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How can bone tuberculosis be confirmed?

Q: My 32 years old friend has been suffering from right knee pain and little swelling for the last 4 months. He has been under treatment but all his medical reports show no problem including blood, x-ray, etc. So the doctor has advised him to go for a biopsy. The biopsy result showed Acinetobactor baumannii - heavy growth. The doctor advised Amikacin injection daily and he had taken it for one week but suddenly the doctor told him to undergo surgery because the CRP is not reducing in the blood even after one week. We consulted another doctor and he did the blood test again, which showed everything normal except for CRP. The doctor said that these were symptoms of bone tuberculosis (TB). After two months of treatment for TB, his swelling in the knee has gone but there is pain. Now he is worried because two doctors have given different diagnosis. How can TB be confirmed? Is he taking the correct treatment?

A:What you have presented is a common problem. Problems like your friends are difficult to diagnose correctly unless a biopsy is taken. The first doctor thought that it was a bacterial infection while the second doctor thought that it was tuberculosis. The first one was based on the culture but this could also be contaminant from improper sample collection or transportation. The diagnosis of TB was obviously more on empirical diagnosis not based on any culture or any biopsy. The fact that your friend has improved does not really confirm that it was TB nor does it negate tuberculosis. The improvement could have been as a result of natural history of the disease process or if there was some mild infection could be because of response to antibiotics, which are part of anti-tuberculous drug regime.

The bottom line is such diagnosis can be correctly made with certainty only if there is concurrence of clinical, imaging and pathological findings. So, in your friend’s case you asked me what is it? It is very difficult to say. All I would suggest is now that he is on ATT, let him complete the short course chemotherapy for TB and then see the outcome. Meanwhile, if there is a recurrence of symptom he must get a re-evaluation of all his lab and clinical findings.

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