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Tuberculous dactylitis—an easily missed diagnosis

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Abstract

The prevalence of tuberculosis (TB) continues to rise worldwide. Current migration patterns and increased travel to high-prevalence TB countries will result in more frequent presentations of less common forms of TB. Tuberculous dactylitis, a form of tuberculous osteomyelitis, is well recognised in countries with a high prevalence of TB. We provide a systematic review of all published cases of tuberculous dactylitis in children and adolescents and describe a case to illustrate the typical features of the disease. Our review revealed 37 cases of tuberculous dactylitis in children and adolescents, all reported in the last 17 years. Children less than 10 years of age are most frequently affected and the hand is the most commonly affected site. Concurrent pulmonary TB is present in a fifth of cases and systemic symptoms are usually absent. Positive TST and IGRA support the presumptive diagnosis, but cannot be used as rule-out tests. The definitive diagnosis relies on the detection M. tuberculosis by PCR or culture. Treatment should comprise of a standard three to four drug anti-tuberculous regimen. The optimal treatment duration remains unknown. Surgery has a limited role in the treatment in general but may play a supportive role, and curettage of the cavity has been recommended for avascular lesions.

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Acknowledgements

We thank Associate Professor Duncan MacGregor for providing the histopathology photos and accompanying figure legend. NR is supported by Fellowship awards from the Swiss National Science Foundation, the European Society of Paediatric Infectious Diseases and The University of Melbourne. TGC is supported by Fellowship awards from the Nossal Institute of Global Health and The University of Melbourne. MT is supported by a Fellowship awards from the European Society of Paediatric Infectious Diseases and The University of Melbourne.

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Authors and Affiliations

  1. Department of Paediatrics, The University of Melbourne; and Infectious Diseases Unit, Department of General Medicine, Royal Children’s Hospital Melbourne, Flemington Road, Parkville, VIC, 3052, Australia

    N. Ritz, T. G. Connell, M. Tebruegge & N. Curtis

  2. Infectious Diseases Unit, University Children’s Hospital Berne, Berne, Switzerland

    N. Ritz

  3. Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Australia

    N. Ritz, T. G. Connell, M. Tebruegge & N. Curtis

  4. Department of Plastic and Maxillofacial Surgery, Royal Children’s Hospital Melbourne, Parkville, Australia

    B. R. Johnstone

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  1. N. Ritz
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  2. T. G. Connell
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Correspondence to N. Ritz.

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Ritz, N., Connell, T.G., Tebruegge, M. et al. Tuberculous dactylitis—an easily missed diagnosis. Eur J Clin Microbiol Infect Dis 30, 1303–1310 (2011). https://doi.org/10.1007/s10096-011-1239-5

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