TUBERCULOSIS usually attacks the lungs, but can also affect other parts of the body like the bones, sometimes leading to disability. Agnes Kyotalengerire reports.
Grace Alochi, a single mother, was in good health, hawking smoked fish and selling charcoal to fend for her seven children when a strange disease put her down and left her disabled.
Alochi recalls that the disease started after she had given birth to her second baby.
â€œI would feel pain around the hip joint, spreading downwards until it paralysed my entire leg. I did not take it seriously and only took painkillers,â€ she narrates.
In 2008 after the pain failed to subside, Alochi decided to seek medical treatment at Butabika Hospital.
An X-ray revealed a bone infection. Alochi was later referred to Mulago Hospital for further investigations. While admitted at Mulago, another X-ray and biopsy tests were carried out. The results showed that Alochi had a bone infection and was operated upon and started on treatment.
She did not respond to the treatment and the leg started swelling with a lot of pain. With time, staying in hospital became expensive and Alochi decided to transfer to Angal Missionary Hospital in Nebbi district.
The orthopaedics subjected her to another Xâ€“ray, which revealed that she had bone tuberculosis. She was put on tuberculosis treatment and responded well. To repair the damaged hip, Alochi was advised to go to Gulu Hospital, but she could not make it because she had no one to attend to her.
Alochi was later connected to a consultant surgeon in Mulago Hospital, who did another test and confirmed that the tuberculosis had been controlled.
However, the consultant advised her to have a total replacement of the hip, which includes the sockets and the ball.
To buy the socket and ball, including treatment, Alochi requires about sh13m. Whoever wants to help Alochi can deposit the money on Account number 3020566379 Centenary Bank, Entebbe Road Branch.
Complications, diagnosis, treatment
DR. Paul Muwa, an orthopaedic surgeon at Comprehensive Orthopaedic Rehabilitation Services Uganda (CORSU), says bone tuberculosis affects both the young and elderly. Patients whose immune system has been weakened after other medical conditions are at a greater risk.
He observes that although tuberculosis commonly attacks the lungs, 10% of the bone infections at CORSU last year were bone tuberculosis cases.
Emmanuel Odhiambo, an orthopaedic surgeon, estimates that Katalemwa Cheshire Home for Rehabilitation registers about eight new cases of bone TB both from the home and community monthly, with about seven follow-up cases recorded every month.
Dr. Edward Naddumba, a senior consultant orthopaedic surgeon at Mulago Hospital, describes bone tuberculosis as an infection caused by mycobacterium tuberculosis.
He explains that the bacteria enter the lungs through the mouth or nose, then to the blood stream, where they travel and settle in the bones.
â€œThe most affected areas are the long bones, joints and spinal cord because they have a rich blood supply,â€ Dr. Naddumba affirms.
The spinal cord is also prone to infection because of its close proximity to the lung. Secondly, part of the bones are connected to the chest, where the primary focus is.
They depend on the bones affected. In case of the spinal cord, the patient may get paralysed and will have deformity of the back, commonly referred to as the hunchback. For the long bones, the common complication is fractures. If tuberculosis is not treated, it can kill.
Signs and symptoms
â€œFor many people, localised pain in the affected area, fractures, swelling of the limbs and discharge of fluid through the skin are the most common symptoms,â€ says Dr. Muwa.
In some cases, a patient may get fever, sweat at night, loss of weight and deformity of the affected area.
History of contact with a tuberculosis patient is often suggestive of bone tuberculosis.
In addition, chronic bone infection (Osteomyelitis) is a symptom of bone tuberculosis.
Is tuberculosis of the bone contagious?
Tuberculosis is spread through the air, but Dr Muwa says if the patient is not coughing, the chances of the people in close contact getting the disease are minimal. Bone tuberculosis is not contagious.
â€œDiagnosis is by tests, for example, X-rays and blood tests.
However, to confirm bone TB, a piece of bone is taken and tested.
â€œTreatment is primarily by taking a combination of anti-tuberculosis drugs over a period of seven to nine months,â€ explains Dr. Muwa.
He adds that treatment also depends on complications, for example, if the patient has a fracture, surgery is done to correct the complication.
Dr. Muwa notes that treatment for bone tuberculosis is readily available and is given free of charge in Government health facilities. However, at CORSU, children below 18 years are operated on for free, but the patient is required to pay for investigative tests, drugs and their stay at the hospital.
Odhiambo emphasises the importance of starting treatment early.
â€œWhen complications set in, it becomes expensive to treat and some complications may not be corrected,â€ Odhiambo says.
Besides, any infection of the bone should be taken seriously and investigations done correctly.
What is hip replacement?
According to Dr. Paul Muwa, an orthopaedic surgeon at Comprehensive Orthopaedic Rehabilitation Services Uganda (CORSU), the hip is made of a ball and socket.
Hip replacement involves replacing the joint with artificial implants.
Bone tuberculosis left me immobile