Bone & Joint Tuberculosis

8/18/2019 Bone & Joint Tuberculosis

1/39

BONE AND JOINT

TUBERCULOSISDR THIT LWIN

FACULTY OF MEDICINE &HEALTH SCIENCES

UMS


2/39

INTRODUCTION

• Bones and joints a e a!!e"ted in a#o$t % o! 'atients (it) t$#e "$*osis+

•T$#e "$*osis "a$se a , an$*o-ato$s ea"tion(it) tiss$e ne" osis and "aseation+

• "a$sa* o ,anis-. Mycobacterium tuberculosis


3/39

• Mycobacterium tuberculosis


4/39

/ATHOLO0Y

• Mode o! in!e"tion. 1ia t)e *$n, 2d o'*etin!e"tion341ia t)e ,$t 2s(a**o(3

4 t) o$,) t)e s5in 2 a e3


5/39

/ i-a 6 "o-'*e7

• / i-a 6 "o-'*e78 initia* *esion 9*6-')ati"s' ead to e,iona* *6-') node+

• initia* *esion. in *$n,: ')a 6n7 o ,$t+

4$s$a**6 no "*ini"a* i**ness+4 t(o se;$e*s<=+ )ea*ed o "a*"i!ied>+ sensiti?ation and e4in!e"tion

"a$sin, dest $"ti1e *esion+


6/39

Se"onda 6 s' ead

• Wides' ead disse-ination 1ia t)e #*oodst ea-: "a$sin, -i*ia 6 TB: o -eni,itis+

• Te tia 6 *esion. dest $"ti1e e7t a'$*-ona 6*esion 1ia #*ood s' ead a!te -ont)s o 6ea s*ate +

•


7/39

Te tia 6 Lesion

• / edi*e"tion. 1e te# a* #odies and t)e *a ,es6no1ia* joints+• sta t in t)e joint and t)en s' ead to #one o

vice versa +• Ma6 #e in!e"ted si-$*taneo$s*6+• C)a a"te isti" *esion is a "o**e"tion o!

e'it)e*oid and -$*tin$"*eated ,iant "e**s$ o$ndin, an a ea o! ne" osis: (it)*6-')o"6tes a o$nd t)e 'e i')e 6+


8/39

• a+ ' i-a 6 s' ead is $s$a**6 a ested in t)e *6-') ,*and+• #+ se"onda 6 s' ead is #6 t)e #*ood st ea-+• "+ te tia 6 is *o"a* dest $"ti1e *esion+


9/39

• A t6'i"a* tuberculous granuloma : (it) "ent a*ne" osis and s"atte ed ,iant "e**s s$ o$nded

#6 *6-')o"6tes and )istio"6tes+


10/39

• Caseo$s ne" osis -a6 "oa*es"e to !o - an

a#s"ess "ontainin, '$s and ne" oti" #one! a,-ents+

• #one t$#e "$*osis tend to s' ead a'id*6 and

e'i')6sea* "a ti*a,e is no #a ie to in1asion+• joint t$#e "$*osis. s6no1i$- #e"o-e t)i"5

and oede-ato$s: ,i1in, ise to -a 5ed

e!!$sion+


11/39

• A 'ann$s o! , an$*ation tiss$e -a6 e7tend

a" oss t)e joint and a ti"$*a "a ti*a,e isdest o6ed+• T)e in" eased 1as"$*a it6 "a$se *o"a*

osteo'o osis+• "aseation e7tend into t)e s$ o$ndin, so!t

tiss$e to ' od$"e "o*d a#s"ess +

• T)is -a6 #$ st t) o$,) t)e s5in: !o -in, asin$s o t a"5 a*on, t)e tiss$e '*ane to 'oint atdistan"e site+


12/39

• Hea*in, .• =+ 2ea *6 sta,e3 #6 eso*$tion to a''a ent

no -a*it6+

• >+ #6 !i# osis 2!i# o$s an56*osis3 (it) ' o, essi1e joint de!o -it6 .


13/39

CLINICAL FEATURE

• Ma6 #e ' e1io$s in!e"tion o e"ent "onta"ts+• "o-'*aint o! 'ain and s(e**in,• Fe1e o *assit$de and *oss o! (ei,)t

• Ni,)t " ies• M$s"*e (astin,• S6no1ia* t)i"5enin,

• Li-ited -o1e-ent• Sti!!ness o! joint


14/39


15/39

CLINICAL FEATURE

• S'ine. )$n")#a"5 2t)o a"i"32*$-#a 3 an,$*a 56')os is a e*6 1isi#*e

• 1isi#*e a#s"ess in t)e *oin o , oin• 'a*'ation need on*6 $n t)e )and do(n on t)e

s'ino$s ' o"ess+• Coin test. )e #ends )is )i's and 5nees at)e

t)an #endin, )is #a"5

• Wea5ness o *oss o! sensation in t)e *o(e*i-#s


16/39

• Petit triangle.(lumbartriangle)

• nmoenic =LIE


17/39


18/39

15mm induration at 48 hours

• Positive antou! test


19/39

• test $sed to identi!6 indi1id$a*s ()o )a1e ' e1io$s*6 #een in!e"ted (it) Mycobacterium tuberculosis :

• T)e test is 'e !o -ed #6 inje"tin, 0.1 ml o! a so*$tion

t)at "ontains an e7t a"t o! "$*t$ es o! t)e #a"te i$-:"a**edtuberculin : into t)e de -is *a6e o! t)e s5in o!t)e !o ea - (it) a >@4,a$,e need*e+

• de*a6ed )6'e sensiti1it6 ea"tion• T)e s5in ea"tion is ead 48 to 72 hours a!te t)e

inje"tion #6 -eas$ in, t)e a-o$nt o! ind$ ation2s(e**in,3 at t)e inje"tion site in -i**i-ete s


20/39

• 'ositi1e ea"tion=+ )a1e )ad t$#e "$*osis #e!o e and )a1e #een "$ ed>+ )a1e #een e7'osed to t)e t$#e "$*osis #a"te ia o

)a1e #een i--$nised !o t$#e "$*osis 2BC03+ )a1e t$#e "$*osis+


21/39

• !a*se ne,ati1e=+ ta5in, -edi"ine to *o(e 6o$ immunity e,+ ste oids

o ")e-ot)e a'6 d $,s>+ )as a viral i**ness e,+ -eas*es: -$-'s o $#e**a

+ )as e"ent*6 #een vaccinated (it) *i1e 1i $ses+ is1e 6 si"5+

%+ A 'ositi1e es$*t does not ne"essa i*6 -ean 6o$ )a1et$#e "$*osis


22/39

u

• S'ina* t$#e "$*osis4 'at)o*o,6. / o, essi1e

in" easin, dest $"tion o! t)e ! ont o! t)e1e te# a* #odies *eads to !o (a d "o**a'se .


23/39

4RAY

2=3 so!t tiss$e s(e**in,2>3 'e ia ti"$*a osteo'o osis2 3 (as)ed4o$tG a''ea an"e on #one end

2 3 na o(in, o! joint s'a"e2%3 *ate : e osion o! t)es$#a ti"$*a #one 2onboth side of the joint )


24/39

• So!t tiss$es)ado( in

4 a6 s'ineA/ 1ie(


25/39

• Joint s'a"e na o(in, and osteo'o osis on t)e*e!t


26/39

• Hea*in, #6 !i# osis


27/39

• =+In" eased 56')oti" "$ 1e o! t)o a"i" s'ine (it) an,$*ation atT 4= *e1e*+>+ Co**a'sed T and T= 1e te# a* #odies (it) o#*ite ation o!

T 4= inte 1e te# a* dis" s'a"e+

+ Bi*ate a* 'a as'ina* so!t tiss$e 2a o(s3+


28/39

• MRI s)o(in, 'a a1e te# a*

a#s"ess


29/39


30/39


31/39

• T)e disease -a6 #e,in as s6no1itis oosteo-6e*itis+


32/39

• not a** "a ti*a,e is dest o6ed: and )ea*in, is$s$a**6 #6 !i# o$s an56*osis+


33/39

• /ottGs 'a a'*e,ia. t)e s'ina* "o d -a6 #e"o-' essed 2a3 #6 an a#s"ess o 2#3 #6 a )a d5n$"5*e o! #one ()i") "*ea *6 needso'e ation+ 2"3 =4t anst)o a"i" >4 ante o*ate a*+


34/39

"

• T(o adja"ent1e te# ae

• T(o adja"ento''osin, s$ !a"es


35/39


36/39

Ant o*ate a*a'' oa") to

de"o-' ess t)e 'a a1e te# a*a#s"ess


37/39

TB t eat-ent e,i-ens #6 t)eWHO

Treatment category PatientsCate,o 6 I = +Ne( s'$t$- s-ea 4'ositi1e

'$*-ona 6 TB>+ Ne( s-ea ne,ati1e /TB (it)e7tensi1e 'a en")6-ain1o*1e-ent

Cate,o 6 II =+S-ea 'ositi1e Re*a'se>T eat-ent !ai*$ e

+Ret$ nedde!a$*te

Cate,o 6 III =+E7t a4'$*-ana 6 TB>+ Ne( s-ea ne,ati1e /TB2*i-ited 'a en")6-a 3

Cate,o 6 I C) oni" "ase

Treatment Initial phase Continuation Total


38/39

Treatmentcategory

Initial phase Continuationphase

Totalduration

I H K -,R % -,

=% -,E=> -,

HR

K-ont)s

II H:R: :E:S 7 >-ont)sH:R: :E 7=-ont)

H:R:E 7 %-ont)s -ont)s

III H:R: 7> -ont)s H:R 7 -ont)s K-ont)s

I WHO ,$ide*ines !o $seo! se"ond *ine d $,s

4 months#months

H4INHR4Ri!a'i"in

4/6 a?ina-ideE4Et)a-#$to*


39/39

•THAN YOU

Bone & Joint Tuberculosis

Documents

Transcript of Bone & Joint Tuberculosis