ORIGINAL ARTICLES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2004 December;163(6):265-71

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Changes in the epidemiology of tuberculosis in Serbia and Montenegro during the last decade of the 20th century

Lesic A. ¹, Bumbasirevic M. ¹, Cobeljic G. ², Bajin Z. ²

¹ Department of Orthopaedic Surgery and Traumatology, University Clinical Centre, Belgrade; ² Special Orthopaedic Hospital “Banjica”, Belgrade

Aim. The goal of this study is to estimate the trends of tuberculosis (TB) and skeletal tuberculosis in Serbia and Montenegro (former Yugoslavia) during the period 1990-2000.
Methods: According to the medical records of bone TB cases from the 2 main Belgrade orthopaedic hospitals, the age, gender and localization of the TB process in the skeletal system, as well as the treatment method and outcome were analyzed.
Results. Of 594 patients with osteoarticular forms of tuberculosis we found a female predominance (55% in female vs 45% in male). The distribution of patients by age has shown that the highest number of patients belonged to the elderly group (60 or more 54.1%) while in the young age group (up to 19) it was 18% of patients. The spinal localization of bone TB was most frequent: in 49% of cases, most of them without neural damage (36% of 49%). It was followed by cases with TB localizations on the hip (15.5%), sacroiliac joint (9.9%) and knee involvement (6.1%). Other localizations were noted in 19.5% of cases. Seventy-five percent of the cases were only treated with chemotherapy, an additional 25% of cases needed some kind of surgery, mostly decompression and stabilization of the spine.
Conclusion: Even in the highly developed countries physicians must bear in mind the possibility of encountering patients with bone and joint TB. Beside numerous patients with rheumatoid arthritis or other arthropathies, especially in the immigrant group of patients or immunodeficient patients, bone TB is most likely present. The combined diagnostic methods (bacteriology, microbiology culture, histology, radiology) are preferable in establishing the diagnosis. The therapy with a combination of antituberculotic drugs (multiple anti-TB drugs) which follow the recommendations of the International group for TB is the best choice, especially in undeveloped countries, or countries in transition. DOTS strategy: directly observed, short course treatment is advisable. Surgery is reserved for complicated and well defined cases (spine compression and destroyed joints). Screening by fluoroscopy and prophylaxis with BCG vaccination is still advisable in such countries.