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Tuberculous dactylitis - an easily missed diagnosis

Tuberculous dactylitis - an easily missed diagnosis
Tuberculous dactylitis - an easily missed diagnosis
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
0934-9723
1303-1310
Ritz, N.
01953c34-5267-4807-8f93-1c6973f7d57c
Connell, T.G.
5535c7a7-38cc-48db-a48e-aaad185b5d3d
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
Johnstone, B.R.
0401d60f-866a-4493-b47d-4336d46badbb
Curtis, N.
f12bb8b9-1dd8-42c3-b0a8-93cb0005d5cb
Ritz, N.
01953c34-5267-4807-8f93-1c6973f7d57c
Connell, T.G.
5535c7a7-38cc-48db-a48e-aaad185b5d3d
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
Johnstone, B.R.
0401d60f-866a-4493-b47d-4336d46badbb
Curtis, N.
f12bb8b9-1dd8-42c3-b0a8-93cb0005d5cb

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)

Record type: Article

Abstract

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

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More information

e-pub ahead of print date: 14 April 2011
Published date: November 2011
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 337538
URI: http://eprints.soton.ac.uk/id/eprint/337538
ISSN: 0934-9723
PURE UUID: 3f467fe6-dcbd-486a-a087-5800ada37a9b

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Date deposited: 27 Apr 2012 08:32
Last modified: 14 Mar 2024 10:54

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Contributors

Author: N. Ritz
Author: T.G. Connell
Author: Marc Tebruegge
Author: B.R. Johnstone
Author: N. Curtis

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