi:10.15226/2374-6904/1/2/00109
16. Naing C, Mak JW, Maung M, Wong SF, Kassim AI. Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis. Lung. 2013;191(1):27-34. doi:10.1007/s00408-012-9440-6
17. Sbrana E, Grise J, Stout C, Aronson J. Co-morbidities associated with tuberculosis in an autopsy case series. Tuberculosis (Edinb). 2011;91(Suppl 1):S38-S42. doi:10.1016/j.tube.2011.10.008
18. Kawamura I, Kudo T, Tsukahara M, Kurai H. Infection control for extrapulmonary tuberculosis at a tertiary care cancer center. Am J Infect Control. 2014;42(10):1133-1135. doi:10.1016/j.ajic.2014.06.022
19. Young F, Wotton CJ, Critchley JA, Unwin NC, Goldacre MJ. Increased risk of tuberculosis disease in people with diabetes mellitus: record-linkage study in a UK population. J Epidemiol Community Health. 2012;66(6):519-523. doi:10.1136/jech.2010.114595
20. Webster AS, Shandera WX. The extrapulmonary dissemination of tuberculosis: A meta-analysis. Int J Mycobacteriol. 2014;3(1):9-16. doi:10.1016/j.ijmyco.2014.01.003
21. Pérez-Guzmán C, Vargas MH, Arellano-Macías MR, Hernández-Cobos S, García-Ituarte AZ, Serna-Vela FJ. Clinical and epidemiological features of extrapulmonary tuberculosis in a high incidence region. Salud Publ Mex. 2014;56(2):189-196. doi:10.21149/spm.v56i2.7334
22. Agashe V, Shenai S, Mohrir G, et al. Osteoarticular tuberculosis--diagnostic solutions in a disease endemic region. J Infect Dev Ctries. 2009;3(7):511-516. doi:10.3855/jidc.469
23. Mora RB, Ávila JMJ, Nakamura AC. Spinal tuberculosis in western Mexico, 2008-2013. Coluna Columna. 2014;13(4):298-301. doi:10.1590/S1808-18512014130400476
24. Córdoba-Meisser AL, Barrios-Henao EG, Uribe-Ríos A, Toro-Posada A, López-Valencia JE. Perfiles epidemiológico y clínico de la tuberculosis osteoarticular: estudio observacional en el Hospital Universitario San Vicente de Paúl de Medellín, 1994-2004. Iatreia. 2005;18(3):279-288. Accessed January 17, 2017. https://www.redalyc.org/pdf/1805/180513850002.pdf
25. Mora RB, Ávila JMJ, Nakamura AC. Spinal tuberculosis in western Mexico, 2008-2013. Coluna Columna. 2014;13(4):298-301. doi:10.1590/S1808-18512014130400476
26. Dunn R, Zondagh I, Candy S. Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine (Phila Pa 1976). 2011;36(6):469-473. doi:10.1097/brs.0b013e3181d265c0
27. Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Phys. 2005;72(9):1761-1768. Accessed January 17, 2017. https://www.aafp.org/pubs/afp/issues/2005/1101/p1761.html
28. García-Rodríguez JF, Álvarez-Díaz H, Lorenzo-García MV, Mariño-Callejo A, Fernández-Rial Á, Sesma-Sánchez P. Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infecc Microbiol Clin. 2011;29(7):502-509. doi:10.1016/j.eimc.2011.03.005
29. Scott C, Cavanaugh JS, Pratt R, Silk BJ, LoBue P, Moonan PK. Human tuberculosis caused by Mycobacterium bovis in the United States, 2006-2013. Clin Infect Dis. 2016;63(5):594-601. doi:10.1093/cid/ciw371
30. Medina E, Ryan L, LaCourse R, North RJ. Superior virulence of Mycobacterium bovis over Mycobacterium tuberculosis (MTB) for MTB-resistant and MTB-susceptible mice is manifest as an ability to cause extrapulmonary disease. Tuberculosis (Edinb). 2006;86(1):20-27. doi:10.1016/j.tube.2005.04.003
31. Bobadilla-del Valle M, Torres-González P, Cervera-Hernández ME, et al. Trends of Mycobacterium bovis isolation and first-line anti-tuberculosis drug susceptibility profile: a fifteen-year laboratory-based surveillance. PLOS Negl Trop Dis. 2015;9(9):e0004124. doi:10.1371/journal.pntd.0004124
32. Mokaddas EM, Saadaldeen H, Ahmad S. Comparison of two molecular methods and an automated liquid culture system for the early detection of Mycobacterium tuberculosis from both pulmonary and extrapulmonary specimens in Kuwait. Int J Mycobacteriol. 2016;5(Suppl 1):S74-S75. doi:10.1016/j.ijmyco.2016.09.004
33. Raveendran R, Wattal C. Utility of multiplex real-time PCR in the diagnosis of extrapulmonary tuberculosis. Braz J Infect Dis. 2016;20(3):235-241. doi:10.1016/j.bjid.2016.01.006
34. Ak O, Dabak G, Ozer S, Saygi A, Dabak R. The evaluation of the QuantiFERON-TB Gold test in pulmonary and extrapulmonary tuberculosis. Jpn J Infect Dis. 2009;62(2):149-151. Accessed January 17, 2017. https://www.niid.go.jp/niid/images/JJID/62/149.pdf
35. Farah MG, Rygh JH, Steen TW, Selmer R, Heldal E, Bjune G. Patient and health care system delays in the start of tuberculosis treatment in Norway. BMC Infect Dis. 2006;6:33. doi:10.1186/1471-2334-6-33
2. Centro Nacional de Programas Preventivos y Control de Enfermedades. Morbilidad tuberculosis 1990-2015. (CENAPRECE). 2015. Accessed December 08, 2023. http://www.cenaprece.salud.gob.mx/programas/interior/micobacteriosis/tuberculosis/cifras_oficiales.html
3. World Health Organisation. TB in the US-Mexico border region. 2014. Accessed January 16, 2017. http://search.who.int/search?q=Tb+in+the+USMexico+Border+Region+2014&ie=utf8&site=who&client=_es_r&hl=lang_es&lr=lang_es&proxystylesheet=_es_r&output=xml_no_dtd&oe=utf8
4. Pan American Health Organization. The situation of tuberculosis on the United States-Mexico border. 2011. Accessed January 16, 2017. http://iris.paho.org/xmlui/bitstream/handle/123456789/3491/fep003175.pdf?sequence=1
5. World Health Organisation. Global tuberculosis report. 2016. Accessed January 16, 2017. http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1
6. García-Elorriaga G, Martínez-Elizondo O, del Rey-Pineda G, González-Bonilla C. Clinical, radiological, and molecular diagnosis correlation in serum samples from patients with osteoarticular tuberculosis. Asian Pac J Trop Biomed. 2014;4(7):581-585. doi:10.12980/APJTB.4.201414B112
7. Agashe, Vikas M et al. “Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World-A WAIOT View.” Microorganisms vol. 8,9 1312. 28 Aug. 2020, doi:10.3390/microorganisms8091312
8. World Health Organisation. Definiciones y marco de trabajo para la notificación de tuberculosis. 2013. Accessed January 16, 2017. http://www.who.int/tb/publications/definitions/es/
9. Malaviya AN, Kotwal PP. Arthritis associated with tuberculosis. Best Pract Res Clin Rheumatol. 2003;17(2):319-343. doi:10.1016/s1521-6942(02)00126-2
10. Ramírez-Lapausa M, Menéndez-Saldaña A, Noguerado-Asensio A. Extrapulmonary tuberculosis. Rev Esp Sanid Penit. 2015;17(1):3-11.
doi:10.4321/S1575-06202015000100002
11. Espinosa Gimeno A, Martínez-Sanz J, Asong Engonga Obono L, Rodríguez Zapata M. Protocolo diagnóstico y terapéutico de las tuberculosis extrapulmonares. Medicine. 2014;11(52):3091-3097. doi:10.1016/S0304-5412(14)70745-0
12. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis. 2009;49(9):1350-1357. doi:10.1086/605559
13. Mousa A-L. H. Bones and joints tuberculosis. Bahrain Med Bull. 2007;29(1):1-9. Accessed January 17, 2017. https://bahrainmedicalbulletin.com/march_2007/Bones_Joints_Tuberculosis.pdf
14. Tuli SM. General principles of osteoarticular tuberculosis. Clin Orthop Relat Res. 2002;398(398):11-19. doi:10.1097/00003086-200205000-00003
15. Pedro Carlos PC. Spectrum of skeletal tuberculosis in children. J Exer Sports Orthop. 2014;1(2):1-10.
doi:10.15226/2374-6904/1/2/00109
16. Naing C, Mak JW, Maung M, Wong SF, Kassim AI. Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis. Lung. 2013;191(1):27-34. doi:10.1007/s00408-012-9440-6
17. Sbrana E, Grise J, Stout C, Aronson J. Co-morbidities associated with tuberculosis in an autopsy case series. Tuberculosis (Edinb). 2011;91(Suppl 1):S38-S42. doi:10.1016/j.tube.2011.10.008
18. Kawamura I, Kudo T, Tsukahara M, Kurai H. Infection control for extrapulmonary tuberculosis at a tertiary care cancer center. Am J Infect Control. 2014;42(10):1133-1135. doi:10.1016/j.ajic.2014.06.022
19. Young F, Wotton CJ, Critchley JA, Unwin NC, Goldacre MJ. Increased risk of tuberculosis disease in people with diabetes mellitus: record-linkage study in a UK population. J Epidemiol Community Health. 2012;66(6):519-523. doi:10.1136/jech.2010.114595
20. Webster AS, Shandera WX. The extrapulmonary dissemination of tuberculosis: A meta-analysis. Int J Mycobacteriol. 2014;3(1):9-16. doi:10.1016/j.ijmyco.2014.01.003
21. Pérez-Guzmán C, Vargas MH, Arellano-Macías MR, Hernández-Cobos S, García-Ituarte AZ, Serna-Vela FJ. Clinical and epidemiological features of extrapulmonary tuberculosis in a high incidence region. Salud Publ Mex. 2014;56(2):189-196. doi:10.21149/spm.v56i2.7334
22. Agashe V, Shenai S, Mohrir G, et al. Osteoarticular tuberculosis--diagnostic solutions in a disease endemic region. J Infect Dev Ctries. 2009;3(7):511-516. doi:10.3855/jidc.469
23. Mora RB, Ávila JMJ, Nakamura AC. Spinal tuberculosis in western Mexico, 2008-2013. Coluna Columna. 2014;13(4):298-301. doi:10.1590/S1808-18512014130400476
24. Córdoba-Meisser AL, Barrios-Henao EG, Uribe-Ríos A, Toro-Posada A, López-Valencia JE. Perfiles epidemiológico y clínico de la tuberculosis osteoarticular: estudio observacional en el Hospital Universitario San Vicente de Paúl de Medellín, 1994-2004. Iatreia. 2005;18(3):279-288. Accessed January 17, 2017. https://www.redalyc.org/pdf/1805/180513850002.pdf
25. Mora RB, Ávila JMJ, Nakamura AC. Spinal tuberculosis in western Mexico, 2008-2013. Coluna Columna. 2014;13(4):298-301. doi:10.1590/S1808-18512014130400476
26. Dunn R, Zondagh I, Candy S. Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine (Phila Pa 1976). 2011;36(6):469-473. doi:10.1097/brs.0b013e3181d265c0
27. Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Phys. 2005;72(9):1761-1768. Accessed January 17, 2017. https://www.aafp.org/pubs/afp/issues/2005/1101/p1761.html
28. García-Rodríguez JF, Álvarez-Díaz H, Lorenzo-García MV, Mariño-Callejo A, Fernández-Rial Á, Sesma-Sánchez P. Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infecc Microbiol Clin. 2011;29(7):502-509. doi:10.1016/j.eimc.2011.03.005
29. Scott C, Cavanaugh JS, Pratt R, Silk BJ, LoBue P, Moonan PK. Human tuberculosis caused by Mycobacterium bovis in the United States, 2006-2013. Clin Infect Dis. 2016;63(5):594-601. doi:10.1093/cid/ciw371
30. Medina E, Ryan L, LaCourse R, North RJ. Superior virulence of Mycobacterium bovis over Mycobacterium tuberculosis (MTB) for MTB-resistant and MTB-susceptible mice is manifest as an ability to cause extrapulmonary disease. Tuberculosis (Edinb). 2006;86(1):20-27. doi:10.1016/j.tube.2005.04.003
31. Bobadilla-del Valle M, Torres-González P, Cervera-Hernández ME, et al. Trends of Mycobacterium bovis isolation and first-line anti-tuberculosis drug susceptibility profile: a fifteen-year laboratory-based surveillance. PLOS Negl Trop Dis. 2015;9(9):e0004124. doi:10.1371/journal.pntd.0004124
32. Mokaddas EM, Saadaldeen H, Ahmad S. Comparison of two molecular methods and an automated liquid culture system for the early detection of Mycobacterium tuberculosis from both pulmonary and extrapulmonary specimens in Kuwait. Int J Mycobacteriol. 2016;5(Suppl 1):S74-S75. doi:10.1016/j.ijmyco.2016.09.004
33. Raveendran R, Wattal C. Utility of multiplex real-time PCR in the diagnosis of extrapulmonary tuberculosis. Braz J Infect Dis. 2016;20(3):235-241. doi:10.1016/j.bjid.2016.01.006
34. Ak O, Dabak G, Ozer S, Saygi A, Dabak R. The evaluation of the QuantiFERON-TB Gold test in pulmonary and extrapulmonary tuberculosis. Jpn J Infect Dis. 2009;62(2):149-151. Accessed January 17, 2017. https://www.niid.go.jp/niid/images/JJID/62/149.pdf
35. Farah MG, Rygh JH, Steen TW, Selmer R, Heldal E, Bjune G. Patient and health care system delays in the start of tuberculosis treatment in Norway. BMC Infect Dis. 2006;6:33. doi:10.1186/1471-2334-6-33