Polymerase chain reaction for the detection of Mycobacterium tuberculosis in synovial fluid, tissue samples, bone marrow aspirate and peripheral blood.

Extrapulmonary tuberculosis accounts for approximately 10% of tuberculous infections; the musculoskeletal system is involved in a small number of these (10%). Skeletal tuberculosis is an indolent disease, and diagnosis may be delayed. Conventional methods are time consuming and have a low sensitivity rate. In recent years PCR-based protocols raised hopes as a reliable and fast diagnostic tool for extrapulmonary tuberculosis. The authors report the detection of Mycobacterium tuberculosis complex DNA in specimens from six patients using a nested PCR protocol specific for IS6110 insertion element of Mycobacterium tuberculosis complex. Three men and three women are reported with ages ranging from 42 to 68 years. The sites of infection were the knee and shoulder in one case each, the hip in two cases, and the thoracic spine in two cases. Diagnosis was established within three days, and treatment was initiated promptly. PCR is a technically easy approach that can be used as a first step diagnostic tool for early recognition and treatment of bone and joint tuberculosis.