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What To Know About Bone Tuberculosis
Bone tuberculosis is a form of tuberculosis that spreads beyond the lungs and affects the bones. Recognizing bone tuberculosis symptoms early is essential for successful treatment.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria.
The bacteria is transmitted when a person with the infection coughs, speaks, or sings. TB normally affects a person's lungs but can spread to any other part of the body. If TB spreads to the bone, it is known as bone tuberculosis.
Other names for bone TB are osteoarticular, musculoskeletal, or skeletal TB.
TB is normally preventable and treatable if treatment is started early. However, TB can be a fatal condition.
The Centers for Disease Control and Prevention (CDC) reported 8,300 cases of TB in the United States in 2022.
Read on to learn more about bone TB, including its causes and risk factors.
When a TB infection spreads beyond the lungs, it is called extrapulmonary TB (EPTB). According to the CDC, in 2020 21% of TB cases in the United States involved extrapulmonary TB.
If a person's extrapulmonary TB infection is in their bones, joints, or spine, they have bone TB. In 2020, 9% of all extrapulmonary TB cases in the United States were bone and joint extrapulmonary TB.
One common form of bone TB that affects a person's spine is Pott disease, also known as TB spondylitis.
People with TB in their lungs or throat can transmit the bacteria through their breath. People are most likely to contract TB from people they spend time with in person, such as family, friends, or co-workers.
People contract TB by breathing in the TB bacteria. The bacteria settle in their lungs or throat and then begin to grow. If the infection then spreads to their bones, it can cause the person to develop bone TB.
Bone TB alone is not infectious. If a person has only bone TB, they cannot transmit it to others. However, TB is transmissible if the bacteria are in their lungs or throat as well as their bones.
People with weakened immune systems are more likely to develop TB. This includes infants and people with the following conditions:
Certain treatments can also weaken the immune system, such as:
People have a higher risk of developing some types of bone TB if they have HIV or a vitamin D deficiency. These conditions affect the body's ability to counter the spread of TB bacteria in the body.
Symptoms of bone TB typically come on gradually, sometimes over months or years. Symptoms can include:
People generally have bone TB in one area but may have it in multiple areas. People can have bone TB in any bone or joint. However, it is more common in the spine and weight bearing joints.
Symptoms of bone TB are different from TB in general. A person may have general TB symptoms, bone TB symptoms, or both. The symptoms depend on where the TB is in a person's body.
General TB symptoms include:
If a person suspects they have TB or have been around people who have TB, they should seek testing from healthcare professionals. People with TB may experience severe and potentially fatal complications if they do not get sufficient treatment.
People may also have TB but no symptoms. Doctors call this latent TB. People with latent TB cannot transmit it to others, but treatment is still needed.
Early treatment can prevent TB from developing further and causing issues, such as joint deformity or losing joint function.
Healthcare professionals usually treat bone TB with multiple anti-TB medications, such as chemotherapy.
If a person also has TB in their throat or lungs, doctors prescribe antibiotics for at least 6 months. Doctors may perform surgery in some cases of bone TB in the spine.
However, health authorities in the United States do not generally recommend the BCG vaccine because of the low risk of infection with TB bacteria. The BCG vaccine may also complicate some tests doctors use when prescribing TB treatment.
Bone tuberculosis (TB) develops if a person's TB infection spreads beyond the lungs to the bones.
TB is infectious. It is transmitted through the air in droplets when a person with pulmonary TB coughs, sneezes, spits, laughs, or talks. A person cannot directly transmit bone TB without also having TB in their lungs.
Bone TB symptoms often become noticeable very gradually. This can make it harder for doctors to diagnose the disease. Doctors typically treat bone TB with a combination of antibiotics, chemotherapy, and surgery.
If a person suspects they have TB or have been around people with TB, they should seek professional treatment as soon as possible.
Tuberculosis-tainted Bone Graft Causes Deadly Infection In Patient
Bone graft materials contaminated with tuberculosis (TB) were used in three dozen dental and medical procedures, causing infections in five people, including one who died, according to the U.S. Centers for Disease Control and Prevention (CDC).
The CDC is warning hospitals and dental offices to identify employees who may have been exposed to the potentially deadly bacterial infection, which affects the lungs and spreads through respiratory droplets from an affected person, during patient surgery or care. The cases appear to be linked to bone grafts from Silver Springs, MD-based Aziyo Biologics, which voluntarily recalled them on July 13, according to the CDC. This is the second time a tuberculosis outbreak has been linked to Aziyo bone grafts.
The CDC recommends that all patients who received Aziyo's ViBone Moldable or alloOss Plus (lot No. TDS222820) be treated for tuberculosis even if they have no symptoms. Health and dental providers should ensure that patients who received these bone graft materials get evaluated and receive treatment, which should be coordinated with infectious disease and tuberculosis experts, according to the CDC.
"CDC and FDA are working with state and local health departments, hospitals, surgical centers, and dental offices in the affected states to ensure patients are rapidly evaluated and treated, prevent further patient harm, and determine if additional measures can be taken to prevent similar outbreaks in the future," according to the CDC.
Furthermore, healthcare providers should report adverse patient outcomes to the U.S. Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program, as well as notify Aziyo, according to the agency.
About the bone graftsBetween February 27 and June 20, shipments of the bone grafts were sent to 13 hospitals and dental offices in California, Louisiana, Michigan, New York, Oregon, Texas, and Virginia. All involved healthcare providers and states have been notified about the bone grafts and all unused units of the products, which have been made from human tissue, have been removed from inventory and will not be used.
Aziyo's recall notice states that the products were voluntarily pulled after it learned of postsurgical tuberculosis infections in two patients after they were treated with viable bone matrix product from a single donor. Prior to release of the products, samples from this specific lot had tested negative for Mycobacterium tuberculosis by an independent laboratory using a nucleic acid test that is designed to specifically detect the organism that causes tuberculosis, according to a company press release announcing the recall. Additionally, the company suspended shipments of all viable bone matrix products from all donor lots "out of an abundance of caution," Aziyo said.
"We are taking immediate action to safeguard patients by implementing a full product recall as we work with the CDC to investigate this event," Dr. Randy Mills, Aziyo's president and CEO, said in the recall notice. "The people of Aziyo care deeply about the patients we serve and will continue to work with the medical community, patients, and regulatory authorities as we gather additional information."
Past problems with TB-infected bone graftsThough it is highly unusual for tuberculosis to be associated with transplanted tissues, this is not the first time that products from Aziyo Biologics have been associated with a tuberculosis outbreak. In the spring of 2021, the company voluntarily recalled its FiberCel viable bone matrix, as it was linked to a large tuberculosis outbreak in at least 87 patients. Eight patients died.
This outbreak was linked to tainted material that came from one single tissue donor, a deceased man. An investigation into the outbreak, which was published in August 2022 in Lancet Infectious Diseases, determined that the donor had "unrecognized risk factors, symptoms, and signs consistent with tuberculosis."
This Company Keeps Selling TB-tainted Bone Grafts, Causing Deadly Outbreaks
Tuberculosis outbreaks linked to transplanted tissue are very rare, yet this isn't the first time Aziyo's bone graft products have been linked to such an outbreak. Just two years ago, a different bone graft product from the company was linked to a large outbreak in which at least 87 patients developed tuberculosis, and eight died.
That outbreak, which came to light in May 2021, was linked to contaminated product from a single tissue donor, a deceased man in his 80s. An outbreak investigation published last year found that the donor had "unrecognized risk factors, symptoms, and signs consistent with tuberculosis."
Tissue from the man was made into 154 units of bone matrix material—described as a malleable putty that includes human cells—which was shipped to 37 health care facilities in 20 US states. From there, 136 units were implanted into the spines of 113 patients, some of whom got multiple units. Of those 113 patients, 87 had signs of tuberculosis disease, 55 were readmitted to the hospital for complications, and 48 had to undergo secondary spinal surgeries for drainage, to remove damaged tissue, and/or to remove hardware. Of the 105 surviving patients, all were treated for tuberculosis, taking multiple antibiotics for a median course of 69 days.
It's unclear how the problem occurred again. In its recall announcement earlier this month, Aziyo said the contaminated lot, again from a single donor, had tested negative for the bacterium that causes tuberculosis, Mycobacterium tuberculosis, by an independent laboratory using a nucleic acid test before distribution. The company added that it is "fully cooperating and investigating the events" in coordination with the CDC and the Food and Drug Administration.
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