Bone tuberculosis (TB) is not a rare disease, it is suspected in patients with persistent bone or back pain, said Prof Rajesh Malhotra, head of orthopedics and senior consultant orthopedics, Indraprastha Apollo Hospital, Delhi. In an interview with Kavita Bajeli-Datt, he says that bone TB is curable with timely medicines and surgery is needed only in selected cases. Edited excerpts:
How prevalent is bone TB in India?
Bone and joint TB forms about 10–15% of extrapulmonary TB, which translates to roughly 1–3% of all TB cases. Because India has a high TB burden, we continue to see a significant number of skeletal TB patients in clinical practice.
How is bone TB detected?
It is suspected in patients with persistent bone or back pain, swelling, or deformity, and confirmed using MRI imaging and biopsy tests such as GeneXpert or culture.
Who is in the high-risk group? Is it contagious?
High-risk groups include people with weak immunity, diabetes, HIV, malnutrition, or previous TB exposure. Bone TB itself is usually not contagious. Transmission mainly occurs from lung TB through airborne droplets.
There is high prevalence in younger populations, with increasing multi-drug resistance (MDR-TB) and diagnostic delays averaging 6.1 months. Treatment of multi drug resistant TB is particularly challenging.
What causes bone TB?
Bone TB is caused by mycobacterium tuberculosis, which usually spreads through the bloodstream from a primary infection, most commonly in the lungs.
Why is the spine most commonly affected?
The spine accounts for nearly half of skeletal TB cases because its vertebrae have a rich blood supply, making them more vulnerable to infection spread.
What is the treatment? Is it curable?
Bone TB is largely curable with timely antitubercular medicines for 9–12 months; surgery is needed only in selected cases with nerve compression, deformity, or instability.
What initiatives is the government taking?
A lot is being done by the government for TB elimination. The National Tuberculosis Elimination Programme (NTEP) is India’s flagship public health initiative under the Ministry of Health and Family Welfare to eradicate tuberculosis. The programme provides free diagnostics such as sputum microscopy, CBNAAT/Truenat molecular testing, and culture and drug-susceptibility testing. India’s strategies to eliminate TB is early detection; free treatment; drug-resistance surveillance and nutritional support schemes.
India utilises the DOTS strategy (Directly Observed Treatment Short-course) to provide free diagnostics, and treatment and drug resistance monitoring to all citizens, aiming for a >85% cure rate and >95% notification rate. The four strategic pillars of the programme are – Detect-Treat-Prevent-Build (DTPB).
Since nearly 25% load of tuberculosis is from bone and joints, the vision of a ‘TB Mukt Bharat’, has an inclusive approach to TB management, without differentiating between chest and other than chest tuberculosis.