A dependable method for the rapid diagnosis of osteoarticular tuberculosis has become increasingly important, as routine methods are neither very sensitive nor very specific. The objective of this study is to verify the reliability of polymerase chain reaction (PCR) in the diagnosis and management of osteoarticular tuberculosis. This investigation was a prospective study conducted at the Kasturba Medical College, Manipal, India. Tissue samples of 74 patients suspected of osteoarticular tuberculosis were sent for PCR and histopathologic examination. Taking histopathology as the gold standard, PCR has a sensitivity of 73.07% and a specificity of 93.75% (with 95% confidence interval [CI] 62.97; 83.17).The positive agreement between histology and PCR was 0.693, indicating good agreement. PCR showed a sensitivity of 90% with spinal samples. It has a low false positivity of 13.63%. We conclude that conventional methods are neither sensitive nor specific enough and are also time consuming. PCR is an effective method for diagnosing tuberculosis and antitubercular treatment can be started if PCR is positive, since false-positive rates are very low.Résumé Une méthode pour le diagnostic rapide des tuberculoses osseuses articulaires voit sont importance augmenter par rapport aux méthodes de routine cependant très sensitives mais peu spécifiques. L'objectif de cette étude est de vérifier la fiabilité de la PCR (polymérase réaction en chaêne) diagnostic dans la conduite et le traitement des tuberculoses ostéo articulaires. Matériel et méthode: au cours d'une étude prospective conduite au Collège Médical Kasturba de Manipal Indes, les fragments tissulaires de 74 patients suspects de tuberculose ostéo articulaire ont été adressés, pour examen histopathologique et dosage PCR. Résultats: l'histopathologie reste le « gold standard », la PCR a une sensitivité de 73.07% et une spécificité de 93.75% (avec 95% d'intervalle de confiance CI 62.97; 83.17). La compatibilité entre histologie et la PCR est de 0.693, la PCR montre une sensitivité de 90% avec du tissu rachidien. Il existe des faux positifs (13.63%). Conclusion: les méthodes conventionnelles ne semblent ni sensitives ni spécifiques et demandent beaucoup de temps. La PCR est une méthode diagnostique de la tuberculose fiable et permet de suivre et de démarrer le traitement anti tuberculeux si la PCR est positive, les taux de faux positifs étant très bas.

In general, chest radiographs (CXR) have high sensitivity and moderate specificity for active pulmonary tuberculosis (ptB) screening when interpreted by human readers. However, they are challenging to scale due to hardware costs and the dearth of professionals available to interpret cXR in low-resource, high ptB burden settings. Recently, several computer-aided detection (cAD) programs have been developed to facilitate automated cXR interpretation. We conducted a retrospective case-control study to assess the diagnostic accuracy of a cAD software (qXR, Qure.ai, Mumbai, india) using microbiologically-confirmed PTB as the reference standard. To assess overall accuracy of qXR, receiver operating characteristic (Roc) analysis was used to determine the area under the curve (AUc), along with 95% confidence intervals (CI). Kappa coefficients, and associated 95% CI, were used to investigate inter-rater reliability of the radiologists for detection of specific chest abnormalities. In total, 317 cases and 612 controls were included in the analysis. The AUC for qXR for the detection of microbiologicallyconfirmed PTB was 0.81 (95% CI: 0.78, 0.84). Using the threshold that maximized sensitivity and specificity of qXR simultaneously, the software achieved a sensitivity and specificity of 71% (95% CI: 66%, 76%) and 80% (95% CI: 77%, 83%), respectively. The sensitivity and specificity of radiologists for the detection of microbiologically-confirmed PTB was 56% (95% CI: 50%, 62%) and 80% (95% CI: 77%, 83%), respectively. For detection of key PTB-related abnormalities 'pleural effusion' and 'cavity', qXR achieved an AUC of 0.94 (95% CI: 0.92, 0.96) and 0.84 (95% CI: 0.82, 0.87), respectively. For the other abnormalities, the AUC ranged from 0.75 (95% CI: 0.70, 0.80) to 0.94 (95% CI: 0.91, 0.96). The controls had a high prevalence of other lung diseases which can cause radiological manifestations similar to PTB (e.g., 26% had pneumonia, 15% had lung malignancy, etc.). In a tertiary hospital in india, qXR demonstrated moderate sensitivity and specificity for the detection of PTB. There is likely a larger role for cAD software as a triage test for ptB at the primary care level in settings where access to radiologists in limited. Larger prospective studies that can better assess heterogeneity in important subgroups are needed.

Background: The presence of granuloma, visualized in histopathology for diagnosing tuberculosis in tissue samples, is not a specific finding. Moreover, histopathological examination of tissue sections needs one to two weeks for final reporting. A rapid and sensitive method is therefore needed for detection of Mycobacterium tuberculosis in these paucibacillary tissue samples. Methodology: A PCR-assay specific for IS6110 was evaluated for 104 different tissue samples in comparison to histopathology that was considered gold standard. Results: PCR showed 74.1% sensitivity and 96.1% specificity. False positive and false negative results were observed in three (2.88%) and seven (6.73%) samples, respectively. Positive agreement between histopathology and PCR was observed as 0.737, indicating substantial good agreement between two tests. Conclusions: PCR can be used for early diagnosis of tuberculosis in tissue samples that can help to initiate timely anti-tubercular treatment and prevent progression to irreversible changes.

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