Tuberculous dactylitis explained

Tuberculous dactylitis
Field:infectious disease

Tuberculous dactylitis, also known as spina ventosa,[1] is a skeletal manifestation of tuberculosis, one of the commonest forms of bacterial osteitis. It affects children more often than adults.[2] The first radiological description of the condition is credited to Feilchenfeld in 1896; however, the first histological description was given by Rankin in 1886.[3] The Swedish botanist and physician Carl von Linne was the first to mention the condition by the name spina ventosa (lit. inflated bone).[4]

Multiple bones are involved in children and usually only a single bone is involved in adults suffering from tuberculous dactylitis. Tuberculous dactylitis affects the short tubular bones of the hands and feet in children. It often follows a mild course without fever and acute inflammatory signs as opposed to acute osteomyelitis. There may be a gap of a few months to 2 to 3 years from the time of initial infection to the point of diagnosis.[5] [6] [7]

Nearly 85% of patients with spina ventosa are below 6 years of age. The bones of hands are more commonly involved than those of the feet. The proximal phalanx of the index and middle fingers are the commonest sites of involvement. Up to nearly 7% of children with pulmonary tuberculosis may develop this condition.[8] Spread to the skeletal system is believed to occur via blood and lymphatics.[9]

Pathogenesis

In the pediatric age group, the marrow in the phalangeal bones are still active, a conducive place for the tuberculous bacilli to multiply. Slowly, the whole marrow space gets involved and this underlying granulomatous disease leads to expansion of the overlying soft cortex. Finally there is a fusiform dilation of the bone, with thinned out cortex and destruction of the marrow space leading to a balloon like shape; this cystic expansion of the bone is termed as spina ventosa.[10]

Diagnosis

The diagnosis of the condition is made on the basis of histological and bacteriological studies. Tuberculosis dactylitis may be confused with conditions like osteomyelitis, gout, sarcoidosis and tumors.[11] [12]

Treatment

Spina ventosa is mainly treated conservatively. Most patients respond to anti tuberculosis treatment. The regimen consists of initial two months' intensive therapy with isoniazid, rifampicin, ethambutol and pyrazinamide followed by a six to twelve month course of isoniazid and rifampicin.[13] [14] Almost all the patients respond to medical therapy. Surgery is limited in curetting the bone cavities to promote early healing in cystic tuberculosis.

Notes and References

  1. Book: 1995. Springer-Verla. London. 99. 10.1007/978-1-4471-3011-6_6. Imaging of Skeletal Tuberculosis. Childhood Tuberculosis: Modern Imaging and Clinical Concepts. Cremin. B. J.. Jamieson. D. H.. 978-1-4471-3013-0. Reviewed in 1511729. 1996. Cant. A. J.. Childhood Tuberculosis. Modern Imaging and Clinical Concepts. Archives of Disease in Childhood. 75. 4. 359. 10.1136/adc.75.4.359-a.
  2. 10.1007/s00330-002-1609-6. 12942283. Imaging features of musculoskeletal tuberculosis. European Radiology. 13. 8. 1809–19. 2003. Vuyst. Dimitri De. Vanhoenacker. Filip. Gielen. Jan. Bernaerts. Anja. Schepper. Arthur M. De. 13465651.
  3. Pearlman. H. S.. Warren. R. F.. Tuberculous dactylitis. American Journal of Surgery. 1961. 101. 6. 769–71. 10.1016/0002-9610(61)90724-3. 13733764.
  4. Book: Linnaeus, Carl. Västgöta resa år 1746. Wahlström & widstrand. 1978. 91-46-13190-6. Stockholm. 131.
  5. Subasi. M. Bukte. Y. Kapukaya. A. Gurkan. F. Tuberculosis of the metacarpals and phalanges of the hand. Annals of Plastic Surgery. 2004. 53. 5. 469–72. 10.1097/01.sap.0000130708.80606.6a. 15502464. 35203922.
  6. Book: Coombs. R. Fitzgerald. FH. Infection in the orthopaedic patient. 1989. Butterworth & Co Ltd. Great Britain. 297–8. 978-0-407-01316-2.
  7. Al-Qattan. MM. Bowen. V. Manteo. RT. Tuberculosis of the hand. Journal of Hand Surgery (Edinburgh, Scotland). 1994. 19. 2. 234–7. 10.1016/0266-7681(94)90175-9. 8014559. 39092144.
  8. Salimpour. R.. Salimpour. P.. Picture of the month. Tuberculous dactylitis. Archives of Pediatrics & Adolescent Medicine. 1997. 151. 8. 851–2. 9265892. 10.1001/archpedi.1997.02170450101018.
  9. Zoga. A. Lee. V. W.. Paediatric case of the day. Tuberculosis dactylitis and primary pulmonary tuberculosis. American Journal of Roentgenology. 1999. 173. 3. 813, 815–7. 10470936. 10.2214/ajr.173.3.10470936. free.
  10. Bhaskar. Tashi. Konglah. Bareh. Jerryson. Tuberculous dactylitis (spina ventosa) with concomitant ipsilateral axillary scrofuloderma in an immunocompetent child: A rare presentation of skeletal tuberculosis. Advanced Biomedical Research. 2013. 2. 29. 1 . 10.4103/2277-9175.107993. 23977657. 3748632 . free .
  11. TB or not TB: an unusual sore finger. Emergency Medicine Journal. 2001. 18. 6. 490–1. 10.1136/emj.18.6.490. 11696511. 1725720. Sunderamoorthy. D. Gupta. V. Bleetman. A.
  12. Jensen. CM. Jensen. CH. Paerregaard. A. A diagnostic problem in tuberculous dactylitis. Journal of Hand Surgery (Edinburgh, Scotland). 1991. 16. 2. 202–3. 10.1016/0266-7681(91)90177-P. 2061665. 10289363.
  13. Sequeira . W. . Co . H. . Block . J. A. . November 2000 . Osteoarticular tuberculosis: current diagnosis and treatment . American Journal of Therapeutics . 7 . 6 . 393–398 . 10.1097/00045391-200007060-00009 . 1075-2765 . 11304648.
  14. Nguyen Ngoc . Sang . Nguyen Thai . Ha . Vu Van . Quang . Vu Tung . Lam . Nguyen Ngoc . Rang . Nguyen Van . Hung . 2021-07-05 . Late Discovering Spina Ventosa: A Case Report . International Medical Case Reports Journal . 14 . 449–453 . 10.2147/IMCRJ.S318003 . 1179-142X . 8273899 . 34262359 . free .

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