The study of clinical manifestation of osteoarticular tuberculosis in Siriraj Hospital, Thailand.

OBJECTIVE: To study of clinical manifestations of osteoarticular tuberculosis. MATERIAL AND METHOD: This study is an observational retrospective study design from the electronic medical record database of Siriraj Hospital in 2005-2006. RESULTS: Ninety- nine patients fit in to the inclusion criteria. All were non HIV-infected. There were 44 males (44.4%) and 55 females (55.6%) with a male/female ratio of 8:10. The mean and median age was 50.9 +/- 19.8 and 50 years, respectively, with a range from 1-85 years. The most frequent chief complaint was pain (84.8%), followed by functional disability/neurological deficit (47.5%), constitutional symptoms (38.4%), fever (24.2%), localized swelling (21.2%), fistulas and drainage (11.1%) and discovery as a co-morbid disease (1%). The most frequent clinical manifestation was tuberculous spondylodiscitis (66.7%) followed by tuberculous septic arthritis (28.3%), tuberculous osteomyelitis (10.1%), tuberculous tenosynovitis (4.0%), tuberculous bursitis (2.0%) and tuberculous pyomyositis (2.0%). Concurrent pulmonary TB was 30.3%. The mean and median time to diagnosis was 20.4 +/- 16.9 and 13 weeks, respectively, with a range from 4 days to 104 weeks. The shortest duration of time to diagnosis was 0-4 weeks (19.2%) followed by 12-16 weeks (14.1%) and 20-24 weeks (13.1%). The longest duration of time to diagnosis was 104 weeks (1%). The diagnosis from histopathology was 46.5%, positive AFB 40.4%, positive PCR 33.3% and positive culture 19.2%. The radiological abnormalities were osteolytic lesion (79.8%), narrowing intervertebral disc space/joint space (54.5%), cold abscess (49.5%) and vertebral collapse (43.4%). Surgery with medical treatment was performed on 72.7% while the percentage of those receiving medical treatment only was 27.3%. The results of treatment were improvement with residual deformities/dysfunction occurring in 97%. Death occurred in 3%. CONCLUSION: Osteoarticular tuberculosis is common in all age groups. Tuberculous spondylodiscitis was the most frequent clinical manifestation in Siriraj Hospital, Thailand. Although the patients were provided with adequate medical and surgical therapy, osteoarticular tuberculosis was still associated with mortality and morbidity.