Silber J S, Whitfield S B, Anbari K, Vergillio J, Gannon F, Fitzgerald R H
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA.
J Arthroplasty. 2000 Apr;15(3):392-7. doi: 10.1016/s0883-5403(00)90900-8.
Tuberculosis has re-emerged as an important problem in the United States. More than 10 million people presently are infected with Mycobacterium tuberculosis in the United States alone. The symptoms at first presentation of the disease have become more diverse. With extrapulmonary manifestations, such as musculoskeletal infections, as the sole presenting sign, it often can be difficult to determine the correct diagnosis early in the course of the disease. The presenting symptoms, physical signs, and radiographic findings of intra-articular tuberculosis can mimic those of other intra-articular diseases, such as rheumatoid arthritis, osteoarthritis, and avascular necrosis. In view of the nonspecific findings early in course of the disease, tubercular infection should be considered in the differential diagnosis when there is insidious articular destruction. Failure to consider tuberculosis can lead to devastating outcomes otherwise preventable with today's chemotherapies.
结核病在美国再度成为一个重要问题。仅在美国，目前就有超过1000万人感染结核分枝杆菌。该疾病初次出现时的症状已变得更加多样。对于肺外表现，如肌肉骨骼感染，作为唯一的表现体征，在疾病早期往往很难确定正确的诊断。关节内结核的症状表现、体征及影像学表现可与其他关节内疾病相似，如类风湿关节炎、骨关节炎和缺血性坏死。鉴于疾病早期表现不具特异性，当出现隐匿性关节破坏时，鉴别诊断中应考虑结核感染。不考虑结核病可能导致严重后果，而如今的化疗本可预防这些后果。
