title: Infantile osteoarticular tuberculosis misdiagnosed as Bacillus Calmette-Guerin related osteomyelitis.
abstract: Tuberculosis, a re-emerging public health problem, is uncommon in infancy. Two healthy completely immunized infants presenting with manifestations compatible with osteoarticular infection required surgical debridement. The cultures of the specimens were positive for M. tuberculosis (MTB) complex comprised multiple subspecies. One case was misdiagnosed as a Bacillus Calmette-Guerin (BCG) related osteomyelitis by a polymerase chain reaction (PCR) based on detection of genes at the region of difference 1. Genome extraction and PCR using the rimM gene and sequences analysis against MTB and BCG control samples confirmed that both specimens were infected by M. tuberculosis. The lesions were successfully healed within one year. Surgical debridement of suspected lesions is warranted in infants as a definitive treatment and to obtain tissues for further evaluation. Microbiological cultures only confirm nonspecific MTB complex infection. PCR kits may yield a false positive result. Identification of the pathogen by DNA extraction and sequence analysis should be recommended.
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University 10330 Bangkok Thailand.
authors.forename: Noppachart
authors.initials: N
authors.lastname: Limpaphayom
authors.affiliation: Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Thai Red Cross Society 10330 Bangkok Thailand.
authors.forename: Phatcharapa
authors.initials: P
authors.lastname: Osateerakun
authors.affiliation: Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University 10330 Bangkok Thailand.
authors.forename: Apiradee
authors.initials: A
authors.lastname: Theamboonlers
authors.affiliation: Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University 10330 Bangkok Thailand.
authors.forename: Sumeth
authors.initials: S
authors.lastname: Korkong
authors.affiliation: Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University 10330 Bangkok Thailand.
authors.forename: Yong
authors.initials: Y
authors.lastname: Poovorawan
keywords: Debridement; Infant; Mycobacterium bovis; Mycobacterium tuberculosis; Osteomyelitis