Bone and joint tuberculosis in childhood in a children's hospital, Addis Abeba.

The records of children admitted to the Ethio-Swedish Children's Hospital with the diagnosis of bone and/or joint tuberculosis (TB) between 1985 and 1990 were reviewed. There were 41 patients: 25 (61%) males and 16 (39%) females. The diagnosis was based on history, clinical and radiologic findings supported by a positive PPD reaction and elevated erythrocyte sedimentation rate (ESR). A high index of suspicion based on epidemiologic considerations was also important. Whereas in ambulatory patients the commonest site of bone involvement was the spine, in this series of hospitalized patients the most common site of skeletal TB was the hip joint (22 patients) compared to spinal involvement (14 patients) suggesting the more incapacitating and crippling nature of hip joint disease. In the remaining 5 patients, the knee (1), the ankle (1) a metatarsal (2) or a phalanx (1) were involved. The period of hospital stay ranged from 3 to 180 days, with a mean of 56. Mean hospital stay was much longer for patients with TB arthritis of the hip joint than for those with spondylitis, 71 and 43 days respectively. The need for early diagnosis and treatment aiming at full restoration of function of the involved joint is emphasized. In TB spondylitis, early diagnosis and treatment should aim to minimize deformity and prevent paraplegia.