Tuberculous dactylitis - an easily missed diagnosis

Ritz, N., Connell, T.G., Tebruegge, Marc, Johnstone, B.R. and Curtis, N. (2011) Tuberculous dactylitis - an easily missed diagnosis. European Journal of Clinical Microbiology & Infectious Diseases, 30, (11), 1303-1310. (doi:10.1007/s10096-011-1239-5). (PMID:21491177).


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The prevalence of tuberculosis (TB) continues to rise worldwide. Current migration patterns and increased travel to high-prevalence TB countries will result in more frequent presentations of less common forms of TB. Tuberculous dactylitis, a form of tuberculous osteomyelitis, is well recognised in countries with a high prevalence of TB. We provide a systematic review of all published cases of tuberculous dactylitis in children and adolescents and describe a case to illustrate the typical features of the disease. Our review revealed 37 cases of tuberculous dactylitis in children and adolescents, all reported in the last 17 years. Children less than 10 years of age are most frequently affected and the hand is the most commonly affected site. Concurrent pulmonary TB is present in a fifth of cases and systemic symptoms are usually absent. Positive TST and IGRA support the presumptive diagnosis, but cannot be used as rule-out tests. The definitive diagnosis relies on the detection M. tuberculosis by PCR or culture. Treatment should comprise of a standard three to four drug anti-tuberculous regimen. The optimal treatment duration remains unknown. Surgery has a limited role in the treatment in general but may play a supportive role, and curettage of the cavity has been recommended for avascular lesions

Item Type: Article
Digital Object Identifier (DOI): doi:10.1007/s10096-011-1239-5
ISSNs: 0934-9723 (print)
1435-4373 (electronic)
Subjects: Q Science > QR Microbiology
R Medicine > R Medicine (General)
Divisions : Faculty of Medicine
ePrint ID: 337538
Accepted Date and Publication Date:
14 April 2011Made publicly available
November 2011Published
Date Deposited: 27 Apr 2012 08:32
Last Modified: 31 Mar 2016 14:26

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