Osteoarticular Tuberculosis Research Articles

Several potential serum proteomic biomarkers for diagnosis of osteoarticular tuberculosis based on mass spectrometry

BackgroundOsteoarticular tuberculosis is one of the extrapulmonary tuberculosis (EPTB) diseases, which is mainly caused by infection of Mycobacterium tuberculosis (MTB) in bone and joints. The limitation of current clinical test methods is leading to a high misdiagnosis rate and affecting the treatment and prognosis. This study aims to search serum biomarkers that can assist in the diagnosis of osteoarticular tuberculosis. MethodsProteomics can serve as an important method in the discovery of disease biomarkers. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to analyze proteins in 90 serum samples, which were collected from June 2020 to December 2021, then evaluated by statistical analysis to screen potential biomarkers. After that, potential biomarkers were validated by enzyme-linked immunosorbent assay (ELISA) and diagnostic models were also established for observation of multi-index diagnostic efficacy. Results118 differential expressed proteins (DEPs) were obtained in serum after statistical analysis. After the diagnostic efficacy evaluation and clinical verification, inter-alpha-trypsin inhibitor heavy chain H2 (ITIH2), complement factor H-related protein 2 (CFHR2), complement factor H-related protein 3 (CFHR3), and complement factor H-related protein 5 (CFHR5) were found as potential biomarkers, with 0.7167 (95 %CI: 0.5846–0.8487), 0.8600 (95 %CI: 0.7701–0.9499), 0.8150 (95 %CI: 0.6998–0.9302), and 0.9978 (95 %CI: 0.9918–1.0040) AUC value, respectively. The remaining DEPs except CFHR5 were constructed as diagnostic models, the diagnostic model contained CFHR2 and CFHR3 had good diagnostic efficacy with 0.942 (95 %CI: 0.872–0.980) AUC value compared to other models. ConclusionThis study provides a reference for the discovery of serum protein markers for osteoarticular tuberculosis diagnosis, and the screened DEPs can also provide directions for subsequent pathogenesis research.

Imaging of Knee Tuberculous Arthritis: A Case Report and Literature Review

Osteo-articular tuberculosis is a rare condition, with knee localization ranking third after the spine and the hip. Its symptomatology is vague and persistent, typically presenting as subacute or chronic arthritis, and the diagnosis is often made during the stage of joint destruction. Early diagnosis and appropriate treatment are crucial to prevent functional complications. Imaging plays a prominent role in the diagnostic process. We report a case of advanced knee tuberculosis in a young adolescent, investigated using CT and MRI to highlight the role of imaging in diagnosing this condition.

A Rare Case of Complete Sequestration of the Patella: an Unusual Presentation of Patellar Tuberculosis

Abstract Osteoarticular tuberculosis affecting the knee with isolated involvement of the patella is rare, accounting for less than 0.09% to 0.15% of cases. We present a case of 48-year-old man presenting with chronic knee swelling, pain, and stiffness. Radiographs revealed a completely sclerotic patella with erosions and irregular margins. Magnetic resonance imaging revealed chronic synovitis, joint effusion, and bony erosions with full-thickness cartilage defects in the patella. He underwent surgical debridement with extensive synovectomy, and a total patellectomy was performed. Intraoperative samples conclusively diagnosed it as a tubercular infection of the patella and synovium. The patient was started on antitubercular chemotherapy. A 2-year follow-up revealed good knee function with an extensor lag of 100. There has been no recurrence of infection. This report is a rare case of complete patellar sequestration secondary to tuberculosis patella, which was successfully treated with radical debridement and patellectomy.

Isolated calcaneal tuberculous osteomyelitis in a 13-year female: a diagnostic dilemma: rare case report and review of literature

Foot and ankle involvement in osteoarticular tuberculosis is uncommon and isolated calcaneal tubercular osteomyelitis of foot bones sparing nearby joints with an osteolytic defect is even more rare. Worsening of the disease can occur over a time involving nearby joints and small bones if diagnostic and therapeutic phase are delayed. We present a retrospective study of osteolytic variety of foot calcaneal bone tuberculosis. We present a case report of 13-year female with isolated osteolytic variety of calcaneal tuberculous osteomyelitis to highlight the clinical, radiological features and management challenges of the condition. Biopsy was done to confirm tissue diagnosis based on Gene Xpert, AFB staining, MGIT culture, and histopathology. Surgical intervention was done in form of debridement and sinus tract removal as a diagnostic and therapeutic purpose to prevent further involvement of a nearby joints and small bone with cystic destruction. Isolated calcaneal tubercular osteomyelitis cases are still found to be seen in our environment though considered a rare. When tuberculous pathology is limited to the isolated calcaneal bone sparing the other joints, the prognosis is better than in osteoarticular disease, as there is less deformity, and hence, less residual pain and disability.

A case of primary sternal tuberculosis mimicking a lytic bone tumor lesion of anterior chest wall

Primary tuberculous osteomyelitis of the sternum is a rare entity, accounting for only 1 to 3% of cases of osteoarticular tuberculosis (TB). It usually presents in young patients as a localized swelling, with a discharging sinus tract, and is accompanied by one of the systemic symptoms in the form of fever, night sweats, weight loss, or anorexia. Due to its atypical presentation, it poses a diagnostic challenge. We report the case of a 37-year-old female with primary sternal TB mimicking a lytic bone tumor lesion of the anterior chest wall.

Osteoarticular tuberculosis cases in the southwest of China: A 9-year retrospective study.

Osteoarticular tuberculosis (TB) is an uncommon form of extrapulmonary TB. In this study, we analyzed the epidemiological characteristics, common sites, and drug resistance profiles of osteoarticular TB infections occurring in southwest China. A total of 3,254 cases of patients clinically diagnosed with osteoarticular TB infections between 2013 and 2021 were retrospectively analyzed. Patients' demographic and clinical characteristics were collected. Drug sensitivity testing was performed using the microporous plate ratio method. Chi-squared analysis was used to analyze the rates of and trends in mycobacterial isolates. Of the 3,254 patients, 1,968 (60.5%) were men and boys, and 1,286 (39.5%) were women and girls; patients' ages ranged from 1 to 91 years, with an average of 42 ± 19.3 years. In terms of disease, 2,261 (69.5%) had spinal TB, mainly thoracic (815, 36%) or lumbar (1,080, 48%); joint TB was found in 874 cases (26.9%), mainly occurring in the knee (263, 30%) or hip (227, 26%); and both spinal and joint TB were observed in 119 cases (3.7%). Drug susceptibility tests were performed on 241 isolated strains of MTB; 70 strains (29.0%) were resistant to at least one drug, and MDR-TB and XDR-TB were observed in 7.1 and 1.2% of strains, respectively. In southwest China over this period, osteoarticular TB mainly affected middle-aged and young men with poor nutritional status. Patients from ethnic minority areas also accounted for a large proportion of cases. Spinal TB is prone to occur in the lumbar and thoracic vertebrae, and joint TB is prone to occur in the lower limb joints. Additionally, there has been an increasing trend in the number of TB cases over the past 9 years, and drug resistance has also increased.

Применение бисфосфонатов при экспериментальном туберкулезном остите: КТ-визуализация

Introduction The complex treatment of osteoarticular tuberculosis is based on combination of anti-tuberculosis therapy, complete (radical) removal of involved bone and restoration of the supporting and motor function of the affected musculoskeletal segment. Inhibited activity of osteoclasts involved in osteoresorption as one of the mechanisms of reparative osteoregeneration can be involved in regulation of bone formation after radical reconstructive surgery. The objective was to explore CT signs of osteoregeneration due to multimodal treatment of experimental tuberculous osteitis with use of bisphosphonates as targeted inhibitors of osteoclasts. Material and methods An experimental study was carried out on 21 mature male Chinchilla rabbits. The first stage included bone tuberculosis simulated in the medial condyle of the right femur using invasive local infection with M. tuberculosis strains H37Rv, a virulent reference laboratory strain. Pathological focus was resected and bone graft used at the second stage. Animals receiving antituberculosis therapy (ATT), ATT and bisphosphonates (BP) and BP only were divided into three groups at the third stage. Animals were sacrificed at 3 and 6 months of surgical treatment at the fourth stage. Autopsy implantation zone, bone of the contralateral condyle and intact femur were quantitatively and qualitatively assessed using micro-CT imaging. Results Positive dynamics in bone restoration was seen in the groups. ATT group showed complete lysis of the implant with bone cavities identified and no bone restoration in half of the cases seen at 6 months. Rabbits treated with BP demonstrated absence of complete lysis of the implant and CT signs of ingrowth of bone trabeculae. CT signs of maximum osteoregeneration were noted in the group of isolated BP therapy. Discussion The use of bisphosphonates can prevent lysis of grafts preserving the osteoconductive properties and facilitating formation of new bone. Conclusion Targeted osteoclast inhibitors can be safety and efficaciously used in the complex treatment of focal infectious skeletal lesions and be recommended as a potential component of pathogenetic therapy in the postoperative treatment of infectious (tuberculous) skeletal lesions.

Diagnostic Problem in a Patient with Tuberculosis Arthritis

Extra-pulmonary tuberculosis (TB) remains a big public health problem worldwide. Although TB most commonly affects the lungs, any organ or tissue can be involved. TB arthritis is a rare form of extra-pulmonary TB. TB arthritis usually manifests as mild and non-specific arthritis. A 35-year-old male was admitted to the emergency room of Dr. Soetomo General Academic Hospital Surabaya due to pain of left knee since two days prior to admission. His symptom began on previous six months with the swelling of the left knee that gradually worsened so that he had an antalgic gait. Radiological examination of left knee joint showed inflammatory arthritis, accompanied by joint effusion and soft tissue swelling. USG examination of the left knee showed the presence of non-specific left knee arthritis. Patient underwent debridement. Anatomical pathology examination of the tissue obtained at the time of debridement, showed the TB granulomatous inflammation. The Ziehl-Nielson stain of left knee tissue also showed the TB granulomatous inflammation. Patient was then treated with analgesics and anti-TB drugs. The intensive phase of anti-TB therapy was planned to be 2 month, then evaluated and followed by continuation phase for about 7 months. The knee joint is the third most common site of osteoarticular TB after spine and hip. Insidious onset of pain which, in some patients may be present for years, is the usual presentation. The joint is usually warm, and wasting of the thigh muscles is usually marked. Synovial hypertrophy and effusion are present in most patients. The gold standard for diagnosis of TB arthritis is synovial biopsy, with positive results in 80% of cases. It shows caseating granulomas, lymphocytes, and giant cells with caseation, which are characteristics of TB arthritis. Synovial biopsy is generally recommended in any arthritis where clinical evaluation and routine investigations do not give a clear diagnosis.

Clinical-epidemiological profile of confirmed cases of osteoarticular tuberculosis.

Introduction: tuberculosis (TB) remains a major cause of morbidity and mortality worldwide. The incidence of TB has increased since the 1980s. Given the increasing prevalence of TB worldwide, osteoarticular TB (OATB) is a significant health problem. Methods: retrospective study of a case series of hospitalized patients with confirmed OATB by culture or histopathological examination who were seen at a reference orthopedic hospital in São Paulo, Brazil, from 2014 to 2019. Results: thirty patients with confirmed bone and joint TB were seen from 2014 to 2019. The main sites of OATB were the spine (83.3 %) and the appendicular skeleton (26.7 %). Indication of surgical treatment was significantly related to the need for hospitalization ( ) and the increased length of hospital stay ( ). Presence of sequelae at the end of treatment was correlated with the presence of motor deficit at the time of OATB diagnosis ( ) as well as with initial presence of functional limitation ( ) and with high value of C-reactive protein at the end of treatment ( ). Conclusions: the delay in the onset of clinical and laboratory signs of cases of osteoarticular infections hinders the early diagnosis and treatment of the disease, resulting in major complications sometimes requiring surgical treatment and consequently leading to a prolonged hospital stay, evidence of high inflammatory activities, and the presence of neurological deficits.

Diagnostic Challenges in Patients with Osteoarticular Tuberculosis in Mexico: Case Series

Introduction: Osteoarticular tuberculosis poses a significant diagnostic and therapeutic challenge in developing countries, where the absence of molecular tools demands reliance on clinical suspicion and histopathological findings for diagnoses. Here, we present a compilation of case studies on osteoarticular tuberculosis for academic reference and support to aid primary care physicians in providing the best possible patient care. Methods: Retrospective analysis of cases diagnosed with osteoarticular tuberculosis through biopsy from 2010 to 2020 at a Mexican Traumatology and Orthopedics Hospital, examined using descriptive statistics. Results: Thirty-three patients were registered: 23 men (70%) and 10 women (30%). The most affected regions included the spine in 28 cases (84%), the hip in 3 (9%), and the elbow and sternoclavicular joints in 1 case each. The main clinical manifestations were paravertebral abscesses in 16 patients (48%), discitis in 12 (36%) and arthritis in 5 (15%), while the primary associated diseases were immunosuppression in 8 cases (24%), 2 cases with hepatitis (6%) and 3 with hypertension (9%). Discussion: Tuberculosis is endemic in Mexico, similar to other developing countries, with numerous reported cases of osteoarticular tuberculosis. This study highlights the importance of using alternative diagnostic tools when molecular tests and cultures are not accessible to general practitioners and orthopedic physicians who treat patients with clinical suspicion of osteoarticular tuberculosis.

Unmasking the “Great Masquerader:” Tuberculosis of the Foot

Abstract Introduction: Osteoarticular tuberculosis (TB) accounts for only 1%–3% of extrapulmonary TB, of which ankle and foot involvement accounts for only 8%–10%. Foot and ankle TB has a varied clinical and radiological presentation and can mimic many conditions. The aim of this study is to throw light on the varied clinical and radiological presentations of this disease. Materials and Methods: We studied 20 patients with suspected osteoarticular TB of the ankle and foot region over 3 years. The patients were evaluated based on clinical presentation, radiology, magnetic resonance imaging (MRI) findings, molecular studies (cartridge-based nucleic acid amplification test [CBNAAT]), biopsy, microbiological staining and culture, erythrocyte sedimentation rate ESR, and C-reactive protein levels. The patients were categorized into subgroups in accordance with their findings. Results: All cases had some form of pain, swelling, tenderness, or inability to bear weight. Twenty-five percent presented with single or multiple draining sinuses at or around the ankle. On X-rays, 30% had unremarkable radiographs, and osteopenia/cavitation of one or more bones was found in 30% of cases. Sequestrum formation was seen in 20% of the cases. No advanced arthritis and collapse were noted. In MRI, all cases had marrow edema of one or more bones. Twenty percent had features of tenosynovitis. CBNAAT was done for all the patients of whom eight turned positive for the pathogen. Discussion: The classical features of skeletal TB may elusive in cases of TB of the foot and ankle. Plain radiographs may not be sensitive in detecting early cases. In MRI studies, the calcaneum and talus were mostly affected. This may indicate toward a hypothesis that the calcaneum/talus may be the primary source of origin in osteoarticular TB of the ankle and foot region. Biopsy remains the gold standard in diagnosing TB. All patients responded well to the medical management. We can conclude with surety that TB of the foot and ankle is primarily a medical condition if prompt and early diagnosis is made.

Clinical Characteristics of 68 Patients with Osteoarticular Tuberculosis

Objective To analyze the clinical features of patients with osteoarticular tuberculosis. Method This retrospective study included a cohort of 68 osteoarticular tuberculosis patients hospitalized in Peking Union Medical College Hospital from January 2013 to December 2020.Results The patients included 42(61.8%)males and 26(38.2%)females,with a median age of 56 years.Tuberculosis pathogen was detected in 39(57.4%)patients,and 29(42.6%)patients were diagnosed by clinical manifestations.The median time from onset to diagnosis was 4 months.The most common manifestations were pain and dysfunction(86.8%),followed by fever(47.1%),weight loss(36.8%),and night sweats(13.2%).Concomitant active tuberculosis in other organs was observed in 27(39.7%)patients.Unifocal and multifocal osteoarticular tuberculosis occurred in 51(75.0%)patients and 17(25.0%)patients,respectively,which mainly attacked thoracic and lumbar spines.Tuberculosis T cell test was positive in 92.7% patients.All the bone biopsies revealed epithelioid granuloma with/without necrosis,with 75.0% positive for mycobacterial DNA,55.1% positive for mycobacterial culture,and 20% positive for acid-fast staining.The risk of developing multifocal osteoarticular tuberculosis in the patients with weight loss was 5.333 times(P=0.013)that of the patients with stable weight.Conclusions The diagnosis of osteoarticular tuberculosis is difficult and tuberculosis T cell test is an effective means.Bone biopsy is the key to diagnosis,and the PCR of mycobacterial DNA shows the highest positive derection rate.Multifocal osteoarticular tuberculosis is not rare,especially in the patients with weight loss.Thus,a comprehensive imaging evaluation is recommended to avoid missed diagnosis.

The Incidence of Osteoarticular Tuberculosis in the Siberian and Far Eastern Federal Districts in 2018-2020

The incidence of osteoarticular tuberculosis in 15 regions of the Siberian and Far Eastern Federal Districts from 2018 to 2020 was assessed. The incidence of osteoarticular tuberculosis and co-infection of osteoarticular tuberculosis with HIV and osteoarticular tuberculosis with hepatitis B/C was analyzed. Variants of osteoarticular tuberculosis with respiratory tuberculosis, variants of tuberculosis sites in the bone articular system and the most typical neurological disorders in those patients were presented.

Treatment duration of osteoarticular tuberculosis: How long is optimum?

Treatment duration of osteoarticular tuberculosis: How long is optimum?

ANTITUBERCULOSIS CHEMOPROPHYLAXIS IN TOTAL HIP PROSTHESIS ON COXALGIA SEQUELAE (ABOUT THREE CASES)

Osteoarticular tuberculosis (OAT) is defined as the set of pathological manifestations secondary to damage to the bone and joint structures of the musculoskeletal system by the Kochs bacillus (BK). These lesions can lead in the long term to very important functional sequelae due to damage to the hip. The total hip replacement (THR), by restoring mobility and indolence, will transform the life of these patients. The objectif of this study is to evaluate the usefulness of antitubercular chemoprophylaxis after a total hip replacement for coxalgia sequelae. This work consists in to carry out a retrospective study of three cases of THP realise on sequelae of coxalgia in the department of orthopedic of the Mohammed VI University Hospital of Oujda between September 2015 and December 2021.Our series includes four patients, two women and two men. The average age at the time of surgery was 54 years. The Postel Merle dAubigné scoring system was used to evaluate the condition of the hip before and after surgery. All patients had a history of coxalgia treated with antibacillaries. All patients had Martini stage 4. The Moore posterolateral approach was performed in all patients. The THP was cemented in two cases and uncemented in one case and dual mobility in all patients. No patient was put on postoperative anti-tubercular therapy. The clinical and radiological results for the four patients, after a mean follow-up of 27 months, were satisfactory in the majority of cases. In the case of advanced bone destruction with very poorly tolerated functional repercussions in a mature subject, total arthroplasty remains the treatment of choice for the sequelae of coxalgia without recourse to postoperative chemoprophylaxis.

Structure of the incidence of extrapulmonary tuberculosis in Sumy region

Objective — to clarify the peculiarities of the course of extrapulmonary tuberculosis to improve its diagnosis by studying the trend of this form of tuberculosis in Sumy region.
 Materials and methods. The structure of the incidence of extrapulmonary tuberculosis of the Sumy region among residents during 2004—2020 was analyzed.
 Results and discussion. During the period from 2004 to 2020, 1414 new cases of extrapulmonary tuberculosis were registered in the region. The largest number of patients with this form of tuberculosis — 142 (24.3 %) was registered in 2004. The lowest — in 2020 — 33 (9.8 %) patients, ie decreased by 2.5 times. In the study period in Sumy in 2020, 3.1 patients per 100,000 population were diagnosed with extrapulmonary tuberculosis, which is almost 3 times less than in 2004 (11.3 patients per 100,000 population). 68 % of cases were registered in children. Among children with extrapulmonary tuberculosis, the incidence ranged from 13 cases per 100,000 children in 2004 to 0.7 per 100,000 in 2020. At the same time, the decrease in the incidence of extrapulmonary tuberculosis occurred with a sharp decrease to 0.7 per 100,000 in 2013—2014 and increase to 4.8 per 2015 and 7.0 per 100,000 children in 2016. And in 2020 again a sharp drop to 0.7 per 100,000 children. Compared to 2019, when the incidence of extrapulmonary tuberculosis was 6.3 per 100,000 children, this figure decreased by 9 times. The reduction in the number of BCG vaccinations in the region during the study period more than 2 times (in 2004 — 14,564 vaccinations, and in 2019 — 6,154) has an impact on changing the incidence of extrapulmonary tuberculosis among children.
 Conclusions. The number of patients with extrapulmonary tuberculosis decreased 3.6 times during 2004—2020: from 11.3 to 3.1 patients per 100,000 population. Extrapulmonary forms of tuberculosis predominated in children (68 %). The incidence of such forms of tuberculosis at the age of 0—14 years during 2004—2020 decreased from 13 to 0.7 cases per 100,000.Extrapulmonary tuberculosis of the respiratory organs accounted for 57.4 %, tuberculosis of the bones and joints — 21.6 %, tuberculosis of the genitourinary system — 15.1 %.The incidence of osteoarticular tuberculosis in children (30.6 %) exceeded the corresponding figure in adults (21.1 %) and was 2.6 higher than the corresponding figure in Ukraine (11.7 %). Detection of peripheral lymph node tuberculosis in children of Sumy region (0.7 %) was significantly lower than in Ukraine (7.3 %).In adolescents, extrapulmonary respiratory tuberculosis significantly prevailed between all localiza­tions — 82.2 %. The incidence of tuberculosis of bones and joints was 4.4 %, which is 4.8 times less than in adults and 7 times less than in children. The last indicator in Sumy region was 2 times less than the corresponding indicator in Ukraine (9.0 %).

Differential diagnosis in vertebral destruction

Tuberculous spondylitis is the most common form of osteoarticular tuberculosis. In recent years, there has been an increase in cases of tuberculosis infection and a rise in its extrapulmonary manifestations, which are associated with the AIDS epidemic and the problem of multidrug resistance of Mycobacterium tuberculosis. In this connection, over the past decades the clinical picture of the disease has become more diverse, the duration of the disease has increased, and the prognosis has changed.

Bone tuberculosis in calcaneus case report

Osteoarticular extrapulmonary tuberculosis is an infrequent entity (16%), with extra vertebral involvement being even more rare. We present a clinical case of a 68-year-old male patient, with systemic arterial hypertension and chronic kidney disease, who presented with pain in the left hindfoot of one year of evolution, that has evolved torpidly, worsening after infiltration with steroids, presenting volume increase, functional limitation and ulcerative lesion with purulent exudate on the medial side. It is evaluated clinically and with imaging studies by diverse physicians and surgeons. An open biopsy and bone culture were performed, reporting as diagnosis: Bone tuberculosis, superinfected, in left calcaneus. Surgical treatment was performed, and antituberculosis treatment was started, the patient evolved satisfactorily in the immediate postoperative period, recovering joint mobility, without pain and decreased hindfoot volume.

Osteoarticular Tuberculosis Mimicking Ewing’s Sarcoma in an Infant

Osteoarticular tuberculosis (TB) of the bone is a rare form of TB, accounting for 1-5% of all extra-pulmonary TB cases worldwide. An otherwise healthy 11-month-old girl complained of swelling on her right wrist and avoidance of using it. She had no history of trauma, fever, weight loss, or other systemic symptoms. A mass on the dorsolateral side of the right wrist, measuring about 4x5cm, was found. In magnetic resonance imaging results, it was reported that there was a mass lesion of lytic character (Ewing’s sarcoma) with periost reaction. Excisional biopsy was performed; non-necrotizing granuloma was found. Mycobacteriological culture could not be performed since the tissue specimen was formalin-fixed and paraffin-embedded. The biopsy material obtained from the bone has no fresh tissue; the M. TB complex was determined upon mycobacteriological molecular examination of the tissue specimen on the waxed block. Therapy lasted for nine months. TB of the bone should be among the differential diagnoses even in the absence of pulmonary involvement and constitutional symptoms of TB. For diagnosis, it is essential to culture for the mycobacterial subtype by tissue biopsy and confirms the culture material by PCR.

Clinical performance of quantitative PCR for the molecular identification of skeletal tuberculosis from formalin-fixed paraffin-embedded tissues

BackgroundAt present, skeletal tuberculosis (TB) diagnosis is mostly by histopathology, but the positivity rate is low. There is a need to develop new methods for the molecular identification of this disorder. Therefore, we aimed to investigate the clinical utility of quantitative PCR (qPCR)-based diagnosis of skeletal TB from formalin-fixed paraffin-embedded (FFPE) tissues and its comparative evaluation with acid-fast bacillus staining (AFS).MethodsWe detected Mycobacterium tuberculosis (M. tuberculosis/MTB) DNA using qPCR and AFS in FFPE tissue samples from 129 patients suspected of having skeletal TB. The sensitivity, specificity as well as area under the curve (AUC) of qPCR and AFS were calculated. Meanwhile, some factors potentially affecting qPCR and AFS results were investigated.ResultsOverall, qPCR outperformed AFS in detecting M. tuberculosis. The AUC of qPCR was higher than that of AFS (0.744 vs.0.561, p < 0.001). Furthermore, decalcification of bone tissues did not affect the sensitivity and specificity of qPCR tests. Whereas it impacted the performance of AFS, decalcification increased AFS's specificity and decreased its sensitivity (p < 0.05). Moreover, qPCR had a significantly larger AUC than AFS in decalcified and non-decalcified groups (0.735/0.756 vs. 0.582/0.534, p < 0.001) respectively. Similarly, the AUC of PCR was more extensive than that of AFS regardless of skeletal TB patients with concomitant pulmonary TB or not (0.929 vs. 0.762; 0.688 vs. 0.524, p < 0.01).ConclusionsOur data demonstrate that qPCR offers superior accuracy for the detection of mycobacteria in FFPE tissues compared to traditional AFS, indicating its clinical value in osteoarticular TB diagnosis.