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Evaluation of adequacy of short-course chemotherapy for extraspinal osteoarticular tuberculosis using 99mTc ciprofloxacin scan

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Abstract

In the evidence-based medicine era, objective treatment guidelines have been laid down for pulmonary tuberculosis, but the same is not true for osteoarticular tuberculosis. This has led to demands for standardising the treatment protocol and to a lack of consensus between doctors regarding the composition and duration of treatment. Twenty-five patients with extraspinal osteoarticular tuberculosis were evaluated prospectively. Following the diagnosis, patients were given standard directly observed treatment short course (DOTS) regimen and were monitored for disease activity at zero, three and six months with the help of technetium-99m-labelled ciprofloxacin (99m Tc) scan. Tracer activity at the site was recorded and compared on sequential scans. Clinical and radiological profile of all the patients were also recorded at regular intervals and compared. All 25 cases had a positive 99mTc bone scan initially. Four patients (16%) converted to negative scans at three months, whereas the remaining 21 patients (84%) showed negative scans at six months. The end of six months therapy also coincided with resolution of clinical and radiological parameters in all cases. In conclusion, 99mTc scan is a promising tool for monitoring drug response in osteoarticular tuberculosis; however, due to the small sample size, studies with a large number of patients might be of help.

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References

  1. Dye C, Garnett GP, Sleeman K, Williams BG (1998) Prospects for worldwide tuberculosis control under the WHO DOTS strategy. Lancet 352:1886–1891

    Article  PubMed  CAS  Google Scholar 

  2. Nakajima H (1993) Tuberculosis a global emergency. World Health 46(4):3

    Google Scholar 

  3. Tuli SM (2004) Tuberculosis of the Skeletal System, (third ed); 3-4

  4. Masood S (1992) Diagnosis of tuberculosis of the bone and soft tissue by fine-needle aspiration biopsy. Diagn Cytopathol 8:451–455

    Article  PubMed  CAS  Google Scholar 

  5. World Health Organization: treatment of tuberculosis. Guidelines for national programs Ed 2, Geneva, World Health Organization 1997

  6. Glassroth J (2000) Clinical considerations in designing trials of vaccines for tuberculosis. Clin Infect Dis 30(Suppl 3):S229–S232

    Article  PubMed  Google Scholar 

  7. Mitchison DA, Ellard GA, Fox W (1999) Studies on the treatment of tuberculosis undertaken by the British Medical Research Council Tuberculosis Unit between 1946-86. Int J Tuberc Lung Dis 10:231–279

    Google Scholar 

  8. Balasubramanian R (1991) Fully intermittent six-month treatment regimen for pulmonary tuberculosis in south India. Ind J Tuberc 38:51–53

    Google Scholar 

  9. MRC Working Party on Tuberculosis of the Spine (1993) Controlled trial of short-course regimens of chemotherapy in the ambulatory treatment of spinal tuberculosis results at three years of a study in Korea twelfth report of the medical research council working party on tuberculosis of the spine. J Bone Joint Surg Br 75:240–248

    Google Scholar 

  10. MRC Working Party on Tuberculosis of the Spine (1999) Five-year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months’ duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spin. Int Orthop 23(2):73–81

    Article  Google Scholar 

  11. Ramachandran S, Clifton IJ, Collyns TA, Watson JP SB (2006) 6-month treatment for bone tuberculosis. Int J Tuberc Lung Dis 10(9):1063–1065

    Google Scholar 

  12. Yoon HJ, Song YG, Park WI, Choi JP, Chang KH, Kim JM (2004) Clinical manifestations and diagnosis of extrapulmonary tuberculosis. Yonsei Med J 45(3):453–461

    PubMed  Google Scholar 

  13. Martini M, Cuahes M (1988) Bone and joint tuberculosis: a review of 652 cases. Orthopedics 11:861–866

    PubMed  CAS  Google Scholar 

  14. Maekura R, Nakagawa M, Nakamura Y, Hiraga T, Yamamura Y, Ito M, Ueda E, Yano S, He H, Oka S et al (1993) Clinical evaluation of rapid serodiagnosis of pulmonary tuberculosis by ELISA with cord factor (trehalose-6,6'-dimycolate) as antigen purified from Mycobacterium tuberculosis. Am Rev Respir Dis 148:997–1001

    Article  PubMed  CAS  Google Scholar 

  15. Chiac P, Yen TSB, You JB, Maa JS, Fiss EH, Chang CH (1990) Detection and identification of Mycobacterium tuberculosis by DNA amplification. J Clin Microb 28:1877–1880

    Google Scholar 

  16. Noel AB, Lecossier D, Nassif X, Birgite G, Frebault VL, Hance AJ (1989) Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples. Lancet 2(8671):1069–1071

    Article  Google Scholar 

  17. Pandey V, Chawla K, Acharya K, Rao S, Rao S (2009) The role of polymerase chain reaction in the management of osteoarticular tuberculosis. Int Orthop 33(3):801–805

    Article  PubMed  Google Scholar 

  18. Soler R, Rodriguez E, Remuinan C, Santos M (2001) MRI of musculoskeletal extraspinal tuberculosis. J Computer Assisted Tomography 25(2):177–183

    Article  CAS  Google Scholar 

  19. Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper AM (2003) Imaging features of musculoskeletal tuberculosis. European Radiology.; 13:1809-1819

    Google Scholar 

  20. Britton KE, Vinjamuri S, Hall AV et al (1997) Clinical evaluation of technetium-99 m Infecton for the localization of bacterial infection. Eur J Nucl Med 24:553–556

    PubMed  CAS  Google Scholar 

  21. Hall AV, Solanki KK, Vinjamuri S, Britton KE, Das SS (1998) Evaluation of the efficacy of 99mTc-Infecton, a novel agent for detecting sites of infection. J Clin Pathol 51:215–219

    Article  PubMed  CAS  Google Scholar 

  22. Britton KE, Wareham DW, Das SS, Solanki KK, Amaral H, Bhatnagar A, Katamihardja AHS, Malamitsi J, Moustafa HM, Soroa VE, Sundram FX, Padhy AK (2002) Imaging bacterial infection with 99mTc-ciprofloxacin (Infecton). J Clin Path 55:817–823

    Article  PubMed  CAS  Google Scholar 

  23. Vinjamuri S, Hall AV, Solanki KK et al (1996) Comparison of 99mTc Infecton imaging with radiolabeled white-cell imaging in the evaluation of bacterial infection. Lancet 347:233–235

    Article  PubMed  CAS  Google Scholar 

  24. Easmon CSF, Crane JP, Browers A (1986) Effect of ciprofloxacin on intracellular organism in-vitro and in-vivo studies. J of Antimicrob Chemotherapy 18(suppl):46–48

    Google Scholar 

  25. Sharma R, Tewari KN, Bhatnagar A, Mondal A, Mishra AK, Singh AK, Chopra MK, Rawat H, Kashyap R, Tripathi RP (2007) Tc-99 m ciprofloxacin scans for detection of tubercular bone infection. Clin Nucl Med 32(5):367–370

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India

    Vikas Bhardwaj, Tarun Suri, Sumit Sural & Anil Dhal

  2. Department of Orthopaedics, University College of Medical Sciences, Dilshad Garden, Shahdara, Delhi, 110095, India

    Mayank Agrawal

  3. Department of Nuclear Medicine, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India

    Ravi Kashyap

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  1. Vikas Bhardwaj
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  2. Mayank Agrawal
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  3. Tarun Suri
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  4. Sumit Sural
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  5. Ravi Kashyap
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  6. Anil Dhal
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Correspondence to Mayank Agrawal.

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Bhardwaj, V., Agrawal, M., Suri, T. et al. Evaluation of adequacy of short-course chemotherapy for extraspinal osteoarticular tuberculosis using 99mTc ciprofloxacin scan. International Orthopaedics (SICOT) 35, 1869–1874 (2011). https://doi.org/10.1007/s00264-010-1162-x

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  • DOI: https://doi.org/10.1007/s00264-010-1162-x

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