5.4. Bone and Soft Tissue Infection - Tuberculosis

Question 1

What are the 3 Classifications of Tuberculosis Infection in the Bones and Joints?

Answer 1

1. Extra-Articular
2. Intra-Articular
3. Vertebral Body

Question 2

What does the “Extra-Articular” Classification of Tuberculosis Infection in the Bones and Joints include?

Answer 2

Epiphyseal / Bones with Haemodynamic Marrow

Question 3

What does the “Intra-Articular” Classification of Tuberculosis Infection in the Bones and Joints include?

Answer 3

Large Joints

Question 4

How often do Multiple Lesions appear on a patient?

Answer 4

1/3 of patients experience multiple lesions

Question 5

What are the Clinical Freatures of Tuberculosis Infection in the Bones and Joints?

Answer 5

1. Insidious Onset and General Ill Health (Pyrexia)
2. Pain (Especially at night)
3. (Joint) Swelling and Deformities
4. Loss of Weight
5. Ankylosis (stiffening of a joint)

Question 6

What is the Pathology of Tuberculosis Infection in the Bones and Joints?

Answer 6

1. There is a primary complex (in the lung or the gut)
2. Secondary spread can go to Bones / Joints
3. A Tuberculous Granuloma forms in 2 phases:
4. a) Early (Short Lived) Vascular Phase
5. b) Chronic Avascular Phase
6. The Chronic Avascular phase has Obilterative Endarteritis - and so is very difficult to treat with Antibiotics

Question 7

How is the Diagnosis of Tuberculosis Infection in the Bones and Joints made?

Answer 7

1. History
2. Involvement of a Single Joint
3. Marked Thickening of the Synovium
4. Marked Muscle Wasting
5. Periarticular Osteoporosis

Question 8

What investigations will be carried out in Tuberculosis Infection in the Bones and Joints?

Answer 8

1. Full Blood Count
2. Inflammatory Markers - ESR
3. Mantoux Test
4. Sputum / Urine Culture
5. X-Ray
   6 Joint Aspiration and Biopsy

Question 9

What is an X-Ray looking for in Tuberculosis Infection in the Bones and Joints?

Answer 9

1. Soft Tissue Swelling
2. Periarticular Osteopaenia
3. Articular Space Narrowing

Question 10

What is a Joint Aspiration and Biopsy used for in Tuberculosis Infection in the Bones and Joints?

Answer 10

1. AAFB test

2. Culture

Question 11

What is the Differential Diagnosis of Tuberculosis Infection in the Bones and Joints?

Answer 11

1. Transient Synovitis
2. Monoarticular Rheumatoid Arthritis
3. Haemorrhagic Arthritis
4. Pyogenic Arthritis