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Published on: September 5, 2017
Osseous manifestations of tuberculosis in children
1Department of Orthopaedic Surgery, Nelson R. Mandela School of Medicine, Durban, South Africa. Katia@med.Und.Ac.Za
Insights
Tuberculous osteomyelitis in children presents with diverse bone lesions, often mimicking other conditions. Surgical curettage combined with antituberculous therapy is effective for treatment.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Radiology
Background:
- Tuberculous osteomyelitis is a significant bone infection in children.
- Diagnosis can be challenging due to varied presentations resembling other bone pathologies.
- Understanding lesion types and locations is crucial for effective management.
Purpose of the Study:
- To characterize the clinical and radiological features of tuberculous osteomyelitis in children.
- To evaluate treatment outcomes for pediatric tuberculous osteomyelitis.
- To emphasize the diagnostic importance of biopsy.
Main Methods:
- Retrospective review of 42 children diagnosed with tuberculous osteomyelitis (1984-1999).
- Analysis of lesion types (cystic, infiltrative, focal erosions, spina ventosa) and locations.
- Histologic confirmation of diagnosis in all cases.
Main Results:
- Ages ranged from 1 to 12 years, with 50 osseous lesions identified.
- Cystic lesions were most common (n=26), predominantly in metaphyses (n=25).
- Bone lesions mimicked pyogenic/fungal infections and bone tumors; biopsy confirmed tuberculosis in all.
Conclusions:
- Tuberculous osteomyelitis in children exhibits diverse manifestations.
- Combined surgical curettage and antituberculous treatment achieved good outcomes.
- Histologic confirmation via biopsy is essential for accurate diagnosis.
Abstract:
Forty-two children with tuberculous osteomyelitis were seen and treated between 1984 and 1999. The age ranged from 1 to 12 years (average 6); there were 31 boys and 11 girls. There were 50 osseous lesions (excluding spinal and synovial). Five children had multifocal bone involvement. There were four basic types of lesions: cystic (n = 26), infiltrative (n = 10), focal erosions (n = 8), and spina ventosa (n = 6). The majority of the lesions were in the metaphyses (n = 25); the remainder were in the diaphysis, epiphysis, short tubular bones, flat bones, and small round bones. The erythrocyte sedimentation rate was normal in seven, and the Mantoux test was negative in four. Bone lesions resembled pyogenic and fungal infections and benign and malignant bone tumors. Histologic confirmation was obtained in all patients. Curettage and antituberculous treatment yielded good results in the majority of patients, with follow-up of 6 months to 9 years. Biopsy is mandatory to confirm the diagnosis.
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