Dr Davies (June 2003 JRSM1) highlights the challenge faced by clinicians in the diagnosis and management of pulmonary tuberculosis (TB). We feel that skeletal TB has likewise suffered neglect. Notified cases of non-pulmonary TB have risen by over 25% in the UK since 1993.2 Skeletal TB occurs in approximately 1–2% of cases of TB.3
In the past 18 months our orthopaedics department has treated 22 patients with TB involving bone. Of these, 15 (68%) were spinal infections. In addition, we have encountered tuberculous arthritis and osteomyelitis. The time to diagnosis from onset of symptoms ranged from 1 week to 2 years (median 2 months). All but one of the cases arose in patients from ethnic minority groups, most of whom were immigrants or refugees. This concurs with the study of Hayes et al., who found that 95% of cases of spinal TB occurred in the immigrant population.4
In 1968 Walker highlighted the importance of entertaining the diagnosis of TB as a cause of skeletal pain.5 With a rising incidence of all forms of TB, all clinicians should be alert to the possibility of skeletal TB if adverse outcomes are to be avoided.
References
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