Aims

Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford.

As in other high-income countries, tuberculosis (TB), including musculoskeletal TB, occurs infrequently in Australia. Only 954 new TB cases (i.e. 5.15 per 105 population) were reported in 1997 with 44 cases of musculoskeletal TB. Hence, most Australian physicians and surgeons are unfamiliar with musculoskeletal TB, which can often present as a chronic slowly-progressive destructive disease. Consequently delays in diagnosis are common resulting in significant morbidity. In contrast, TB rates are more than 100 per 105 population in many countries in SE Asia and the Pacific. Medical staff are therefore familiar with the manifestations of TB but often lack the laboratory facilities to confirm the diagnosis or perform drug susceptibility tests (DSTs).

This presentation will provide research findings of interest to medical staff from both Australia and neighbouring countries. A review of musculoskeletal TB cases reported in South Australia over the last decade will be presented highlighting the delays in diagnosis and the resulting morbidity. Recent advances in TB diagnostics (i.e., novel agar media, Alamar blue, and Mycobacterium Growth Indicator Tubes) that represent appropriate technologies for low-resource countries will also be described.

Primary tuberculous bursitis was a relatively frequent manifestation of the disease before the antituberculosis drug era. Nowadays, it is considered a rare condition; it accounts for 1–2% of all musculoskeletal tuberculosis. The diagnosis and treatment of tuberculous bursitis may be delayed because the paucity of symptoms, its indolent clinical course and a low clinical suspicion. A 50-year-old patient with tuberculous trochanteric bursitis is reported. A 50-year-old woman was referred to our department to investigate a persistent pain in her left hip with 6 months duration. She was afebrile. The examination revealed a diffuse swelling from the buttock through the thigh, notable over the trochanter, but no sign of acute inflammation such as heat and redness. Her past medical and family histories revealed no previous tuberculosis. Plain films of the left hip showed a partial destruction of the margin of the greater trochanter, lytic foci in the underlying bone and a small focus of calcification in the adjacent soft tissues. A computed tomogram showed a soft tissue mass and demonstrated the relationship with the trochanter. We performed a needle biopsy which revealed granulomatous tissue. The patient underwent complete excision of the bursa and curettage of the surface of the trochanter. The postoperative course was uneventful. Mycobacterium tuberculosis was isolated and definitive diagnosis of tuberculous bursitis was made. There was no evidence of concomitant tuberculosis at other musculoskeletal sites. The patient completed a treatment with rifampicin and etambutol for 6 months. There has been a complete resolution of the symptoms after 3 months and no recurrence after 4 years of follow-up. On plain radiograph the remodeling of the bone structure is clearly visible. Tuberculosis in the region of the greater trochanter is extremely rare. This rarity leads orthopedic surgeons to neglect this potential diagnosis, resulting in a delay in treatment. The pathogenesis of tuberculosis of the greater trochanteric area has not been well defined. The incidence of concomitant tuberculosis at other musculoskeletal sites, as well as the lung, is approximately 50%. Both hematogenous infection and propagation from other locations are reasonable explanations. Surgical intervention is mandatory for cure and the use of several antituberculosis agents is a standard approach