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Bone and joint tuberculosis in childhood in a children's hospital, Addis Abeba
1Department of Paediatrics and Child Health, Faculty of Medicine, Addis Abeba University, Ethiopia.
Insights
Pediatric bone and joint tuberculosis (TB) disproportionately affects the hip joint in hospitalized children, leading to longer hospital stays compared to spinal TB. Early diagnosis and treatment are crucial for functional recovery and preventing complications like paraplegia.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Radiology
Background:
- Bone and joint tuberculosis (TB) is a significant pediatric health concern.
- Hospitalized children present unique challenges in diagnosing and managing skeletal TB.
- Understanding the epidemiological and clinical patterns of pediatric bone and joint TB is essential.
Purpose of the Study:
- To review the clinical characteristics and outcomes of children diagnosed with bone and/or joint tuberculosis.
- To identify the most common sites of skeletal involvement in hospitalized pediatric TB patients.
- To compare the duration of hospital stay for different sites of bone and joint TB.
Main Methods:
- Retrospective review of pediatric bone and joint TB cases admitted between 1985 and 1990.
- Diagnosis based on clinical, radiological findings, purified protein derivative (PPD) tests, and erythrocyte sedimentation rate (ESR).
- Analysis of patient demographics, affected joint sites, and length of hospital stay.
Main Results:
- 41 pediatric patients (61% male) were diagnosed with bone and/or joint TB.
- The hip joint was the most common site (22 patients), followed by the spine (14 patients).
- Mean hospital stay was longer for hip joint TB (71 days) than spinal TB (43 days).
Conclusions:
- Hip joint tuberculosis is more prevalent and debilitating in hospitalized children compared to spinal TB.
- Prompt diagnosis and comprehensive treatment are vital for restoring joint function and preventing long-term disability.
- Early intervention in spinal TB is critical to prevent deformity and neurological complications such as paraplegia.
Abstract:
The records of children admitted to the Ethio-Swedish Children's Hospital with the diagnosis of bone and/or joint tuberculosis (TB) between 1985 and 1990 were reviewed. There were 41 patients: 25 (61%) males and 16 (39%) females. The diagnosis was based on history, clinical and radiologic findings supported by a positive PPD reaction and elevated erythrocyte sedimentation rate (ESR). A high index of suspicion based on epidemiologic considerations was also important. Whereas in ambulatory patients the commonest site of bone involvement was the spine, in this series of hospitalized patients the most common site of skeletal TB was the hip joint (22 patients) compared to spinal involvement (14 patients) suggesting the more incapacitating and crippling nature of hip joint disease. In the remaining 5 patients, the knee (1), the ankle (1) a metatarsal (2) or a phalanx (1) were involved. The period of hospital stay ranged from 3 to 180 days, with a mean of 56. Mean hospital stay was much longer for patients with TB arthritis of the hip joint than for those with spondylitis, 71 and 43 days respectively. The need for early diagnosis and treatment aiming at full restoration of function of the involved joint is emphasized. In TB spondylitis, early diagnosis and treatment should aim to minimize deformity and prevent paraplegia.