PCR identification of Mycobacterium tuberculosis complex in a clinical sample from a patient with symptoms of tuberculous spondylodiscitis

Abstract

A 42-year-old male complaining of thoracic spine pain was admitted to the hospital for evaluation. An X-ray and computer tomography of the thoracic spine showed spondylodiscitis of the L3 lumbar and L2-L3 intervertebral disk. The tuberculin skin test (PPD) was strongly positive. A radioscopy-guided fine needle aspirate of the affected area was cultured but did not reveal the cause of the disease. Two biopsy attempts failed to reveal the cause of the disease by culturing or by acid-fast-resistant staining (Ziehl Neelsen) of the specimens. A third biopsy also failed to detect the infectious agent by using microbiological procedures, but revealed the presence of a 245-bp amplicon characteristic of the Mycobacterium tuberculosis complex after PCR of the sample. The result demonstrates the efficacy of PCR for the identification of M. tuberculosis in situations in which conventional diagnosis by culturing techniques or direct microscopy is unable to detect the microorganism. Following this result the patient was treated with the antituberculous cocktail composed by rifampicin, pirazinamide and isoniazid during a six-month period. At the end of the treatment the dorsalgia symptoms had disappeared. Correspondence

Clinical value of polymerase chain reaction in the diagnosis of joint tuberculosis by detecting the DNA ofMycobacterium tuberculosis

“…Few reports on the application of PCR in the diagnosis of joint TB have been published, most of them having been clinical case-reports or clinical observations with small sample sizes. These reports have indicated that PCR also possesses outstanding advantages in regard to the early and rapid diagnosis and differential diagnosis of joint TB [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] , yet, to the best of our knowledge, a systematic clinical appraisal of PCR in the diagnosis of joint TB, especially with large sample sizes, had not yet been published.…”

Adult Scheuermann’s disease as cause of mechanic dorsalgia

“…Nelle forme settiche non vi è la presenza di raccolta gassosa nello spazio inter-discale (31). La risonanza magnetica è l'esame che non solo permette di fare diagnosi di SDI, ma segnala alcune caratteristiche sulla possibile eziologia: un disco quasi del tutto risparmiato con presenza di masse paravertebrali, erosione del margine paravertebrale anteriore (per diffusione sub-ligamentosa dell'infezione) e scarsa sclerosi orientano per un quadro di tipo tubercolare (38)(39)(40). L'endocardite batterica, il diabete mellito insulinodipendente complicato, le infezioni sistemiche, la dialisi, le malattie croniche intestinali, e gli interventi chirurgici sulla colonna vertebrale predispongono alla SDI (37,(41)(42)(43)(44)(45)(46).…”