title: Characteristics and Clinical Outcome of Bone and Joint Tuberculosis From 1994 to 2011: A Retrospective Register-based Study in Denmark.
abstract: BACKGROUND
  Most information on bone-joint (BJ)-tuberculosis is based on data from high-incidence areas. We conducted a nationwide register-based analysis of BJ-tuberculosis in Denmark from 1994 to 2011.
  
  
  METHODS
  We linked data from the national tuberculosis surveillance system on BJ-tuberculosis, hospital records, the Danish Hospital and Civil Registration System.
  
  
  RESULTS
  We identified 282 patients with BJ-tuberculosis, 3.6% of all tuberculosis cases (n = 7936). Spinal tuberculosis was found in 153 of 282 patients (54.3%); 83.3% of all cases were immigrants. Danes were older and had higher Charlson comorbidity index scores than immigrants (P < .01). C-reactive protein and erythrocyte sedimentation rates were elevated in most cases. Median time to diagnosis after first hospital contact was 19.5 days for spinal tuberculosis and 28 days for other forms of BJ-tuberculosis (P = .01). Of patients with spinal tuberculosis, 54/133 (40.6%) had neurologic deficits at admission and 17.3% presented with cauda equina. Diagnosis was culture verified in 87%. (Resistance to any drug was found in 10.2%). Median time on antituberculous treatment for patients with spinal and other forms of BJ-tuberculosis was 9 months and 7 months, respectively (P < .01). Surgery was required in 44.4% patients with spinal tuberculosis and in 32.6% patients with other forms of BJ-tuberculosis (P = .04). Sequelae were reported in 57.5% of patients with spinal tuberculosis and 29.1% of patient with other forms of BJ-tuberculosis (P < .01). One-year mortality was 25.5% among Danes compared with 1.3% among immigrants (P < .01).
  
  
  CONCLUSIONS
  BJ-tuberculosis was rare and seen mainly in younger immigrants in Denmark. More than half of cases were spinal tuberculosis, presenting with more severe symptoms and worse outcome, compared with other forms of BJ-tuberculosis.
authors.affiliation: Department of Infectious Diseases, Odense University Hospital.
authors.forename: Isik S
authors.initials: IS
authors.lastname: Johansen
authors.affiliation: Department of Infectious Diseases, Odense University Hospital.
authors.forename: Stig L
authors.initials: SL
authors.lastname: Nielsen
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet.
authors.forename: Malene
authors.initials: M
authors.lastname: Hove
authors.affiliation: Department of Infectious Diseases, Odense University Hospital.
authors.forename: Michala
authors.initials: M
authors.lastname: Kehrer
authors.affiliation: Department of Infectious Diseases.
authors.forename: Shakil
authors.initials: S
authors.lastname: Shakar
authors.affiliation: Institute of Pathology, Aalborg University Hospital.
authors.forename: Arne V T
authors.initials: AV
authors.lastname: Wøyen
authors.affiliation: Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Andersen
authors.affiliation: Department of Infectious Diseases, Odense University Hospital Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bjerrum
authors.affiliation: Department of Infectious Diseases GloHAU, Center for Global Health, Department of Public Health, Aarhus University Hospital, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Wejse
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet.
authors.forename: Åse B
authors.initials: ÅB
authors.lastname: Andersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D003646:Debridement; D003718:Denmark / Q000453:epidemiology; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D014399:Tuberculosis, Spinal / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Pott disease; epidemiology; spinal tuberculosis; tuberculous osteomyelitis