A recent seminar on orthopaedic infections took place organised by the Pacific Islands Orthopaedic Association.  Here is the presentation: Zoom tutorials – Spine TB Ferguson 2020 final_cb.    References are within the presentation.   Some take home messages: 

Epidemiology

• High burdens of latent TB infection in Pacific Nations
• Need for clinical vigilance for active TB, especially in those with risk factors (Age, systemic steroids, HIV, smokers, alcohol, diabetes, vitamin D deficiency (active treatment of latent TB optimal)
• Drug resistant TB is emerging and already at a significant level in PNG

Diagnosis and confirmation

• Direct molecular detection (sputum and other) of TB and MDR is now the standard of care
• Special diagnostic considerations for children and those with HIV

Medical management

• Local clinical expertise required – patient education, close monitoring and drug management (side effects, MDR)
• Don’t neglect MDR-TB management- must embrace local detection & control
• Emerging shortened course management regimens for MDR

References

• Global TB Report (WHO) 2019
• THE DUAL EPIDEMIC OF TB AND DIABETES (WHO) 2015
• Recent update on TB diagnostic techniques – GenXpert MTB/RIF Ultra  (9 Apr 2018 Ian Marr)
• WHO Rapid Communication: Molecular assays as initial tests for the diagnosis of
  tuberculosis and rifampicin resistance (11 Jan 2020)
• WHO Rapid Communication: Key changes to treatment of multidrug- and
  rifampicin-resistant tuberculosis (10 Oct 2018)
• WHO operational handbook on tuberculosis: module 1: prevention: tuberculosis preventive treatment (22 Mar 2020)