Comprehensive Insights into Musculoskeletal Tuberculosis: Exploring Bones, Joints, and Beyond

Below, we discuss Tuberculosis of the spine, Tuberculous arthritis of hip or knee joints, Tuberculous mastoiditis, Tuberculous osteomyelitis, Tuberculous myositis, Tuberculous synovitis, and Tuberculous tenosynovitis.

1. Pott’s disease (Tuberculosis of the spine)

Tuberculosis of the spine, also referred to as Pott’s disease or curvature of spine, Tuberculous arthritis, Tuberculous osteomyelitis of the spine, or Tuberculous spondylitis, is a type of extrapulmonary Tuberculosis caused by Mycobacterium tuberculosis, which primarily involves the intervertebral discs of the spine.

1.1 Symptoms

A patient with spinal Tuberculosis can experience;

  • back pain (which can be localized to the spine or radiate to the extremities);
  • numbness and tingling;
  • paraplegia (inability to feel or move the legs and lower body);
  • paresis (slight paralysis or muscle weakness);
  • tenderness;
  • stiffness;
  • muscle spasms,
  • prominent spinal deformity;
  • fever; and
  • weight loss.

1.2 Diagnosis

Providers diagnose the condition based on a tuberculin skin test and previous history of Tuberculosis or active disease. MRI or CT scans may reveal vertebral body bone destruction or osteoporosis in progressive disease. Definitive diagnosis is made by bone and tissue biopsy or abscess samples for acid–fast bacilli (AFB).

1.3 Treatment

Treatment includes antituberculous chemotherapy with isoniazid, rifampin, rifabutin, pyrazinamide, and ethambutol; other drugs may be tried if these drugs are ineffective. In severe cases, surgical therapy is indicated. This condition has high mortality.

2. Tuberculous arthritis of hip or knee joints

Tuberculous arthritis of the hip (joint) or knee (joint) is a type of extrapulmonary Tuberculosis acquired by direct introduction of the bacteria through an open wound or resulting from reactivation of the bacilli lodged in the area from an original infection by Mycobacterium tuberculosis and rarely by Mycobacterium bovis associated with pain, swelling, and limitation of movement of the affected joint.

2.1 Symptoms

A patient with tuberculous arthritis of the hip (joint) or knee (joint) can experience;

  • local pain;
  • tenderness;
  • inflammation; and
  • stiffness of the affected anatomy.

2.2 Diagnosis

Providers diagnose the condition based on a tuberculin skin test and previous history of Tuberculosis or active disease. MRI or CT can detect tuberculous osteomyelitis and arthritis. A definitive diagnosis is made by biopsy.

2.3 Treatment

Treatment includes antituberculous chemotherapy with isoniazid, rifampin, rifabutin, pyrazinamide, and ethambutol; other drugs may be tried if these drugs are ineffective. In severe cases, surgical therapy is indicated.

3. Tuberculous mastoiditis & Tuberculous osteomyelitis

Tuberculous mastoiditis and tuberculous osteomyelitis are types of extrapulmonary Tuberculosis acquired by direct introduction of the bacteria through an open wound or resulting from reactivation of the bacilli lodged in the area from an original infection by Mycobacterium tuberculosis and rarely by Mycobacterium bovis.

3.1 Symptoms

A patient with Tuberculous mastoiditis or tuberculous osteomyelitis experience;

  • severe pain;
  • tenderness;
  • inflammation; and
  • stiffness of the affected anatomy.

3.2 Diagnosis

Providers diagnose the condition based on a tuberculin skin test and previous history of Tuberculosis or active disease. MRI or CT can detect tuberculous osteomyelitis and thinning of the bone. Definitive diagnosis is made by bone and tissue biopsy or abscess samples for acid–fast bacilli (AFB).

3.3 Treatment

Treatment includes antituberculous chemotherapy with isoniazid, rifampin, rifabutin, pyrazinamide, and ethambutol; other drugs may be tried if these drugs are ineffective. In severe cases, surgical therapy is indicated.  

4. Other musculoskeletal Tuberculosis

Other musculoskeletal Tuberculosis are;

With other musculoskeletal Tuberculosis (TB), we refer to an infection caused by Mycobacterium tuberculosis, which enters through the respiratory system; the bacilli (rod–shaped bacterium) migrate to other areas through the lymph system or blood circulation and form granulomas (inflammatory masses of cells), which can remain dormant for long periods but eventually rupture and infect the involved structure.

4.1 Symptoms

A patient with TB or other musculoskeletal structures experiences pain, inflammation, and stiffness in the affected muscle or skeletal body.

The formation of granulomas or tuberculomas (tuberculous “tumors”) can result in fibrosis (thickened and scarred connective tissue), leading to restricted movement and wasting (reduction in the amount of tissue).

4.2 Diagnosis

The patient may experience other typical symptoms of TB, such as night sweats, fever, and weight loss. Providers diagnose the condition based on blood tests, tuberculin skin tests, and previous Tuberculosis or active disease history. MRI or CT may detect granulomas or tuberculomas. Tissue biopsy provides a definitive diagnosis.

4.3 Treatment

Treatment includes standard antituberculous chemotherapy with isoniazid, rifampin, rifabutin, pyrazinamide, and ethambutol; other drugs may be tried if these drugs are ineffective.

At times, adjunctive steroid therapy helps treat symptoms of swelling and inflammation. The provider may perform surgery to treat abscesses, tuberculomas, and fibrosis of the connective tissues.

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