Bone and joint tuberculosis

Koštano-zglobna tuberkuloza je granulomatozna upala dijelova sustava za kretanje izazvana acidorezistentnim bacilom Mycobacterium tuberculosis. Čini između 10-35% svih slučajeva izvanplućne tuberkuloze pri čemu tuberkuloza kralješnice odnosno Pottova bolest čini 50-60% svih koštano-zglobnih oblika tuberkuloze. Predilekcijska mjesta gdje nastaje infekcija su kosti i zglobovi koji nose težinu tijela kao što su kosti i zglobovi kralješnice, kuka, koljena i stopala. Prodor infekcije olakšavaju stanja kao što su: slabljenje imunosnog sustava uslijed malnutricije, infekcija humanim virusom imunodeficijencije, starija životna dob, kronične bubrežne bolesti i ostala pridružena stanja. Lokalizacija bolesti Pottove bolesti jest najčešće u području torakalne kralješnice (65%), zatim lumbalne kralješnice (20%), cervikalne (10%) te torakolumbalne kralješnice (5%). Kod ekstraspinalnog tuberkuloznog artritisa najčešće zahvaćeni zglobovi su zglobovi kuka, sakroilijačni zglob, zglobovi koljena te zglobovi stopala. Dijagnostika se postavlja anamnezom, kliničkim pregledom, mikroskopskim, citološkim i molekularnim metodama. Radiološke metode uključuju rendgen, magnetsku rezonanciju i kompjutoriziranu tomografiju. Konzervativna terapija sastoji se od propisivanja antituberkulotika, simptomatske terapije i mjera jačanja imuniteta. Ortopedsko liječenje uključuje imobilizacijske tehnike te operativne postupke. U osnovne operativne postupke ubrajamo punkciju i ekskohleaciju tuberkuloznog žarišta, debridement i artrolizu zahvaćenog zgloba te sinovektomiju. U slučaju uznapredovale destrukcije kostiju i zgloba pristupa se artroplastici ili artrodezi.Bone and joint tuberculosis is a granulomatous inflammatory disease, caused by acid-fast bacillus Mycobacterium tuberculosis, which affects the locomotor system. It accounts for 10-35% of all cases of extrapulmonary tuberculosis while spinal tuberculosis, i.e. Pott´s disease, accounts for 50-60% of all cases of bone and joint tuberculosis. Predilection sites where infection occurs are the bones and joints which carry weight such as bones and joints of the spine, hip, knee and foot. Conditions which facilitate breach of the infection are: weakening of the immune system due to malnutrition, human immunodeficiency virus infection, old age, chronic kidney diseases and other associated conditions. The most common sites of Pott´s disease are thoracic spine (65%), lumbar (20%), cervical (10%) and thoracolumbar spine (5%). The most affected joints in the cases of extraspinal tuberculous arthritis are hip joint, sacroiliac joint, knee joints and foot joints. Investigations include patient´s medical history, physical examination, microscopy, cytology and molecular analysis. Radiology procedures include X-ray, MRI and CT. Conservative therapy consists of administration of antituberculotics, symptomatic treatment and boosting of the immune system. Orthopedic treatment includes immobilization techniques and surgical procedures. Basic surgical procedures include puncture and excochleation of the tuberculous focus, debridement and arthrolysis of affected joint and synovectomy. In case of advanced destruction of bones and joints, arthroplasty or arthrodesis are performed