The spectrum of osteoarticular tuberculosis in Brunei Darussalam

Ketan PANDE ¹, Hjh Salizawati MOHD ZAINAL², Bhoopathy BALASUBRAMANIAN²,

Bheemayya  BADESAB²

¹ Department of Orthopaedics, RIPAS Hospital and ² National Tuberculosis  Coordinating Centre, Kampong Kiarong, Brunei Darussalam

ABSTRACT

Introduction: Tuberculosis (TB) is a public health problem worldwide including Brunei Darussalam. Osteoarticular involvement is common. The purpose of this study was to review the demographics, clinical features and treatment outcome of patients with osteoarticular tuberculosis (OATB) in Brunei Darussalam. Material and Methods: Patients receiving treatment for OATB between 2003 and 2008 were identified from the National Tuberculosis Coordinating Centre (NTCC) registry. Data was recorded on pre-designed proforma. Results: Twenty-one patients (10 male: 11 female) were identified with a mean age of 49 years (range 19 to 75). Nineteen were Bruneian citizens. The most common presenting symptoms were pain at affected site (n = 15), focal neurological deficit and loss of appetite (n = 7). Two patients gave a positive family history of TB and three had radiological evidence of pulmonary TB. Radiograph of the involved part was positive in nine cases while advanced imaging studies (computed tomography scan and magnetic resonance imaging) were required in 15 instances. The results of positive confirmatory tests were obtained from: smear (n = 10), culture (n = 3) and biopsy (n = 8). In five cases treatment had to be started without any of the confirmatory tests. The spine was the most common site of involvement (n = 12) with five non-spinal and four cases with combined lesions. Surgical intervention was required in six cases. All patients completed the treatment successfully. Conclusions: OATB is not uncommon in Brunei Darussalam and can present diagnostic problems. A high index of suspicion, early confirmation of diagnosis and complete monitored treatment is necessary for successful management of these cases.

Keywords: Epidemiology, osteoarticular tuberculosis, tuberculosis

Brunei Int Med J. 2010; 6 (1): 34-40