Osteoarticular tuberculosis of the ankle, a rare localization: a case report
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Tuberculosis is a real scourge, posing a real public health problem in countries where the disease is endemic. Osteoarticular tuberculosis represents 3% to 5% of all tuberculosis cases and 10% to 15% of extra-pulmonary tuberculosis cases. Involvement of the foot and ankle is rarer. We report the case of osteoarticular tuberculosis of the ankle in a 71-year-old patient with type 2 diabetes and hypertension who presented to the trauma department of the Mohammed V Military Hospital with a painful swelling of the ankle. Standard X-rays and CT scan of the ankle showed inflammatory involvement of the bone and joints. Antitubercular therapy was instituted. Given the context of endemicity, any atypical presentation of lingering bone lesions should raise the suspicion of an osteoarticular tuberculosis in order to ensure early therapeutic management.
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In the summary I suggest you delete the "real scourge" half sentence as it seems redundant with the second half of the sentence. Otherwise you have addressed the raised concerns and the manuscript can be published after you addressed the minor point mentioned before.
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. Please provide more more detailed description for the images, with arrows pointing to areas of interest. In your revision, please include more up-to-date literature for your references (see point 4 reviewer 1). Consider re-organising the narrative and include more details in parts as specified by the reviewer comments.
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Comments to Author
A. Description of the case overall is ok, but need more details: 1) line 50- "The patient did not present any signs of tuberculosis infection". Please broaden the signs of tuberculous infection such and such or does it mean any systemic constitutional symptoms? Please clarify and broaden. 2) Examination should have included systemic examination -especially chest examination even if it was normal as this will be the first thing to ask how the chest sounds like. And, can I know what the indication of doing CT chest scan was? Was it because the chest auscultation was abnormal or was something else suspected such as cancer? Is it a normal practise there? 3) Was there any radiologist comment on CT chest scan finding on "diffuse bronchial micro nodules"? Did you discuss with respiratory physician regarding …
Comments to Author
A. Description of the case overall is ok, but need more details: 1) line 50- "The patient did not present any signs of tuberculosis infection". Please broaden the signs of tuberculous infection such and such or does it mean any systemic constitutional symptoms? Please clarify and broaden. 2) Examination should have included systemic examination -especially chest examination even if it was normal as this will be the first thing to ask how the chest sounds like. And, can I know what the indication of doing CT chest scan was? Was it because the chest auscultation was abnormal or was something else suspected such as cancer? Is it a normal practise there? 3) Was there any radiologist comment on CT chest scan finding on "diffuse bronchial micro nodules"? Did you discuss with respiratory physician regarding bilateral pleural effusion for the possibility of pleural tap and sampling? Even if there was no discussion s such, please mention. 4) Last but not least, please mention if the case has been discussed and managed among multidisciplinary team as I gathered the patient presented to trauma centre in the first place so I presumed that later it would have been managed under physician or joint collaboration with physicians/Infectious diseases team etc. The practice/system might be a bit different from place to place, but if possible, please mention if there was collaboration or joint management. B. Presentation of results overall is ok. However, in line 108, "The atypical location, the insidious clinical presentation, the lack of an initial diagnosis of pulmonary 109 tuberculosis, as well as the hemiparesis, explains the delayed diagnosis" -- the case did not give an enough evidence of delayed diagnosis. I gathered from case description that the patient had ONLY a month history of ankle pain and swelling, then admitted, and the team performed examination, scans, surgery and sampling, then got diagnosis with ZN stain and Gene Expert straight away, which all means quite straight forward and fast. Can you clarify this? C. Academic writing style, references and literature reviews are good.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
1. Description of the case(s) The description of the case is very succint, compared to the extension of the discussion. Temporally, the case is poorly described, with just the mention of 1 month of disease. A natually flow, would have been anamnesis, examination, then labs, images, but authors describe the very few lab results last. 2. Presentation of results Description of the images does not seem to correlate with what is shwon. For example, inclusion of arrows could help the reader (like this one) to see the pleural effusions they are mentioning (I can't see any). 3. How the style and organization of the paper communicates and represents key findings Use of unusual terminology makes the narrative sound odd. The paper is redundant at various places. 4. Literature analysis or discussion They …
Comments to Author
1. Description of the case(s) The description of the case is very succint, compared to the extension of the discussion. Temporally, the case is poorly described, with just the mention of 1 month of disease. A natually flow, would have been anamnesis, examination, then labs, images, but authors describe the very few lab results last. 2. Presentation of results Description of the images does not seem to correlate with what is shwon. For example, inclusion of arrows could help the reader (like this one) to see the pleural effusions they are mentioning (I can't see any). 3. How the style and organization of the paper communicates and represents key findings Use of unusual terminology makes the narrative sound odd. The paper is redundant at various places. 4. Literature analysis or discussion They mention "...Involvement of the foot and ankle is rarer [5]." which is a reference from 1991. I just did a quick google search, and only in the past 5 years there are more than 10 TB cases of the ankle published. A search in ncbi yielded an even longer list: https://www.ncbi.nlm.nih.gov/pmc/?term=tuberculosis+ankle
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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