title: Osteoarticular tuberculosis--diagnostic solutions in a disease endemic region.
abstract: BACKGROUND
  We conducted a study of osteoarticular tuberculosis in patients from private and public settings in a disease endemic area. Our objective was to assess the role of mycobacterial culture and polymerase chain reaction (PCR) in the diagnosis of osteoarticular tuberculosis (TB) in settings where only clinical and imaging diagnosis form the basis for treatment.
  
  
  METHODS
  Ninety-three consecutive specimens collected from clinically suspected patients of osteoarticular TB were screened for bacterial culture, mycobacterial culture and in-house nested PCR. In addition, specimens were examined by imaging and histopathology. Ten specimens collected from patients suffering from other bone diseases were included as negative controls.
  
  
  RESULTS
  Of the 93 clinically suspected TB patients, mycobacterial culture was positive for Mycobacterium tuberculosis (MTB) in 47 (51%) patients who were confirmed as definite TB cases. Of the remaining patients, 16 (17%) were diagnosed as probable, 19 (20%) as possible, and 11 (12%) as only clinically suspected TB cases. In-house nested PCR was positive in 65 (70%) cases. Fifteen patients were resistant to one or more anti-tuberculous drugs; twelve patients were multi-drug resistant, two of whom were extensively drug resistant.
  
  
  CONCLUSIONS
  Mycobacterial cultures using liquid media with susceptibility should form the backbone of management of osteoarticular TB. Nested PCR enhances the sensitivity if performed in addition to culture.
authors.affiliation: P.D. Hinduja National Hospital & Medical Research Centre, Mahim, Mumbai-400016, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agashe
authors.forename: Shubhada
authors.initials: S
authors.lastname: Shenai
authors.forename: Ganesh
authors.initials: G
authors.lastname: Mohrir
authors.forename: Minal
authors.initials: M
authors.lastname: Deshmukh
authors.forename: Anita
authors.initials: A
authors.lastname: Bhaduri
authors.forename: Ramesh
authors.initials: R
authors.lastname: Deshpande
authors.forename: Ajita
authors.initials: A
authors.lastname: Mehta
authors.forename: Camilla
authors.initials: C
authors.lastname: Rodrigues
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D019353:Endemic Diseases; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011859:Radiography; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D003470:Culture Media