Mycobacterium tuberculosis (MTB) is a rare cause of prosthetic joint infection. The diagnosis is challenging especially in cases of latent tuberculosis. QuantiFERON-TB Gold (QFT®) is an interferon-gamma relative assay (IGRA) which is highly specific and sensitive for detection of MTB infection. We report a case of 76-year-old lady diagnosed with tuberculous prosthetic joint infection following total knee replacement. Histological examination of abnormal synovial tissue taken intraoperatively reveals chronic granulomatous lesion and raised suspicion of tuberculous infection in otherwise asymptomatic patient. The tuberculin skin test, MTB acid-fast stain and tuberculosis polymerase chain reaction were negative. The diagnosis dilemma was solved with positive result of QuantiFERON TB Gold Test. The patient was treated with anti-tuberculous drug without any surgical intervention. At five months follow-up, patient was clinically well with no symptoms and signs of infection
Interferon-gamma ; latent tuberculosis ; mycobacterium tuberculosis ; total knee replacement ; tuberculosis

Hypertension is one of the commonest health problems in Malaysia and its cases are on a rise. In conjunction with the above statement, it is predictable that the cost of healthcare services will further increase in the future. Therefore, cost study is necessary to estimate the health related economic burden of hypertension in Malaysia. A cross sectional study was carried out to quantify the direct treatment cost of hypertension. Three hundred and ninety one hypertensive patients’ data from Bandar Tasik Selatan Primary Medical Centre in year 2010 were collected and analysed. The direct treatment costs were calculated. The result showed that out of 391 hypertensive patients, 12.5% was diagnosed hypertensive without any co-morbidity, 25.3% with 1 co-morbidity dyslipidemia only; 4.3% with diabetes mellitus type 2 only; 0.5% with chronic kidney disease only and none with ischaemic heart disease. Patients with 2 co-morbidities (dyslipidemia and diabetes mellitus type 2) were 42.2%; with 3 co-morbidities (diabetes mellitus type 2, dyslipidemia and chronic kidney disease) was 4.3%. The mean cost of direct treatment of hypertension per visit/ year was RM289.42 ±196.71 with the breakdown costs for each component were medicines 72.2%, salary 14.6%, laboratory tests 5.0%, administration 4.4% and radiology tests 3.8%. Dyslipidemia is by far the commonest co-morbidity among hypertensive patients. Direct costs of treating hypertension are mostly dependent on present of co-morbidity and numbers of drugs used. Thus, the annual budget could be calculated precisely in the future especially for drugs.