The lack of an accurate, rapid diagnostic test
for mycobacterium tuberculosis (TB) is a major handicap in the management
of spinal TB. GeneXpert, a new, rapid molecular diagnostic test
is recommended as the first line investigation for suspected pulmonary
TB in areas with a high prevalence of HIV or drug resistance, yet
it has not been validated for the diagnosis of musculoskeletal TB. The aim of this study was to assess the accuracy of GeneXpert
in diagnosing spinal TB. A prospective clinical study of 69 consecutive adults with suspected
spinal TB was conducted at a tertiary hospital in an area with the
highest incidence and prevalence of TB in the world. GeneXpert was
used on tissue samples of the enrolled patients and its diagnostic
accuracy compared with a reference standard of tissue in liquid culture.
A total of 71 spine samples from 69 patients (two re-biopsies) were
included in the study. The GeneXpert test showed a sensitivity of 95.6% and specificity
of 96.2% for spinal TB. The results of the GeneXpert test were available
within 48 hours compared with a median of 35 days (IQR 15 to 43)
for cultures. All cases of multi-drug resistant TB (MDR TB) were
diagnosed accurately with the GeneXpert test. The MDR TB rate was
5.8%. Cite this article:
A prospective series of 32 cases with tuberculosis of the hand and wrist is presented. The mean age of the patients was 23.9 years (3 to 65), 12 had bony disease and 20 primarily soft-tissue involvement. The metacarpal of the little finger was the most commonly involved bone. Pain and swelling were the usual presenting features and discharging sinuses were seen in three cases. All patients were given anti-tubercular chemotherapy with four drugs. Operative treatment in the form of open or arthroscopic debridement, or incision and drainage of abscesses, was performed in those cases where no response was seen after eight weeks of ATT. Hand function was evaluated by the modified score of Green and O’Brien. The mean was 58.3 (25 to 80) before treatment and 90.5 (80 to 95) at the end. The mean follow-up was for 22.4 months (6 to 43). Conservative treatment was successful in 24 patients (75%). Eight who did not respond to chemotherapy within eight weeks required surgery. Although tuberculosis of hand has a varied presentation, the majority of lesions respond to conservative treatment.
A series of 14 patients suffering from tuberculosis of the sternum with a mean follow-up of 2.8 years (2 to 3.6) is presented. All were treated with antitubercular therapy: ten with primary therapy, two needed second-line therapy, and two required surgery (debridement). All showed complete healing and no evidence of recurrence at the last follow-up. MRI was useful in making the diagnosis at an early stage because atypical presentations resulting from HIV have become more common. Early adequate treatment with multidrug antitubercular therapy avoided the need for surgery in 12 of our 14 patients.
