1 - Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) – EPE, Lisbon, Portugal
2 - Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
3 - Paediatric Orthopaedic Unit, Hospital de Dona Estefânia, CHULC – EPE, Lisbon, Portugal
4 - Clinical Pathology, Hospital de Dona Estefânia, CHULC – EPE, Lisbon, Portugal
5 - Neuroradiology Unit, Hospital Dona Estefânia, CHULC, Lisbon, Portugal
6 -Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
- Journal of Medical Microbiology, Volume 71, Issue 12, 19 December 2022
Introduction: Bone and joint tuberculosis (BJTB) is rare in developed countries, particularly in the paediatric population.
Hypothesis/Gap Statement: The clinical features and sequelae of paediatric BJTB in Europe are not well characterized and should be assessed to achieve a better approach.
Aim: To assess the management and outcomes of paediatric BJTB.
Methodology: Longitudinal observational study of all paediatric patients (0–17 years old) diagnosed with BJTB between 2008 to 2020 in a tertiary-care hospital.
Results: We identified 18 patients with BJTB, with a median age of 10 years (IQR 6–14.8), 66.7 % male. Most (72 %) were diagnosed after 2015 and were foreign-born (88.9 %), mainly from Portuguese-speaking African countries, and none had HIV. The most common symptoms were pain (77.8 %), fever (50 %) and bone deformity (44.4 %). Spinal TB (STB) affected 13 (72.2 %) and extra-spinal TB (ESTB) 9 (50 %) patients, and 4 (27.7 %) had both conditions. Diagnostic positive procedures included positive nucleic acid amplification technique (NAAT) (44.4 %), Mycobacterium tuberculosis isolation (44.4 %) and compatible histology (33.3 %). All completed antituberculous drugs for a median of 12 months (IQR 12–13) and nine (50 %) had surgery. Overall, acute complications occurred in 16 (88.9 %) patients – 11/13 (84.6 %) with STB and 5/5 (100 %) with ESTB – and included abscesses, spinal compression, spine deformity and pathological fractures. Sequelae were still present at the 12-month follow-up in seven cases (46.7 %), and were more common in foreign-born patients sent to Portugal to receive medical treatment (66.7 vs 20 %).
Conclusions: Paediatric BJTB is difficult to diagnose and has high morbidity, requiring long-term follow-up. Over the last decade, foreign-born TB seems to be increasing, with still longer treatment courses and more acute complications and sequelae.
Palavras Chave: bone and joint infections, paediatric, tuberculosis