Tuberculosis of bones - Causes, symptoms and treatment. MF.

Bone tuberculosis is the most common form of tuberculosis after pulmonary tuberculosis. The disease can occur at any age, but more often affects adults. Tuberculosis occurs in various departments of the musculoskeletal system, but, as a rule, most often the pathological process develops in the spine.

Causes of bone tuberculosis

The development of the disease contributes to increased physical stress, trauma, recurring diseases, including infectious, hypothermia, unfavorable living and working conditions.

Prior contact with a patient with tuberculosis is crucial. The disease occurs when infecting the infection - mycobacterium tuberculosis from the tuberculosis focus in the lungs through the blood and lymph vessels in the bone. Therefore, in the risk zone are the bone structures that have a good blood supply, such as the humerus, femur, vertebral bodies, the shins of the lower leg and the forearm.

When multiplication of mycobacteria, specific tubercles-granulomas are formed, which then undergo destruction. When the granuloma grows, bone substance dissolves, abscesses are formed( cavity filled with pus), fistulas( absent in normal joint between bone and external environment, having inflammatory origin), sequestration( the detached part of the necrotic bone).

With tuberculosis of the spine, the disease begins, as a rule, in one vertebra. In the process of development of granuloma, the bone mass of the vertebra is destroyed, the inflammatory process passes to neighboring sites. The spine is deformed. When the thoracic spine is affected, often due to compression of the spinal cord, paresis and paralysis are formed.

Possible symptoms of bone tuberculosis

In , the onset of disease, the characteristic manifestations of tuberculosis may be weak or nonexistent. Patients are concerned about a moderate increase in temperature to 37 ° C, rarely higher. Children become sluggish, drowsy, adults complain of a pronounced general weakness, irritability, pulling, aching muscles, reduced performance. In some patients, after physical exertion or by the end of the day, there are weak pains in the spine area without a clear location. After rest they completely pass.

Thus, at the onset of the disease, all manifestations are nonspecific, so most patients do not seek medical help, explaining these symptoms with banal fatigue.

You must remember the following rule. If the pain does not go away after taking anti-inflammatory or analgesic drugs, or the effect of the medication is insufficient or short-lived, then such pains are a sign of a serious illness that you yourself most likely will not be able to cope with.

When the tuberculosis process goes beyond the vertebrae( in case of spinal tuberculosis), the second phase of the spinal cord begins. Weakness, lethargy, shattering intensify, high body temperature persists. However, there are severe pains in this or that part of the spine. Because of the pain, the patient tries to move less, forming a violation of gait and posture. At rest, the intensity of pain either decreases, or they completely disappear. The muscles located along the spine are constantly in a tonus, bulging, painful when feeling.

In , the third phase of tuberculosis of the spine, the inflammatory process passes to the adjacent vertebrae. The general condition of patients is severe. They significantly lose weight, body temperature rises to 39-40 degrees, there is a pronounced general weakness. The pains in the spine are intense, often intolerable, at rest their intensity somewhat decreases. Due to constant stay in tone, the muscles along the spine atrophy, movements in the spine are greatly hampered or impossible.
After the treatment, patients remain deformed in the spine, atrophy of the back muscles, and limited mobility.

Deformation of the spine with bone tuberculosis

Sandro Botticelli "The Birth of Venus", detail, XV century. It is known that the model with which Venus was written died at the age of 22 from tuberculosis. In the picture, the sharply lowered left shoulder attracts attention. It can be assumed that the girl has a tuberculosis of the spine or shoulder joint.

Some patients have complaints of a sense of instability in the spine, pain in the area of ​​the affected vertebrae.

The development of tuberculosis of the bones of the upper and lower extremities of the passes through the same stages as the spinal tuberculosis. Inflammation is accompanied by pain, redness of the skin and development of an edema over the area of ​​the lesion. Due to the destruction of the bone, deformity of the limb, gait disturbance, up to lameness, decrease in ability to work.

Diagnosis of bone tuberculosis

All patients with suspected bone tuberculosis perform radiography or tomography of the affected organ in two projections. At the same time, foci of bone destruction, sequestration, and sometimes shadows from infiltrated abscesses are determined.

Radiography of the lumbar spine. The red circle shows typical bone damage in spinal tuberculosis.

In the presence of abscesses or fistulas, fistulography or abscessography is performed to determine their extent. The cavity of the abscess or fistulous course is filled with contrast medium, then a series of pictures is performed. Very important for the diagnosis is the microbiological examination of the areas of the dead bone, the contents of the abscess or the fistulous course. In favor of tuberculosis of bones, the detection of mycobacteria of tuberculosis says. The blood test identifies all the signs of infectious inflammation: an increase in the number of leukocytes, accelerated ESR, the appearance of a C-reactive protein, etc. To confirm the diagnosis, provocative tuberculin samples are also used.
Given the secondary nature of the disease, when suspected of tuberculosis of the bones, it is always necessary to perform chest radiography, and in the presence of specific complaints, to conduct a survey of other organs.

Treatment of tuberculosis of bones

Treatment for bone tuberculosis should be aimed at the prompt elimination of infection, prevention of bone destruction, as well as performing non-specific restorative treatment.

Diet for bone tuberculosis

In the active phase of inflammation in patients with tuberculosis, increased protein breakdown is observed. Therefore, for an early cure, it is necessary to increase the consumption of foods rich in protein. The amount of food consumed should be increased by 1/3.The daily calorific value during the period of active inflammation averages 3100-3500 kcal per day. At the same time, over-nutrition leads to overloading the body with unnecessary carbohydrates, obesity, and therefore is unacceptable.

In a day, a patient with tuberculosis should consume an average of 100-120 g of protein. At high body temperature, protein intake is reduced to 70 g per day. Recommended: soups on meat or fish broth, meat in the form of cutlets, pâté, boiled fish, a variety of dishes from eggs.

With tuberculosis during the recovery period in the diet should be increased the content of milk and lactic acid products as a valuable source of calcium for the damaged bone. In inflammation, as well as during the treatment with antibiotics, it is recommended to consume a large amount of fresh fruits and vegetables, as well as medicines containing a complex of necessary vitamins.

Lifestyle in the treatment of bone tuberculosis

With an active inflammatory process, bed rest is recommended. In the process of recovery can be applied therapeutic exercise, massage. The patient must spend as much time as possible in the open air, solar baths have a good effect. As a rule, treatment and rehabilitation of such patients is carried out in specialized dispensaries and sanatoriums, where such a regime of day and rest is observed.

Medication and Surgical Treatment of Bone Tuberculosis

The most effective treatment for bone tuberculosis is the combination of antibiotic therapy and surgical methods. Antibiotic drugs are used before and after the operation. These drugs are rifampicin, isoniazid, pyrazinamide, ethambutol and others. As a rule, these medicines are used together, for a long time according to a certain scheme.

The amount of surgical intervention depends on the degree of bone destruction, as well as on the presence of abscesses, fistulas. Surgically, sequestrants are removed, the cavities of abscesses and fistulous passages are washed with solutions of antiseptics, antibiotics. Such cavities, with adequate treatment over time, are closed independently or liquidated by a surgeon.

Much more complex operations are performed in the late period of the disease with the development of gross anatomical disorders, significant defects. Such operations do not eliminate the disability of patients, but can significantly reduce its severity.

Rehabilitation after recovery should be phased. Its main task is to fully restore the function of the affected organ and return the patient to normal life. This applies therapeutic exercises, massage, physiotherapy methods of treatment, as well as various methods of professional and social rehabilitation.

Possible complications of bone tuberculosis

Possible complications of tuberculosis of bones are:
• curvature of the spine.

Pronounced curvature of the spine with bone tuberculosis

A hump is often formed at the site of lesions of the vertebrae. This is often combined with secondary deformation of the chest. In this case, compression of the thoracic organs is formed. When the spine is deformed, all patients develop more or less pronounced disorders of the nervous system, beginning with a slight increase in muscle tone or involuntary movements, ending with paresis and paralysis.

• abscesses with spinal tuberculosis are located next to the affected vertebrae. Can have a long extension. The only method of treatment is surgical.

• Fistulas occur when the inflammatory process is released to the surface of the skin. At present they are rare.

Forecast of development of bone tuberculosis

Currently, the death rate from bone tuberculosis is close to zero. But this disease is characterized by a very severe course with the development of irreversible deformities of the bones, which leads to permanent disability. It is established that patients become disabled in half of cases of spinal tuberculosis. The treatment is long, many drugs are toxic, but only timely treatment for medical help and strict adherence to medical prescriptions will help prevent irreversible changes.

Prevention of bone tuberculosis

Common preventive measures include actions aimed at reducing the likelihood of meeting with patients with tuberculosis, as well as preventing hypothermia, injuries, intoxications.

It is recommended that children and adolescents not refuse to conduct routine tuberculin tests, as this can help in the detection of latent forms of the disease. Seeking medical help in the event of pain in the bones, muscles helps to recognize the disease in the early stages and effective treatment.

Doctor therapist Sirotkina EV