1403. Tuberculous sacroiliitis: Clinical and Imaging Characteristics

Background Osteoarticular tuberculosis remains a common disease among which the spine is the most affected site. Less frequently, sacroiliac joint is involved. Its diagnosis is often delayed due to misleading and varied symptoms. The aim of this work was to study the clinical features and the contribution of imaging results in the diagnosis of tuberculous sacroiliitis. Methods We conducted a retrospective study including all patients hospitalized in the infectious disease department for tuberculous sacroiliitis. The diagnosis was based on clinical, laboratory and radiological features. Results In total, we encountered 12 women with a median age of 51 [39-63] years. Three patients had a family history of tuberculosis (25%). The median diagnostic delay was 155 [48-331] days. The revealing symptoms were lower back pain (75%) and hip pain (25%) associated with fever (83.3%) and weight loss (75%). Reduced mobility was noted in 3 cases (25%). Pulmonary tuberculosis and tuberculous spondylodiscitis were associated with tuberculous sacroiliitis in 5 cases (41.7%) and 4 cases (33.3%), respectively. Tuberculin skin test was positive in 6 cases (50%). Laboratory investigations revealed elevated C-reactive protein levels in 11 cases (91.6%) and accelerated erythrocyte sedimentation rates in 9 cases (75%). Needle biopsy of the sacroiliac joint (41.7%) and soft tissues abscess puncture (16.6%) were performed. Computed tomography scan revealed joint space widening (83.3%), peripheral joint erosions (83.3%) and osteolysis (58.3%). Soft tissue abscesses were noted in 66.7% of the cases. Magnetic resonance imaging was performed in 4 cases (33.3%). Sacroiliac joint was hypointense in T1-weighted images (75%), hyperintense in T2 weighted images (50%) and in STIR images (50%). Bone scintigraphy, performed in 5 cases, revealed hyperfixation of the sacroiliac area (100%). All patients received antitubercular therapy. Percutaneous abscess drainage was indicated in 4 cases (33.3%). Conclusion Because of its deep localization, the diagnosis of tuberculous sacroiliitis is mainly based on imaging results associated with epidemiological, clinical and laboratory features. Antitubercular therapy initiated promptly leads to recovery. Disclosures All Authors: No reported disclosures

246. Particularities of Non-axial Osteoarticular Tuberculosis Among Adults

Background Osteoarticular tuberculosis (TB) represents 1% to 3% of all TB cases, among which spondylodiscitis is the most common presentation of the disease. Non-axial TB is less frequent. We aimed to study the clinical, therapeutic and evolutionary features of non-axial osteoarticular TB. Methods We conducted a retrospective study including all patients hospitalized in the infectious diseases department for non-axial osteoarticular TB between 1999 and 2019. Results We encountered 51 cases, among which 26 cases were males (51%). The mean age was 41±20years. Ten patients were previously treated for TB (19.6%). The revealing symptoms were fever (70.5%), asthenia (68.6%), weight loss (60.7%) and night sweets (43.1%). Arthritis was noted in 20 cases (39.2%) represented by TB of the hip (10 cases), knee (4 cases), shoulder (4 cases) and elbow (2 cases). There were 12 cases of sacroiliac osteoarthritis (23.5%) and 6 cases of femur osteomyelitis (11.7%). Other affected sites included sternum (7.8%), toe (5.9%), tibia (5.9%), mandible (2%), clavicle (2%) and mastoid bone (2%). Multifocal TB was noted in 12 cases (23.5%). Pulmonary TB was associated to osteoarticular TB in 13.7% of cases. The mean duration of antitubercular therapy was 10±5months. Fixed dose combinations were prescribed in 17.6% of the cases. The disease evolution was favorable in 47 cases (92.1%). Relapse was noted in 3 cases (5.8%) and death in one case (2%). Conclusion Non-axial osteoarticular TB was not a rare disease. Multiple sites might be involved which facilitate the diagnosis confirmation. Prolonged antitubercular therapy might be required. Disclosures All Authors: No reported disclosures

Conference of the Urals and the Volga region on osteoarticular tuberculosis

The conference was opened with a number of organizational reports on the fight against osteoarticular tuberculosis by employees of the Sverdlovsk Institute of Tuberculosis.

A modern approach to the diagnosis of tuberculous spondylitis (literature review)

Objective — provide a systematic analysis of the scientific literature on the current state of diagnosis of patients with tuberculous spondylitis (TS), and identify prospects for improving the diagnosis of this disease. Materials and methods. To carry out this work, we analyzed 118 literature sources from the Pub Med database on the records of Diagnosis of extrapulmonary tuberculosis. Diagnosis of tuberculous spondylitis, and 26 of them tacked for detailed study. Results and discussion. It was found that TS is the most severe clinical form of osteoarticular tuberculosis (OATB), which is a serious medical and social problem. The percentage of diagnostic errors in TS is very high and its level in recent decades has a clear tendency to increase. The diagnostic pause in this disease usually lasts at least three months. Clinico-radiological examinations are the most accessible and widely used in the world, being the basis for the diagnosis of OATB. From the standpoint of evidence-based medicine, a verified (proven) diagnosis of OATB should be based on data from bacteriological and histological examination of pathological material. Quite often the course of the TS is accompanied by the phenomena of pathomorphosis, which significantly complicates the differential diagnosis. In scientific publications, insufficient attention is paid to the issue of etiological diagnosis of the disease, but traditional methods of clinical and radiological studies have a significant percentage of diagnostic errors. Conclusions. Diagnosis of TS in modern conditions in the vast majority of cases occurs at a later stage (in the advanced form), which causes significant difficulties in the treatment this category of patients.It is important to improve the methods of etiological diagnosis of TS with the following studies sensitivity of the pathogen to antibacterial drugs, which is one of the main conditions for successful treatment.

Diagnosis of osteoarticular tuberculosis: multi-targeted loop-mediated isothermal amplification assay versus multiplex-PCR

Aim: Diagnosis of osteoarticular tuberculosis (OATB) is quite challenging and there is an urgent need to design a prompt and precise diagnostic test. Methods: We developed a multi-targeted loop-mediated isothermal amplification (LAMP) assay using mpt64 (Rv1980c) and pstS1 (Rv0934) targets for the detection of Mycobacterium tuberculosis in OATB patients. Results: The sensitivities of 100 and 82.4% were obtained in confirmed (n = 10) and suspected (n = 57) OATB cases, respectively by multi-targeted LAMP with a specificity of 96.9% (n = 33). Moreover, the sensitivities attained by multi-targeted LAMP in total OATB cases were significantly higher (p < 0.05–0.01) than multiplex-PCR ( mpt64 + pstS1) and GeneXpert assay. Conclusion: Our LAMP is simple, reliable and cost-effective method, which may develop into an attractive diagnostic kit for early detection of OATB cases.

A 20-year retrospective study of osteoarticular tuberculosis in a pediatric third level referral center

Purpose The objective of the present study is to describe the clinical, diagnostic, radiological and therapeutic aspects of osteoarticular tuberculosis (OATB) in patients in a tertiary pediatric hospital, to know if the diagnosis of OATB in pediatrics is a challenge due to its insidious clinical presentation. Methods A retrospective, descriptive study of the cases of Tuberculosis (TB) in children was carried out. A total of 159 cases met the condition for the analysis. Results The most frequent TB modality was extrapulmonary in 85%. Out of this, only 29% was OATB. The mean age was 4.9 years (range 8 months–16 years). Eighty-six per cent of cases received Bacille Calmette-Guérin (BCG) vaccination at birth. Median time of symptoms prior to diagnosis was 8 months. Microbiological confirmation was achieved only in five cases, with a high sensitivity to the antimicrobial treatment. Mycobacterium bovis BCG strain Tokio 172 was confirmed in three cases. Mortality rate was 0% during the time of study Conclusion Our study describes the epidemiological characteristics of OATB cases in Mexican children. This data revealed a high prevalence of bone and joint TB infection. Pediatric OATB should be considered in cases with lytic bone lesions, fever and local pain. In countries with BCG immunization program, M. bovis should not be forgotten as an etiological agent. The low detection rate with one technique approach highlights the urgent need for more sensitive test to diagnose OATB in children.