Management of Musculoskeletal Tuberculosis in Enugu, Nigeria

Abstract

Introduction: Tuberculosis (TB) remains the most common cause of death from infectious disease worldwide. Musculoskeletal TB accounts for about 10-15% of all TB notification in non-industrialized world. The spine is the most common site for osseous involvement, accounting for about 50% of cases. There is little or no data on the epidemiology of musculoskeletal TB in South-Eastern Nigeria. The general aim of the study is to determine the epidemiologic pattern and treatment outcome of musculoskeletal TB in Enugu, south-Eastern Nigeria. Materials and Methods: The study is a retrospective study over a ten year period. The case notes of all the patients diagnosed and treated for musculoskeletal TB were retrieved and those who met the inclusion criteria were analyzed. Results: A total of 104 patients’ case notes were retrieved but 97 patients’ case notes that met the inclusion criteria was analyzed. The incidence of musculoskeletal tuberculosis in Enugu is 1 in 250. 45.4% were males and 54.6% were females. Most of the patients presented with low back pain (61%) and inability to walk (14.4%). Spinal lesions account for 65% of cases. 86.6% of the patients had relative lymphocytosis while Mantoux test was positive in 82.5% of subjects. 82.5% had elevated ESR at diagnosis. These fell significantly at completion of anti TB drugs with 83% resulting in either complete resolution of symptoms or marked improvement of symptoms. Drugs were given for 8 months in 95% while 5% were extended for 12 months. Conclusion: Use of anti TB drugs is still the cornerstone in the management of the disease. Diagnosis is possible with simple clinical, radiological and laboratory evaluation. Once diagnosis is made patient should be immediately commenced on the first line anti TB drugs. ESR, lymphocyte count and clinical evaluation of symptoms can be used to monitor treatment successfully. We recommend high index of suspicion among physicians in developing countries for prompt diagnosis and adequate treatment of musculoskeletal TB especially that of the spine.