External tuberculosis pathology

2021-01-30 12:00 AM

From the damage of spongy tissue, there are small tuberculosis particles in the covering cartilage, then the bone tissue becomes soft and spread very far without clear limits, the shell is thin.

Outline

Osteoarthritis is a chronic, secondary infection of the joints that is transmitted by the bloodstream.

Bone tuberculosis, like osteomyelitis, is more likely to hurt young people, but unlike osteitis, the damage to TB usually begins in the spongy bone and then spreads around it.

Common locations are TB vertebrae 60%, hip joint 15-20%, knee joint 10-15% later to other joints. The location of the hard bone is often found in the knuckles of the hands and feet.

According to Ledoux - Lebard does not have TB imaging at the fracture because the accumulation of the body hinders tuberculosis progression.

The first lesion is a tuberculosis, but usually very small and growing, so although there are clinical signs but no change on the radiograph in the early stage (usually apparent after months or years).

Unlike osteomyelitis, there is a process of stimulating new bone formation, bone tuberculosis only destroys and causes bone resorption and bone death.

Pathology

Localized

Spongy bone tissue fades out at first and is more likely to become pus or fibrosis (less), tuberculosis contains pus and dead bones.

Can spread

From the spongy tissue lesions there are small tuberculosis particles in the cartilage, then the bone tissue becomes soft and spread far and wide without clear limits, the shell is thin, these cold abscesses can come from below the perineal Gradually encroach on the surrounding software.

Although the tuberculosis is located, the bacillus persists and an outbreak of infection can occur at any time. Most tuberculosis foci start at a bone point in the spongy tissue and then spread throughout the joint and destroy the joint surface, in some cases from the capsule to the joint or from the joint cartilage and gradually destroy the joint surface.

Clinical symptoms

Usually progresses through 3 phases.

Initial stage (intrusion)

There are no typical clinical symptoms, affecting the overall status of eating less, weight loss, insomnia

Body fatigue or pain in the joints or vague pain in atypical more distant locations.

In place:

Press in the painful joint.

Painful joint movement.

Joints thicken to the touch.

Muscle atrophy around the joint.

The nodule corresponds to the circular tuberculosis zone, moving painlessly.

Bone radiographs can show:

Photos of osteoporosis.

The joint is blurred or rough.

Narrow joint joints.

Other subclinical diagnosis

IDR, NCD, X-ray of the lungs.

UIV, urine test.

Joint puncture for fluid culture and direct examination.

Bursary biopsy

Full-play stage (demolition phase)

Full of typical symptoms with swelling, pale, strong atrophy of the muscles around the joint.

Examples: Gigot de mouton in pulmonary tuberculosis, rhombic joint in knee tuberculosis.

Limited joint movement, very painful pressure and movement

Clear, sticky, painful to press.

There is an abscess - a cold car spreads away.

X-ray: Osteoporosis, narrow joints, rough or defect joints, obtuse bones, no bone formation reaction.

When leaky TB image is difficult to distinguish from osteomyelitis.

Possible hip dislocation, bone deformity, pathological fracture.

Stable (regenerating) phase but not cured

Symptoms subside.

Eat and sleep, gain weight.

Pain relief in place, if there are complications of deformation left, it cannot go away (eg paralysis, fistula ...).

X-ray: Clear bones, osteoporosis, bone regeneration cannot restore the joint face as well as complications of stiffness joints.

Therefore, it is necessary to diagnose early in the early stages before TB treatment can hopefully recover.

Tuberculosis progression often causes leakage and superinfection, in many cases the disease has recovered clinically and radiographically, but then it recurs because pus contains tuberculosis bacteria.

The principles of treatment

Needs systemic and local treatment

Systemic treatment

Improve fitness.

Anti-TB drugs: Need to use continuously and for enough time and in combination with many drugs.

Always:

INH 5mg / kg / day for adults; 10mg / kg / day for children.

Rifamycin 10mg / kg / day for adults; 15mg / kg / day for children.

Ethambutol 15mg / kg / day.

Drink once in the morning 30 minutes before eating for 18 months. Check liver function, eye nerve to prevent drug complications.

PAS, Streptomycin can be used.

Local treatment

Immobilization in the TB zone is a key way to avoid mechanical stimulation and help the body fight infection smoothly. In cases where the bone has been destroyed, it is necessary to immobilize longer enough to stick the joint.

Parallel to medical treatment, it is necessary to remove the tuberculosis nest because it is impossible to be sure that there will be no recurrence, and at the same time breaking the barrier to help anti-TB drugs work, need surgery after 3-4 weeks of medical treatment.

It is possible to incise drainage - cold car when using the medicine for medical treatment.

When there are complications (paralysis, scoliosis ...) need surgery.

Preventive

Educate the community to grassroots health facilities for proper treatment of tuberculosis: tuberculosis, bone tuberculosis ...

Propaganda against tuberculosis in the community.

Early treatment of skin infections.

Early detection of symptoms of osteitis.