Osteonecrosis of the hip in sickle-cell disease associated with tuberculous arthritis. A review of 15 cases.
We report a study of 15 cases of tuberculous hips with sickle-cell disease who presented during 1991-1993. Although the osteonecrosis was long-standing, biopsy was nearly always required to reveal the more recent tuberculous infection. Management consisted of 6 months of anti-tuberculous chemotherapy with appropriate palliative surgery 5-8 weeks after the start of drug treatment. The operative techniques which we used are described. The results were good both post-operatively, and in 12 patients followed-up at an average of 3 years. We recommend this combined management for the treatment of secondary tuberculous infections of hips previously damaged by sickle-cell disease. (+info)
Genotypic analysis of Mycobacterium tuberculosis from medieval human remains.
Three medieval bone samples with osteological evidence of tuberculosis infection were analysed for the presence of DNA sequences from Mycobacterium tuberculosis using a series of PCRs. In each case amplification of IS6110 and part of the beta-subunit of RNA polymerase identified infection with a bacterium belonging to the M. tuberculosis complex. Amplification of the mtp40 genome fragment and the presence of a guanine residue at position 285 in the oxyR pseudogene, demonstrated the infecting strain to be similar to present day M. tuberculosis isolates rather than to Mycobacterium bovis. Spoligotyping, based on amplification of the direct repeat (DR) region of the mycobacterial genome, provided further evidence of similarity to M. tuberculosis and indicated a close relationship between isolates associated with two separate medieval burials. The study demonstrates the feasibility of amplifying multiple M. tuberculosis loci in ancient human remains and suggests important applications in the study of the palaeoepidemiology and virulence of tuberculosis in past populations. (+info)
Tuberculosis of the spine in the new millennium.
Tuberculosis of the spine is probably one of the earliest diseases to have affected the human race. Over the past few decades, the epidemiology, pathology, natural history and diagnostic methodology have been well studied. The multinational prospective study on the efficacy of conservative chemotherapy and surgical treatment coordinated by the Medical Research Council has just completed a final 15-year follow-up report. Although it appears from this study that conservative treatment is as effective as surgical intervention for earlier and milder diseases, there are still reservations on the effect of such treatment at much longer follow-ups and for more severe diseases. Further developments in diagnosis using molecular genetic techniques, more effective antibiotics and more aggressive surgical protocols in the next millennium may help in solving the problems of late severe deformity and paraplegia in the debilitated immunocompromised patients. (+info)
Tuberculosis of the foot.
In 44 patients with tuberculosis of the foot we identified five radiological patterns of lesions; cystic, rheumatoid, subperiosteal, kissing and spina ventosa. Cystic destruction had the best outcome and rheumatoid the poorest. All the patients were cured after antituberculous treatment for 18 months, and none required surgery. (+info)
Tuberculous arthritis of the knee--an unusual presentation.
A 54 year old male who had an unusual clinical manifestation and radiological features proven to have tuberculosis arthritis of the knee on synovial biopsy is presented here. (+info)
Total hip arthroplasty in healed tuberculous hip.
Total hip arthroplasty was performed in a patient who had tuberculous hip, quiescent for the last 15 years, without pre or postoperative anti-tuberculous chemotherapy. At a 27 month follow up, there has been no evidence of reactivation. A brief review of relevant literature is also presented. (+info)
Total hip arthroplasty for tuberculous coxitis.
We report a case of tuberculous arthritis of the hip in a 22 year old male patient, treated with arthrotomy and antituberculous antibiotic therapy for 9 months; the joint deteriorated and 2 years later he underwent uncemented total hip arthroplasty. He received antibiotic therapy for 3 months preoperatively and for 6 months postoperatively. At 5 year follow-up there was no evidence of recurrent infection. (+info)
BCG osteomyelitis: experience in the Stockholm region over the years 1961-1974.
Eighteen cases of bone and joint tuberculosis in children were diagnosed in the Stockholm region (about 1,500,000 population) over the period 1961-1974. BCG infection was verified by culture and identification of bacterial type in seven, all after 1968. The same origin can be presumed in most of the remaining eleven cases, in spite of the absence of bacterial verification. The increased frequency of complications after BCG vaccination may necessitate a revision of the vaccination programme. We recommend operative treatment, which has not led to any growth disturbances or impairment of joint function, although the lesions were invariably localised close to growth zones and joints. (+info)