Craig Andrew D, Asmar Samir, Whitaker Paul, Shaw David L, Saralaya Dinesh
Department of Trauma & Orthopaedics, Bradford Royal Infirmary, Bradford, UK.
Department of Infectious Diseases, Bradford Royal Infirmary, Bradford, UK.
Bone Jt Open. 2022 May;3(5):432-440. doi: 10.1302/2633-1462.35.BJO-2021-0200.R1.
Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford.
An observational study was conducted, using data from the Bradford Teaching Hospitals TB database of patients with a formal diagnosis of MSK TB between January 2005 and July 2017. Patient data included demographic data (including nationality/date of entry to the UK), disease focus, microbiology, and management strategies. Disease incidence was calculated using population data from the Office for National Statistics. Poisson confidence intervals were calculated to demonstrate the extent of statistical error. Disease incidence and nationality were also analyzed, and correlation sought, using the chi-squared test.
Between January 2005 and July 2017, 109 cases of MSK TB were diagnosed in Bradford. Mean incidence was 1.65 per 100,000 population, per calendar year (SD 0.75). A total of 38 cases required surgical intervention. Low rates of antimicrobial resistance were encountered. A low rate of loss to follow-up was observed (four patients; 3.7%). Overall, 94.5% of patients (n = 103) were successfully treated. 67% of patients (n = 73) reported their country of origin as either India, Pakistan, or Bangladesh. These ethnicities account for around 25% of the local population.
Bradford maintains a high prevalence of MSK TB infection relative to national data; the prevalence within the local immigrant population remains grossly disproportionate. Typical associated factors (HIV/hepatitis coinfection, drug resistance), have only modest prevalence in our dataset. However, local socioeconomic factors such as deprivation and poverty appear germane as suggested by global literature. We advocate a high degree of suspicion in treatment of atypical infection in any area with similar population factors to ensure timely diagnosis. Cite this article: 2022;3(5):432-440.
结核病是全球最大的传染性致死病因之一。自2011年以来，英国的结核病发病率持续下降，但布拉德福德的结核病发病率仍位居英国最高之列。本研究旨在通过分析布拉德福德这个人口极为多样化地区的常见就诊因素，来研究肌肉骨骼（MSK）结核的当地疾病负担。
开展了一项观察性研究，使用了布拉德福德教学医院结核病数据库中2005年1月至2017年7月期间正式诊断为MSK结核的患者数据。患者数据包括人口统计学数据（包括国籍/进入英国的日期）、疾病病灶、微生物学和管理策略。疾病发病率使用国家统计局的人口数据进行计算。计算泊松置信区间以显示统计误差的程度。还使用卡方检验分析了疾病发病率和国籍，并寻求相关性。
2005年1月至2017年7月期间，布拉德福德共诊断出109例MSK结核病例。平均发病率为每10万人口每年1.65例（标准差0.75）。共有38例需要手术干预。抗菌药物耐药率较低。失访率较低（4例患者；3.7%）。总体而言，94.5%的患者（n = 103）得到成功治疗。67%的患者（n = 73）报告其原籍国为印度、巴基斯坦或孟加拉国。这些族裔约占当地人口的25%。
相对于全国数据，布拉德福德的MSK结核感染患病率较高；当地移民人口中的患病率仍然严重不成比例。典型的相关因素（HIV/肝炎合并感染、耐药性）在我们的数据集中患病率仅为中等。然而，正如全球文献所表明的，诸如贫困和匮乏等当地社会经济因素似乎密切相关。我们主张在治疗任何具有类似人口因素地区的非典型感染时保持高度怀疑，以确保及时诊断。引用本文：2022；3(5):432 - 440。
