SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH 770 Vol 40 No. 4 July 2009 Correspondence: Prof Mir Sadat-Ali, PO Box 40071, King Fahd University Hospital, AlKhobar 31952, Saudi Arabia. E-mail: drsadat@hotmail.com OSTEOARTICULAR TUBERCULOSIS: HOW OFTEN IS IT MISSED? Huda A Bukharie 1 , Abdullah M Al-Rubaish 1 , Alhussain Al-Zahrani 2 and Mir Sadat-Ali 3 1 Department of Internal Medicine, 2 Department of Microbiolgy, 3 Department of Orthopedic Surgery, College of Medicine, King Faisal University, Dammam and King Fahd Hospital of the University, AlKhobar, Saudi Arabia Abstract. This study was carried out to analyze the clinical presentations and out- comes of osteoarticular tuberculosis (OAT) at a university hospital in AlKhobar, Saudi Arabia. A prospective observational study was carried out between 1 January 1998 and 31 December 2007. Patients demographic characteristics were recorded, includ- ing age, gender, nationality, clinical manifestation, delay in diagnosis, laboratory re- sults, findings on imaging studies, histological and bacteriological studies of biopsy specimens, treatment modalities, surgical interventions and final outcomes. Fifty-two patients were diagnosed with OAT during the study period. The majority were males (64%), about half were below age 30 years. The mean age at diagnosis was 33 years. There were 32 Saudis (64%), and 18 non-Saudis (36%). Pyrexia, loss of appetite and night sweats were the presenting symptoms in 44, 38 and 36%, respectively. The aver- age time from onset of symptoms to diagnosis was 185 days (7-730 days). On admis- sion, the average erythrocyte sedimentation rate (ESR) was 68 mm/ h (4-142). A Man- toux test was performed, in 48 patients the results were positive. The vertebral col- umn was the site of infection in 88% of patients. All patients were managed with stan- dard antituberculous therapy. Forty-two patients (84%) had a favorable outcome. INTRODUCTION Tuberculosis (TB) is a major global pub- lic health problem leading to morbidity and mortality (Dye et al, 1999). Pulmonary tuber- culosis is the most common form of the dis- ease and spreads easily among close con- tacts. However, extrapulmonary organs may be infected. Osteoarticular tuberculosis (OAT) represents between 3 and 5% of all cases of tuberculosis, and between 10 and 15% of extrapulmonary cases (Meier, 1994). Primary OAT has been reported to occur without a history of contacts with TB pa- tients (Vergara-Amador, 2007). OAT can lead to disablility with secondary arthritis, paraplegia and quadriplegia if the diagno- sis is not made early and treated appropri- ately (Resnick and Niwayama, 1988; Zevallos and Justman, 2003). The diagnosis is often delayed due to a low degree of sus- picion regarding the disease and the insidi- ous nature of the clinical and radiological presentations (Ellis et al, 1993; Al-Saleh et al, 1998; Batra et al, 2007). We report here the presentation of OAT cases during the past decade at our teach- ing hospital, the length of delay in diagno- sis and the procedures involved in the diag- nosis and the outcomes.