HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes.

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Abstract

[Indexed for MEDLINE] 5. J Clin Orthop Trauma. 2020 Mar-Apr;11(2):202-207. doi: 10.1016/j.jcot.2020.01.005. Epub 2020 Jan 22. Paediatric osteoarticular tuberculosis: A review. Agarwal A(1). Author information: (1)Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India. OBJECTIVE: Tuberculosis (TB) is endemic in Indian subcontinent. The paediatric osteoarticular (OA) TB is frequently confused with suppurative etiology as both can have similar clinical, radiological and laboratory presentation. It has become a health hazard due to its association with immunosuppression diseases such as HIV, chronic renal and liver diseases and use of immunosuppressive drugs. Furthermore, there is much dilemma regarding the drug choice and duration of anti tubercular treatment among practicing clinicians. This mini review briefs the reader to the classical regional and atypical tubercular clinical presentations, imaging and laboratory investigations and management for bone and joint TB. METHODS: The article details both common and atypical clinical tubercular presentations, the approach to diagnosis, drug treatment and surgical indications in paediatric OA TB. RESULTS: OA TB in the paediatric age group is uncommon. Diagnosis is often delayed because of diseases' nonspecific symptoms, non-characteristic imaging findings and lack of awareness of the condition. Multidrug antitubercular chemotherapy remains the anchor sheet of tubercular treatment in children. Surgery is needed in select cases to obtain tissue, to ensure better joint movement, prevent deformities and restore neurological function. CONCLUSIONS: TB can have varied presentation and therefore it is essential to keep tubercular infection in differential diagnosis while working up for any infective pathology. Conservative treatment produces good results in vast majority of cases. Surgery is reserved for select indications. © 2020 Delhi Orthopedic Association. All rights reserved. DOI: 10.1016/j.jcot.2020.01.005 PMCID: PMC7026562