title: The use of real-time polymerase chain reaction for rapid diagnosis of skeletal tuberculosis.
abstract: We identified Mycobacterium tuberculosis DNA using real-time polymerase chain reaction on a specimen from an osteolytic lesion of a femoral condyle, in which the frozen section demonstrated granulomas. The process was much more rapid than is possible with culture. The rapid detection of M tuberculosis and the concomitant exclusion of granulomatous disease caused by nontuberculous mycobacteria or systemic fungi are necessary to appropriately treat skeletal tuberculosis. The detection and identification of M tuberculosis by culture may require several weeks using traditional methods. The real-time polymerase chain reaction method used has been shown to be rapid and reliable, and is able to detect and differentiate both tuberculous and nontuberculous mycobacteria. Real-time polymerase chain reaction may become a diagnostic standard for the evaluation of clinical specimens for the presence of mycobacteria; this case demonstrates the potential utility of this assay for the rapid diagnosis of skeletal tuberculosis.
authors.affiliation: Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Fraser
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Bauer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Joyce
authors.forename: Gerri S
authors.initials: GS
authors.lastname: Hall
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Tuohy
authors.forename: Gary W
authors.initials: GW
authors.lastname: Procop
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000032:analysis*; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D005269:Femur / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D010014:Osteolysis / Q000382:microbiology / Q000473:pathology; D011718:Pyrazinamide / Q000627:therapeutic use; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D012293:Rifampin / Q000627:therapeutic use; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin