Pulmonology Book

Tuberculosis

  • Skeletal Tuberculosis

http://www.fpnotebook.com/

Skeletal TuberculosisAka: Tuberculous Arthritis, Pott's Disease, Poncet's Disease, Spinal Tuberculosis, Articular Tuberculosis, Tuberculous Osteomyelitis, Gibbus

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  1. See Also
    1. Tuberculosis
    2. Septic Arthritis
    3. Extrapulmonary Tuberculosis
  2. Definition
    1. Arthritis secondary to Mycobacterium tuberculosis
  3. Epidemiology
    1. Represents 35% of Extrapulmonary Tuberculosis
  4. Distribution
    1. Spinal Tuberculosis (Pott's Disease)
      1. Thoracic spine most commonly involved
      2. Associated with paraspinous abscess
      3. Destroys anterior vertebral body and adjacent disc
        1. Results in anterior wedging
        2. Forms prominence of spine known as gibbus
        3. May compress central cord
    2. Articular Tuberculosis (most common involvement)
      1. Monoarticular Arthritis of weight bearing joints
      2. Presents with insidious monoarticular pain, swelling
      3. May form superficial abscesses and drain to skin
    3. Poncet's Disease (rare)
      1. Acute sterile Polyarthritis
      2. Associated with visceral involvement
    4. Tuberculous Osteomyelitis
      1. May involve any bone
  5. Signs
    1. Doughy synovitis on joint palpation
  6. Labs
    1. Tuberculin Skin Test (Purified Protein Derivative)
      1. Positive in most cases
    2. Synovial Fluid Exam
      1. See Septic Arthritis
  7. Radiology: Chest XRay
    1. Pulmonary involvement in only 50% of Tb arthritis
  8. Diagnosis
    1. Arthrocentesis with Mycobacterium tuberculosis culture
      1. Test Sensitivity: 80%
    2. Synovial biopsy
  9. Management
    1. See Extrapulmonary Tuberculosis
    2. See Tuberculosis Management
    3. Four drug regimen
      1. Isoniazid for 10 to 24 months
      2. Rifampin for 10 to 24 months
      3. Pyrazinamide for 2 months
      4. Ethambutol until Tuberculosis sensitivity established
      5. Atypical Mycobacteria require fifth drug added
        1. Azithromycin or
        2. Clarithromycin
  10. References
    1. Watts (1996) J Bone Joint Surg Am 78:288

Kyphosis deformity of spine (C0022821)

Definition (MSH)Abnormally increased convexity in the curvature of the thoracic spine as viewed from the side. (Dorland, 27th ed)
ConceptsAnatomical Abnormality (T190)
ICD9737.1
MSHD007738
EnglishAngulation of spine, Gibbosity, Gibbus, Humpback, Hunchback, Kyphoses, Kyphosis, Kyphosis deformity of spine
Spanishcifosis, deformidad de la columna vertebral - cifosis, giba, joroba
Parent ConceptsCurvature of spine (C0037932), Non-Neoplastic Bone Disorder (C1334997), Lordosis (C0024003), Deformity of bone (C0410719), Finding of vertebra (C0575161), Ambiguous concept (C1274012)
SourcesDXP, LCH, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Tuberculosis, Spinal (C0041330)

Definition (MSH)Osteitis or caries of the vertebrae, usually occurring as a complication of tuberculosis of the lungs.
ConceptsDisease or Syndrome (T047)
ICD9015.0, 015.0, 015.00
MSHD014399
EnglishPOTT DIS, Pott Disease, Pott's disease, POTTS DIS, Potts Disease, Spinal Tuberculoses, Spinal Tuberculosis, TB OF VERTEBRA-UNSPEC, Tuberculosis of spine, Tuberculosis of vertebral column, Tuberculosis of vertebral column - Pott's, Tuberculous spondylitis, Tuberculous spondylitis -RETIRED-
Spanishenfermedad de Pott, espondilitis tuberculosa, espondilitis tuberculosa - RETIRADO -, tuberculosis de la columna vertebral
Parent ConceptsTuberculosis, Osteoarticular (C0041324), Tuberculosis, Spinal (C0041330), Spondylitis (C0038012), Tuberculosis (C0041296), Spinal Diseases (C0037933), Tuberculous osteomyelitis (C0275922), Finding of vertebra (C0575161), Reason not stated concept (C1276325), Duplicate concept (C1274013)
SourcesDXP, ICD9CM, MSH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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